The Shrink Tank

Psychotherapy in practice, research, and pop culture.

Jared DeFife, Ph.D. is a clinical psychology research scientist at Emory University and Associate Director of the Laboratory of Personality and Psychopathology. See full bio

February 22, 2009, Health

Comments on "Improving Access to Mental Health Care: Is There a Shrink in the House?"

Improving Access to Mental Health Care: Is There a Shrink in the House?

By Jared DeFife, Ph.D. on February 22, 2009 in The Shrink Tank

The difficulties involved in obtaining mental health services can be maddening and demoralizing. Placing phone calls, obtaining referrals, finding a provider who accepts new patients, insurance troubles, long waiting periods. How can access to mental health care be improved? Dutch researchers may have an answer. Read More

Extending the Model

Submitted by SteveM on February 19, 2009 - 9:08am.

That sounds like a great program. Given that GP's now prescribe mood management medications, another benefit of the collaborative care model would be the added knowledge the mental health professional would bring related to psychotropic drug side effects and utility.

Is anybody also exploring mental health "wellness" as a pre-emptive strategy? I'm thinking that even at the high school level young people could be taught meditation, HRV training, self-hypnosis and the positive benefits of exercise and socialization as part of a directed mental wellness program. Hopefully that would incentivize them to integrate what they learn early in their life management practices.

And perhaps the mental health partner with the general practitioner could also provide similar life management guidance even to patients not suffering psychological distress.

An ounce of prevention is worth a pound of cure...

Submitted by Jared DeFife, Ph.D. on February 19, 2009 - 11:27am.

...there's a reason that saying is a cliche! I'm sure there exist many programs aimed at early intervention wellness strategies and that they are valuable (even highly cost-effective) endeavors. Your comment reminded me of a project founded by director David Lynch, which promotes in-school teaching of transcendental meditation. http://www.davidlynchfoundation.org/ As linked from their site, it seems as if researchers are identifying some impressive health effects from the promotion of meditation practice.

Extending Some More...

Submitted by SteveM on February 19, 2009 - 12:16pm.

Hey, thanks for the link. So it's that David Lynch! His initiative looks like a good start.

I'm thinking a little more expansively into the suite of methods I mentioned as well as dedicated instruction on life management Best Practices.

For example, there's a very nice HRV unit available for home use called ION Lightstone. Unfortunately, it comes bundled with a really hokey software package shilled by Deepak Chopra call Wild Divine.

But another guy sells alternative 3rd party HRV software for the unit. One program is called Particle Editor. It's got multiple interface options including music loops. Both visuals and music outputs can be mapped to HRV response. What a simple cheap way to help kids (and adults) take active ownership of their state of mind.

I think it would be great if a school procured even a handful of those units, trained students up and allowed the kids to use them before or after class or during study hall.

About dedicated instruction, the weak link I see is that doctors and teachers mention exercise and perhaps even meditation mostly as an aside. I.e. the "You should lose some weight" type of comments. End of discussion. I think though that if psychological life management were more formally structured and integrated into a short course, the message would be more compelling and hopefully the resulting practices more persistent.

What do you think?

Access to Mental Health Care

Submitted by Eric Shaw on February 19, 2009 - 2:22pm.

Yes! It is great to see people recognizing the problems with accessing mental health care and not only that but that work is being done to improve on it. I am curious to know your thoughts on phone counsling as well. I am starting a comapny to alow for simple access to phone counseling and therapy that meets peoples needs. How do you see technology, internet, and tele-health impacting this problem?

re: Phone counseling

Submitted by Jared DeFife, Ph.D. on February 19, 2009 - 3:09pm.

Thanks for your response, Eric. In terms of some of my thoughts on phone/telecom counseling, check out my post on telephone therapy for depression http://blogs.psychologytoday.com/blog/the-shrink-tank/200811/dial... . Telephone therapy has some demonstrated effectiveness for treating general mental health symptoms such as depression and anxiety. It can be a convienent form of treatment access, especially for individuals with medical conditions or other concerns that make it difficult to leave home. It's an approach that sounds promising for some brief forms of counseling, crisis management, and acute symptom alleviation. Some forms of therapy (DBT for example) encourage phone coaching as an adjunct to face-to-face work. I am skeptical of tele-counseling's viability for longer-term treatments and or as the sole treatment for more complex mental disorders (e.g. dual diagnosis, chronic conditions, personality disorders). Furthermore, there are some serious medicolegal issues involved in not meeting a patient in-person.

Distributed Versus Face-to-Face

Submitted by SteveM on February 19, 2009 - 3:43pm.

Those are great comments. I do collaborative facilitation as part my job. Most facilitators started out doing face-to-face. But then the technology offered distributed collaboration.

But frankly, it just does not work very well. The participants just don't have the focus and a feeling of the social energy driving the topic.

If distributed is a definite second choice for (relatively) healthy group members addressing a business problem, it's hard for me to imagine that distributed therapeutic counseling would be very effective except in some circumstances.

BTW, it's been found that distributed is fine when information is only being exchanged. Say a patient lashes up with his therapist for a status report. But where it does not work very well (in business too) is when there are values issues that have to be worked through. It's much more difficult for the facilitator to manage the dialog distributed given those kinds of problems.

So I wish the OP well with his business initiative. But I would sort of hate it if insurance reimbursement mandated electronic interaction.

Tele-medicine

Submitted by Eric Shaw on February 22, 2009 - 5:54pm.

Thanks for the responses. It is very intersting hearing different opinions on how distributed options or just technology can either be effective as a tool, as a means of simply just accessing healthcare. Tele-medicine (and online tools) are very popular with sites like WebMD and Teledoc, and I feel like mental health should be following more closely.

I have talked with many therapists that have used phone counseling sessions as a main method of communication with patients, althuogh for most of these it is following an already established relationship.

But then where I got frustrated was from the vast majority of people that are just not seeking any help at all, but should be.

From talking with may people and therapists we concluded that the 2 main reasons for this are conveneience issues (time, waiting, scheduling, kids, transportaion, etc) and stigma or feeling to vulnerable. I am curious if either Steve or Jared see a value in technology as a means of annonymous access to help move people into a cycle of getting help in whatever means is necessary. That is my vision at least. Thanks!

Extending the Extension...

Submitted by SteveM on February 23, 2009 - 5:22am.

Eric,

I see what you are saying. Unfortunately, I think the dynamic of human-human interaction pretty much precludes that not much beyond where technology supports the need right now, which is mostly hotlines, call in talk radio and internet blogs where interaction is generally not synchronous. These interventions offer baseline advice and then quickly truncate to "Seek professional help". In other words, there is a tacit recognition of the conversational limitations.

I'm guessing that most therapists really need to size up a new patient with a face-to-face meeting. Like you said perhaps tele-cons can work for established patients. And interaction via video cams where the patient and therapist could see each other improve collaboration quality even more I suppose.

I always have to step back though and remind myself that many people do not have the same kind facility with computers that I have. So a great interaction idea that I have may not resonate with the target audience. Given that, we are then recursively back to tele-cons and face-to-face.

But since people are becoming more and more computer literate, perhaps computer based mental health interventions have a positive longer term potential. I.e., your business model make sense as you mature out the interface and allow the customer base to grow. (Mental Health Zoom!)

I like to follow the KISS principle which is why I think Jared's mental health/primary care lash-up makes sense. I think preventive mental health care that relies on non-pharmaceutical interventions could be very valuable. Under that regime, I envision an annual "mental health" checkup along with a physical checkup.

The resident mental health person at the clinic would provide them. Of course he/she could intervene directly if real or incipient mental illness presented itself. But beyond that, for those who are fundamentally healthy, the therapist could provide advice and instruction on life management techniques to that would help every person better navigate the inevitable bumps in the road. I.e., meditation, biofeedback, journaling, whatever. In other words give the patient the tools to preemptively attenuate the psychological downside of life's complexity.