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A week does not go by in a psychotherapy practice that some interaction with psychiatrist does not take place. Legislatively the psychiatrist is kept in a box and rarely does psychotherapy. Instead, as one could expect in a drug culture society, psychiatry is usually relegated to writing scripts for medication. It was a mere thirty years ago that I worked on a psychiatric treatment team where psychiatry contributed to everything; education, consulting, psychotherapy,etc.

Psychiatric Modality

Legislators seem to wish that mental health treatment should be hospital based, but in reality hospitalization for mental illness is in a short term stay mode. Pushing psychotherapists and psychiatrists out of community care creates only a few alternatives. One, go untreated. Secondly, find a facility like a prison or have several hospitalizations per year

Coming from an institutional model psychiatry lost the battle in a fight to keep state hospitals which began community care models. In part to save $$. In 2012 the community model appears in $$ trouble in favor of institutional care. Nevertheless, there continues to be opportunity for the practitioner to use Medicare B then leave it for other private practice models.

Psychiatric modalities these days are performed by numerous specialists. Psychotherapy, creative arts,technicians, group therapists, psychologists, etc. Over the years each specific discipline has been under fire and suffered such terrible blows from legislators actions to reduce funding that many psychotherapists have gone in private practice.In practical terms this means that chronic mentally ill individuals, workplace mental health programs,once developed to enhance communities will risk costing more in hospitalization.

Whatever happened to the state hospital I once worked in ? It was closed with the hope of providing patients with psychiatric services in the community. That was not the end. Unfortunately patients came to the attention of authorities who created a new asylum program, i.e. prison. Somehow the cost savings closing mental hospitals never came into being. No one I know of has ever made the argument that placing them in prison was cheaper. Dropping funding for psychotherapy in communities wasn’t smart economic policy either.

Psychotherapists in mental health have several so called psychiatric fee reductions. When compared to the $60,000 + cost of psychiatric hospitalization per year in a state hospital versus a few thousand per year its clear where the irrationality is.

No wonder its now hard to find a provider who’ll accept Medicare for mental health services.The warning signs have been there before 2008 and now psychotherapist retention is worse than ever and there’s a shortage of psychiatrists. Who wants the bother ?

This being the case Medicare B can be used for 2-3 years for a beginning psychotherapist to gather a sizeable $$ portfolio to drop Medicare B entirely and go private practice.This would be a satisfactory use of Medicare by psychotherapists who wish a successful career outside the government. Use Medicare B as seed money then get out.