legislation

Wisconsin legislature supports mental health — just not therapy

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One of the more disturbing trends I’ve seen in the mental health landscape lately is policymakers voicing support for mental health care, but not actually providing funding for anything but medication and crisis intervention.
Lots of states reduced their funding for psychotherapy during the economic downturn, and now that the economy is slowly churning back to life, there seems little appetite to restore that money so that people struggling with mental illnesses who may not be actively in crisis can be seen regularly by a therapist.
Case in point: Wisconsin, where the state’s legislature this week sent Governor Scott Walker fully a dozen bills under the banner of promoting and expanding mental health care in the state. The bills will spend a total of $4 million over two years, and the Milwaukee Journal Sentinel report on the mental health bills begins by saying the money will be spent on “treatment,” among other things, which sounds great at first. But the details of the article make clear where the money’s going, and it isn’t to psychotherapy.
Many of the bills don’t actually spend much money at all. One bill, for example, would allow “children with severe emotional disabilities to get in-home treatment through taxpayer-funded Medicaid programs without first requiring them to fail in outpatient treatment, as currently required.”
That’s certainly laudable, and as is the case with most of these bills, I do think they’re important and worthy of support. (The only ones I’m less sure of policy-wise are those that make involuntary commitment easier.) Just pointing out that the state is focusing its money on just about everything but psychotherapy, in spite of reams of evidence that therapy works.
What are they actually spending those millions on? These:

  • $250,000 in grants for mental health crisis intervention teams of law enforcement officers.
  • $1.5 million in grants for physicians and psychiatrists to practice in rural areas.
  • $250,000 in grants for “respite centers” run by (non-therapist) peers, for those in a mental health or substance abuse crisis that warrants attention but not hospitalization.
  • $970,000 to expand a state program that helps find jobs for people with mental illnesses.
  • $250,000 a year for mobile intervention teams to respond to mental health crises in rural areas.

There you have it: More than $3 million on mental health care (expenses from the other bills bring the total to about $4m, according to the Journal Sentinel), spent entirely on crisis intervention, law enforcement, medical practitioners, and peer supports. Those are all worthy expenses, but psychotherapists get nothing? That seems sort of like building a house without a place to sleep: Missing not just a key component, but arguably the most essential component.I’m not from Wisconsin, so it may well be that therapists in the state are doing just fine, thankyouverymuch. But I doubt it. I would welcome Wisconsinites to weigh in.
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By the way, there’s of course a reasonable debate to be had about the overlap between “crisis intervention” and “therapy.” Psychotherapists do a fair amount of crisis work. My point is that no money is being put into even short-term psychotherapy beyond an immediate crisis, which typically means something life-threatening.
Your comments are welcome. You can post them in the comments below, by email to ben[at]bencaldwell[dot]com, or on my Twitter feed.

Whose conscience matters?

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When can a therapist decide their own morals and values outweigh those of their clients?

The AAMFT has kindly made my article on conscience clause laws in mental health the cover story for the September issue of Family Therapy Magazine. You can read the article here if you’re an AAMFT member.

Of course I’m biased here, but I think you’ll find it worth the read. While I’ve written about the topic a few times here on the blog (most recently, I wrote about conscience clause laws being considered in Washington, Texas, Arizona, and Michigan), my focus here has been much narrower than it is in the magazine. In the FTM piece I take a broad look at the issue, from the origins of conscience clauses to the best arguments for and against them. While these laws are often spurred by a desire to protect religious practitioners, you don’t need to be religious to be impacted by them, and you might be surprised at what the laws would appear to allow:

Most conscience clause laws are so broadly written that they could allow […] therapists to refuse to treat sexually active unmarried couples, or therapists morally opposed to immigration to refuse treatment to clients based on nationality, even in a mental health emergency.

Is this a price worth paying to protect therapists’ moral views? My skepticism is raised when considering that the religious practitioners and legislators backing these bills often seem to have a desire to legitimize discrimination against gay and lesbian clients. So, you know, that’s not okay. But the issue isn’t black and white, as I hope the magazine article illustrates.

In addition to the main article, a sidebar I had written about conscience clause laws being considered or adopted in various states around the country was transformed into a really cool national map infographic. I wish I could take credit for that — it’s great visual layout — but that’s all magazine staff. Check it out.

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I have another article in the works proposing a way therapists could consider the appropriateness of a conscience-based referral, within the fuzzy boundaries of existing law and the existing AAMFT Code of Ethics. So stay tuned for that (for several months, in all likelihood, but I’ll keep you updated).

Your comments are welcome. You can post them in the comments below, or email me at ben[at]bencaldwell[dot]com.