Mental health experts like Dr. Sledge (New Haven Register, Feb. 5, 2013) worry about the stigma of mental with good reason. Mental health care practitioners routinely work with clients and families who have eschewed care for years or even decades rather than risk being "labelled" with a psychiatric diagnosis.

Most of these patients would not hesitate to seek medical attention for a physical illness; nor an illness that is attributable to lifestyle choices, and therefore preventable.  Most mental illnesses are not easily preventable; our clients don't choose to be ill, and their illnesses ought not to be stigmatized. 

Neither should our profession.  Psychiatric care practitioners are among the lowest paid care providers, along with pediatricians and primary/preventive caregivers.  

Across this country in the wake of Newtown and Virginia Tech and Columbine has risen a chorus of acknowledgement that the populace in under-served by our mental health care systems.  Sadly, those voices are not echoed by the corporations that set the reimbursement rates for most of the mental health care delivery in this country and in our state.   

Consider the devaluation of psychiatric care by one of the nation's leading private insurance corporations, which controls a significant share of the commercially insured market in Connecticut.  Their reimbursement rate for a widely practiced treatment, the 45-minute office visit with a medicated patient, remained flat between 2007 and 2012.  This is in fact a yearly decrease when adjusted for inflation and cost of living increases.  That company took advantage of an updated national protocol for coding healthcare that went into effect Jan. 1, 2013 to cut the 2007 rate for a 45-minute service by an additional 15 percent. Meanwhile, up-front deductibles and patient co-payments, both of which are disincentives to seeking care, have steadily increased.

Yet some treatment modalities have become more profitable. Short visits, with minimal if any meaningful clinical interaction, where prescriptions for psychiatric medications are provided, remain lucrative.  For those of us with DEA numbers, the economic signaling toward a factory-based model of care is unmistakeable.  Talk is cheap. "Therapy" takes place down the hall by allied professionals, or across town at a reduced hourly rate, and sometimes not at all.  "Coordination of care" among disparate practitioners at distant locations who share a client's care with a prescriber who is medicating 5 to 8 clients per hour, sometimes more, is a far-fetched notion.  Many of us who engage in it know better.  But the opportunity to double or quadruple one's income by abiding a profit-driven care model is difficult to resist, even among professionals whose original interest in mental health was to serve those in need.

Insurers regulate the practice of medicine de facto. They are neither legislative nor regulatory entities, yet we have allowed them to act with that authority.

If, as we profess, particularly in the aftermath of a crisis, this country values a competent mental health system whose interests are aligned with those of the public it serves, we should demand from our legislators and from the regulatory bodies they entrust to act on our behalf, that the economic signals of the profit-makers truly align with the delivery of efficacious care to the public.    

John M Roy

North Haven