Bill Doherty gave an interview to Minnesota Public Radio last month, cautioning that therapists should avoid issuing diagnoses of Republican presidential candidate Donald Trump. Doherty is certainly correct that diagnosing from afar is dangerous, for a multitude of reasons. But as it turns out, most mental health ethics codes are fine with it.
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.