Psychotherapy, Equally Available?

Allan Schwartz, LCSW, Ph.D. was in private practice for more than thirty years. He is a Licensed Clinical Social Worker in the states ...Read More


This week’s edition of The Lancet, (September 13 2007), England’s medical journal that is the equivalent of the Journal of the American Medical Association, produced a disturbing article about depression, its impact on physical health and the availability of treatment for depression and other psychiatric disorders. The article stated that depression worsens the condition of such chronic disorders as angina, arthritis, asthma, and diabetes. The article cited the results of a survey of 245,404 people who were followed for a twelve month period. The survey was conducted by the World Health Organization.

The WHO reports that people with depression plus one or more of these chronic diseases had the worst health scores of all disease states. In other words, co morbid depression worsens health compared to those people who have depression with no chronic disease. Those who have one or more of these chronic diseases but are free of depression do not suffer from health conditions.

The researches at the WHO conclude that it is a matter of urgency to address depression in order to improve overall health. One report from Australia reports that 80 to 90 percent of people with arthritis or asthma receive acceptable levels of treatment but only but less than 30% receive an equally acceptable level of treatment with anti depressants and psychotherapy for depression.


These results are important for two reasons:

1. They demonstrate the damaging effects of depression on overall health and

2. They dramatically point to the fact that depression is not treated as aggressively as physical illnesses.

Yet, psychiatric problems impact on physical health as much as disease states do.

Another study done last year showed that the Anxiety Disorders are tied to physical illnesses. It is thought that worry and anxiety, when they continue long enough, bring about organic changes resulting in physical illness and even substance abuse.

There is a two way street with regard to all of these findings. That two way street seems to point to the idea that illnesses can cause anxiety and depression while anxiety and depression can also cause physical illnesses and worsen them as well.

What is very concerning about all of this is the fact that medical insurance in the United States does not seem to handle psychiatric treatment equally with other medical treatments. My experience has been that psychiatric treatments have higher co pays than medical treatments and allow far fewer visits to the doctor or therapist than do other treatments. Yet, unlike some medical conditions, it takes a lot longer to recover from depression, anxiety and other emotional disorders. Of course, the area where complete coverage is equally difficult has to do with the types of chronic physical illnesses like those listed above.

One of the insurance areas where people with either psychiatric problems, chronic physical problems or both are treated unfairly is the concept of a "Pre Existing Condition." Any patient who has had to change insurance companies either because they have started a new employment or has experienced a change in insurance company where they work has experienced the frustrating fact that treatment will not be reimbursed by the new insurance if it is a pre existing condition which means that it was treated during the last year or two. In other words, these people are left to fend for themselves in paying heavy medical bills because insurance will not reimburse for at least a year or two from the time of the most recent treatment.

When you think about it this mechanism of pre existing conditions is grossly unfair to those with chronic psychiatric and physical illnesses that require ongoing treatment. I cannot think of a more relevant area than substance abuse treatment. I have known of several instances of people who relapsed but could not go into inpatient detox treatment or ongoing rehab treatment because they were refused by their insurance companies for pre existing conditions.

It seems best to just not become ill and poor you if you do.

Your comments are encouraged on this frustrating issue.

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