At the beginning of each year, it seems only natural to look forward and think about our concerns for the world around us and about what exciting new developments the world has in store for us. So I posed a couple of questions about such things to a few of our bloggers, some of whom are participating here for the first time, and I thought you might find their responses interesting. I did.
What is one of your primary concerns about the mental health field for 2011?
Martha McCrory, MS, CPRP, director, Rehabilitation Services & Wellness, The Menninger Clinic: One of my primary concerns about the mental health field in 2011 is the cutting and/or lack of funding for mental health services. Funding for mental health is being reduced in many states, which reduces the number and quality of services being offered. It also reduces the number of individuals who can receive services. Another consequence of the lack of mental health funding is due to the reduction of hospital space and community-based services, which can lead to individuals with a mental illness being incarcerated instead of receiving appropriate and adequate services. The lack of funding also affects environments such as institutions of higher education providing adequate mental health services to young adults. This is a grave concern, especially in light of recent events.
Dee G. Henderson, RN-BC, MSN, Comprehensive Psychiatric Assessment & Stabilization Program, The Menninger Clinic: There is a continuing problem with access to adequate, complete mental health care for the uninsured outpatient. The current county system in Houston allows patients to see a psychiatrist for medication updates infrequently, and the lucky ones get to see a psychotherapist once a week. The medications are handled through an overloaded pharmacy system, causing patients to have to use an entire day to be seen and get their medications. The formulary is limited, causing patients to either use medications that are not as effective for them or have more side effects, or they have to find a way to pay for preferred meds out of pocket, which can cost hundreds of dollars a month. Expanding the formulary would be a great first step.
Denise Kagan, PhD, staff psychologist, Professionals in Crisis Program, The Menninger Clinic: The downturn in the economy seems to have resulted in people approaching mental healthcare as essentially a luxury rather than as a necessity – as they are also doing with their physical healthcare. This leads to people putting off seeking help until they are in urgent need, which makes their difficulties more difficult to address and results in greater negative consequences (decreased ability to function, manage self-care, etc.).
Thomas E. Ellis, PsyD, ABPP, director, Psychology, The Menninger Clinic: High on my list of concerns is direct marketing of psychoactive medications to patients. It wasn’t so long ago that advertising on TV and in non-professional publications was not permitted, the belief being that it was the role of the physician to assess whether a drug might relieve a given condition. The “ask your doctor” movement has resulted in patients believing that the drug with the most compelling advertising must be safe and effective, and proceeding to make enthusiastic requests of their (usually non-psychiatric) physicians. Lost in this process are the “talking cures,” psychotherapies that repeatedly have been proven safe, effective and less costly (in the long run), with fewer side-effects. Seen a glossy ad in People magazine lately for psychotherapy? Of course not. Competing with corporations with billions of dollars to invest in advertising is virtually impossible; the result is that suffering patients are often deprived of an effective alternate path to healing.
Jon G. Allen, PhD, senior staff psychologist, The Menninger Clinic: Enthusiasm for neuroscience is entirely justified in light of the demonstrable biological basis of major psychiatric disorders. But I am concerned that we are losing sight of the psychological contributions to biological dysregulation (e.g., the “chemical imbalance”) and that we are underutilizing psychotherapy in comparison with psychiatric medications. Both medication and psychotherapy can be effective for different reasons, and both can be complementary when used in combination. Yet psychotherapy has the unique potential to result in enduring benefit related to new learning, and the same benefit cannot be achieved with medication alone. I have dubbed my concern about excessive enthusiasm for biological psychiatry to the exclusion of psychological treatments “biomania.”
What current development in the field of mental health is most exciting to you?
McCrory: One recent development in the mental health field that is exciting to me is the fact that Permanent Supported Housing is now recognized as an evidence-based practice (EBP) through the Substance Abuse and Mental Health Services Administration. In my opinion, all humans deserve the right to safe and affordable housing. However, many times individuals with a mental illness are stripped of this opportunity. Because this practice is considered an EBP, it provides concrete guidelines in which to implement this practice. This can better ensure that individuals with a mental illness are provided opportunities to procure safe, affordable housing with the supports they need. This practice promotes full community reintegration, which I strongly support as a psychiatric rehabilitation practitioner.
Henderson: It is exciting that Menninger is a part of The Gathering Place as it serves as a model program implementing the concept of Assertive Community Treatment (Lehman, Goldman, Dixon, Churchill, 2004). It is providing the desperately needed outreach of holistic mental health services to the community, providing a wide range of supportive services that I hope will serve as the paradigm for other communities. The need to have access to mental health services is being recognized as far broader than the current systems of hospital-based care can accommodate, both from the standpoint of available beds and available funding.
Dr. Ellis: The most exciting current development by far, in my view, is the growing body of research showing that cultivating awareness and acceptance of thoughts and feelings provides an effective complement to more conventional psychotherapeutic approaches more focused on change. Although the desire on the part of both patient and therapist understandably tends toward reducing or eliminating unpleasant thoughts and feelings, experience (and research) tells us that trying to modify “private experience” is often ineffective and sometimes counterproductive. Consider the effort to get rid of a song in your head or force yourself to fall asleep: The harder you try, the less you succeed. Acceptance-oriented approaches such as mindfulness meditation, a centuries-old practice, teach us that some unpleasant states are simply part of being alive, and that by accepting the reality of our pain rather than struggling with it, we can actually reduce our suffering. Now that’s exciting!
Dr. Allen: Over the past few decades, enormous progress has been made in attachment theory and research. The prototype of attachment relationships is the mother-infant emotional bond; yet we all need secure attachments throughout life to flourish. The essence of psychological trauma, as I think about it, is being alone in the midst of unbearable emotional pain without any prospect of solace in a relationship with a person who can empathize with that pain. Thousands of research studies have yielded a wealth of knowledge about secure and insecure attachment relationships throughout life, from infancy to adulthood. I am excited by the fact that this knowledge is beginning to inform not only the practice of psychotherapy with adults but also the fields of parent-infant and parent-child psychotherapy.