AMDG

PSYCHOLOGY

NOT ALL EARMARKS ARE BAD

What is an “earmark”? Earmark.com defines it as “those spending measures inserted by members of Congress into bills that direct taxpayer dollars to their pet projects”
http://earmarkwatch.org/?gclid=CKGJqsjWopYCFQOjFQodNA2R5w .

Anyone who has been following the financial news lately knows that The US Senate tacked on some special goodies to the “Bail out the Banks” bill in order to make it more palatable to some members of the House of Representatives. They did this to sway their votes in favor of the bill. The “sweeteners” were extensions of tax bills that added approximate another 10 billion dollars to the original cost of the bailout. One of the more obscure earmarks had to do with providing more wooden arrows to children. Another had to do with more aid to rural schools. All of these earmarks were soundly criticized by fiscal conservatives.

But the one that attracted me was a new bill that provided for better insurance coverage for mental health and substance abuse problems. It was estimated that this would affect some 13 million Americans by mandating that medical insurance companies treat mental and physical health disorders equally. Since the beginning of the managed care system in this country, people with psychological disorders often had to pay for expensive psychiatric or psychological treatment out of their own pockets. These costs are so prohibitive that they simply could not pay for them. Even this new bill has some limitations but it was a long awaited step in the right direction for mental health advocates. Read more about it your self:
http://www.washingtonpost.com/wp-dyn/content/article/2008/10/09/AR2008100902873.html

The state of the art in psychiatry and clinical psychology has come a very long way since doctors were drilling holes in the forebrains of psychotic patients. Advances in psychopharmacology now arm psychiatrists with a wide variety of medications to relieve the disabling symptoms of complex mental disorders like Schizophrenia, Bipolar Disorder, Panic Disorder and Attention Deficit Disorder. Drugs once considered “dirty drugs” because of their many side effects have given way to scientifically designed drugs that narrowly target only the intended neurotransmitters (brain chemicals) without spreading like shotgun pellets to other chemicals and structures.

In similar manner, talking therapy is no longer restricted only to Freud’s couch. Several other fully validated approaches are available that take less time and are less expensive to achieve the same goals. The most widely accepted is Cognitive-Behavioral Therapy. Then, there are also complex therapeutic systems like Dialectical Behavior Therapy that have been developed to treat only certain disorders like Borderline Personality Disorders that were once very difficult to treat. There is short term and long term therapy; group and individual therapy; family therapy; play therapy; Applied Behavioral Analysis ( for children with autism) and recreational therapy---to name a few.

The major problem, however, with all of these new and sophisticated treatment approaches is that they are not accessible to large portions of the American population---e.g. the homeless poor, the working poor and even the working middle class who have some managed care medical coverage. Medicaid and Medicare does provide some coverage for mental health care but it is sub par. HMO and PPO plans severely restrict the nature and the extent of proper mental health treatment. As it is with so many services and essential products in American society, socio-economic class determines their availability. In simple terms “the poor and much of the middle class do not have access to them.” They are often treated in a “hit or miss” fashion in hospital clinics without proper monitoring and follow up. They don’t get to see “the best doctors or therapists”. They languish away in the back rooms of their homes or worse yet in the streets of big cities.

NB. In my undergraduate courses in clinical psychology, I, of course, teach the state of the art in my discipline and brag about all of the advances the profession has made since mental patients were locked in wooden cages in asylums. In my first class, however, I make it clear to my students that mental health care in this country is not available to all. Some of them already know this personally.