Professors discuss challenges and treatments for mental disorders
Archived article from Sep 28, 2001
By Stacey B. Hersh
With one in five Americans suffering from a diagnosable mental disorder, the need for increased access to quality mental health services is evident. The challenge for today's mental health professionals is to find effective and innovative ways to deliver these services in an atmosphere of rising health care costs and stricter limits on the number of mental health visits covered by insurance.
Focus recently asked several researchers at the Graduate School of Applied and Professional Psychology (GSAPP) to shed light on the critical issues in providing care and the latest advances in treating mental disorders.
Treating the most difficult cases
James Walkup, associate professor of clinical psychology
Despite a proliferation of human services programs designed to treat everything from alcoholism to post-traumatic stress disorder, those suffering from serious mental illness are still likely to go unserved.
Human services agencies do their best work with clients who have familiar problems, but there exists a small minority of people whose problems are so complicated and unfamiliar that they don't
seem to fit easily into any setting. These clients are at risk of getting the runaround and hearing the same mantra, "We aren't equipped to handle that here."
The risk increases when psychiatric problems are complicated by substance abuse, poor health and social welfare needs such as employment and stable housing. A person with schizophrenia fighting addiction may find his psychiatric condition excludes him from drug treatment programs or is told the drug use must be controlled before entering a supported-living setting for psychiatric patients.
Agencies themselves are often a barrier to good care. Many are funded with one kind of client in mind and must satisfy their supporting constituencies. Multiproblem patients are expensive to treat, and reimbursement guidelines are restrictive.
Another barrier is the client, who may have difficulty accepting the diagnosis of mental illness, who has had a bad experience with the existing system of care, or who understands too well that one-size-fits-all treatment plans are unlikely to work.
These clients require more than the usual amount of patience, flexibility and support, and they need a commitment for the long term -- all qualities in short supply.
No solution will be perfect, but treatment teams need to take responsibility for the full range of patient needs, and they need to be given the resources and authority to provide it. The current restructuring of health care could help, since good continuous care is sometimes cheaper than haphazard emergency care. However, good care may also identify unmet needs, resulting in higher costs.
The value of short-term therapy
Stanley B. Messer, dean
Psychotherapy is a cultural phenomenon that is influenced by the social context in which it is practiced. For example, the dramatic increase in dual-career families and the decline of free time have made fewer people available for long-term therapy. And as the cultural stigma attached to therapy has decreased and its popularity has increased, there has been a greater demand for, and rationing of, therapeutic services.
These and other factors have led to an increasing emphasis on various forms of "brief" or "short-term" therapy. This style of therapy ranges from 8 to 25 sessions and focuses on solving a targeted psychological problem.
Over the past 20 years, research on brief therapy has shown that 55 percent of clients feel and function better after 13 sessions, and about 75 percent feel and function better by the 25th session. Controlled studies show that brief therapy is much superior to not being in treatment at all. However, brief therapy is probably not suitable for more severely disturbed patients or those with personality disorders whose problems require more extensive treatment.
Ideally, society should be providing resources for both short- and long-term therapy according to professionally evaluated need. But as medical costs continue to rise and cost-efficiency translates into reduced coverage and a greater financial burden on patients, brief therapy may offer one of the best options for those needing mental health services in the future.
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