The Mental Health Paradigm

The Mental Health Paradigm
by Marc Adler
in Health / Mental Health (submitted 2011-09-03)

Shulamis Lieber, a social worker from New York City who works for a nonprofit called The Institute for Family Health and specializes in mental health for HIV patients, is on the front lines of America's health care crisis. She has three years of experience in the field and sees first-hand how for-profit healthcare and draconian budget cuts are destroying careers and harming patients.

Over the past 10-15 years, she says, the mental health paradigm has shifted away from long-term therapy, in which the patient spends roughly 45 minutes with a professional talking about problems and digging for root causes of distress, to short-term, concrete therapy, in which patients are given medication and engage in problem solving exercises designed to help them take their medicine, focus on things that give them pleasure and transcend barriers to achieving structure in their daily schedules. "Many patients have a real need for and interest in doing long- term therapy," Shulamis says. "An average mental health session used to be 45 minutes to an hour, and now they've really cut that. My average meeting time with a patient is 15 minutes, 30 minutes tops, and it's really a huge difference and huge cutback because the people need more time to feel like they can trust their therapist and develop a unique bond."

The reason for the transformation is that the newer model is cheaper and far more profitable. Public insurers have turned to this method to cope with massive budget cuts created by the financial crisis, and private insurance corporations love it because it dramatically boosts their bottom line by saving money and doubling the number of patients.

Shulamis must treat patients "based on what Medicaid, Medicare and the insurance companies want, and they want you to make a diagnosis in a very short amount of time and use short-term behavior models like cognitive behavioral therapy, which require the least expertise and training, instead of any other type of psychodynamic approach." This has made her job "very difficult."

The object is for social workers to see as many patients in the least possible amount of time.

Last week Shulamis saw a man who is HIV positive and taking his medication on schedule. He just wanted to talk about his struggles coping with the stigma, along with financial and relationship troubles. But he was ineligible for treatment because Shulamis is required to treat only those who are either not taking their medication or struggling with barriers to achieving daily structure and staying positive. In order to properly help her patient therefore, she has to forfeit her lunch break to squeeze him into her schedule and exaggerate the true nature of his condition by writing in her paperwork that he can continue to attend to his medical needs only if he gets support with his financial and relationship problems.