Home Guest Contributor The Troubling Decline in Talk Therapy – Opinion

The Troubling Decline in Talk Therapy – Opinion

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There has been a major drop-off in the amount of outpatient psychotherapy provided by psychiatrists in the United States over the last 25+ years, a period which has simultaneously seen a rise in the prescription of psychoactive drugs. This trend is partially the result of doctors responding to strong financial incentives.

Researchers from Columbia University published their findings in the American Journal of Psychiatry recently. What they found is alarming. Psychiatrists have been recommending psychiatry, known as “talk therapy,” less often, and have replaced it with prescribed medications.

According to the research, psychotherapy appointments recommended by psychiatrists decreased from 44.4 percent in 1997 to only 21.6 percent in 2016. The Columbia University Dept. of Psychiatry estimates that 53% of psychiatrists stopped providing the treatment between 2010 and 2016. Researchers also noted that the percentage is projected to rise

Some Patient Demographics Affected More Than Others

Patients who are younger, who live in rural areas, who are of African or Hispanic descent, and who depend on Medicaid were shown to be the most commonly affected by the trend.

As a result of this change, a patient’s relationships, quality of life, and professional or educational performance can suffer. This hits especially hard for young people in marginalized and impoverished rural communities.

Why the Shift in Providing Psychotherapy is Important

Caregivers face a perpetual ethical dilemma when balancing the demands of patients with the financial obligations and incentives built into the U.S. healthcare system today. By promoting rapid medical-management consultations rather than psychotherapy, psychiatrists are able to see more patients and earn increased profits.

Financial incentives also include managing patient cases with prescribed medicines. Doing so may not adequately address the difficulties a patient may face in his or her life and relationships.

The Need for Mental Health is at an All-Time High

Another influence is that demand is surging. US population expansion has corresponded with an increased awareness of mental health. These outcomes have led to a bigger demand for mental health services. The pandemic only worsened things, as treatments and programs were shut down due to lockdown efforts.

However, providing psychotherapy is not necessarily an obligation of psychiatrists. Because of the gap between the demands and patients and the available practitioners in the field, other resources may be used as well.

Psychologists, social workers, and counselors can also serve the mental health community. Because mental health therapy is time-sensitive, these resources may offer the best support. Research shows that a combination of medicine and psychotherapy leads to the best outcomes overall.

More About the Gap in Talk Therapy

In today’s environment, a psychiatrist can feel stressed and suffer from compassion fatigue. This has led to a national mental health crisis in the field of psychiatry and mental health services.

Mental health treatments are often determined by a patient’s social class and status. Study results show there is a direct correlation between a patient’s social life and the type of care he or she receives. Therefore, patients who can afford their treatment often can access both medication management and psychotherapy help simultaneously.

Patients who need mental health care and can pay for their own care are less affected by a lack of treatment alternatives. Not only are they more likely to have access to a psychiatrist with a lower patient load, but they can also receive the medicines they need as well. However, if a patient lives in a rural area or depends on public health care, he or she has a very different experience.

Additional Funding and Legislation Needed

From all indicators, financial incentives are not likely to go away anytime in the near future. Therefore, lawmakers should make funding for underserved patients a priority. The Biden administration allocated almost $2.5 billion through SAMHSA in April 2021 to address mental health care and addiction.

However, this large amount, according to experts, still falls short of what is needed to address the current mental health crisis. More funding is needed to improve the quality of life for people who cannot afford to pay out-of-pocket for mental health treatment.


About the Author: Scott H. Silverman has been helping men and women recover from mental health disorders for almost 40 years. He is the CEO of Confidential Recovery, an outpatient treatment program in San Diego that specializes in sustainable recovery from addiction.

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