Graham-Cassidy health care bill would be disastrous for US mental health care

US Capitol domeThe US Senate may take action this week on the Graham-Cassidy health care bill, a last-ditch effort by Senate Republicans to repeal and replace the Affordable Care Act. If Graham-Cassidy becomes law, the consequences for US mental health providers and their clients would be disastrous.

The nonpartisan Congressional Budget Office will not score the bill before a September 30 deadline for Senators to vote on it. But estimates suggest that under the bill, at least 16 million Americans would lose health insurance entirely after 10 years, given the bill’s similarity to prior Republican health care bills. This would leave millions paying out of pocket for mental health care that is currently covered by insurance.

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“At least it’s not cancer.”

Courtesy Emma JaegleI was working in a residential treatment center for teens. It was a typical mid-week day, and I was supervising “school time,” a period where clients are able to work on their treatment assignments and homework from their schools back home. Often during this hour, the primary therapists would pull the clients for individual sessions. I happened to know that today was the day that Nicole* was going to be given her diagnosis of depression, and I was prepared to help her process her emotions should she need coaching after her return from session. Sure enough, Nicole returned from her therapist’s office with a solemn look on her face. When she sat down away from her peers, I walked over to her and asked, “How did it go?”

She let out a sigh, “Well, I found out my diagnosis.”

I nodded. “I see. What’s that like for you?”

“I guess it’s better to know what’s going on and have an explanation for everything. At least it’s not like I have cancer!”

That comment gave me pause. I thought: But I have cancer.

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Talkspace forces therapists to break rules. The rules may be the problem.

Matthew Henry / Burst / Licensed under Creative Commons ZeroApp-based therapy platforms may well represent the next evolution of psychotherapy practice. I praised Talkspace a few years ago for offering access to mental health care for many who otherwise would never find their way to a therapist’s office. But the platforms — Talkspace, Betterhelp, and the like — have run into controversy over their confidentiality policies. Therapists using these apps may have little to no ready access to the client’s full name, address, or other information necessary in an emergency.

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Every excuse for California’s MFT Clinical Exam pass rate, debunked

California flagAt the August meeting of the California Board of Behavioral Sciences, I had a tense exchange with representatives from the state’s Office of Professional Examination Services about pass rates for the California MFT Clinical Exam. That pass rate has fallen off a cliff. For the first six months of the year, just 56% of those taking the test for the first time passed.

At the meeting, OPES presented about their exam development process, and argued that nothing meaningful had changed on their end. They and the BBS raised several hypotheses about both the current low pass rate and the drop in pass rate at the start of the year.

Over the past week, I investigated every one of the hypotheses offered. Not one of those hypotheses stands up to scrutiny.

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California’s MFT Clinical Exam is broken

California flagBack in May, I wrote about how pass rates on the California MFT Clinical Exam for licensure had fallen off a cliff. At the time, the state’s Board of Behavioral Sciences offered an explanation for why the pass rate might have been higher than expected at the beginning of 2016. However, they had no explanation for why the pass rate since then had fallen so far.

The most recent data on California licensing exam pass rates [page 25] makes clear that the alarmingly low pass rate in the first quarter of 2017 — when just 57% of first-time test-takers passed the MFT Clinical Exam — was not simply an aberration. It truly does appear that the exam is broken.

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