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Talk, Talk, Talk

Posted Aug 11 2008 9:05pm

People use to talk. Families would talk around the dinner table; folks would sit on the front porch and talk with their neighbors. You would find men chatting at the barbers or the POW or Elk's clubs. Women would be home during the day and would talk with the other housewives. Garden clubs were an opportunity for the ladies to talk about everything except gardening. Of course, these are all things I've only heard of. Certainly I'm not old enough to remember anything like these.

Today everyone is too busy working, too busy working out, too busy watching television. No one seems to talk anymore. Kids were an exception for awhile. They at least talked on their cell phones, but now that even seems a dying breed. Today you rarely see a kids face. They are always looking down at their cell phones while their fingers go at warp speed text messaging instead of actually speaking.

Families aren't the only ones not talking enough anymore. On Tuesday Healthday Reporter reported that psychiatrists are talking less these days. Apparently a National Ambulatory Care Survey, confirmed that the proportion of visits to psychiatrists' offices that included psychotherapy dropped from 44.4 percent in 1996-1997 to 28.9 percent in 2004-2005. 29% What the hell???

What do they say has caused this? The decline coincided with changes in insurance reimbursement, the rise of managed care and a boom in the availability of different psychiatric medications - basically, they've all become pill pushers. Make a prescription, have a nice day and then "Next!" Those psychiatrists who do still provide psychotherapy tend to have self-paying clients.

Self paying clients? We all know who self paying clients are. They're the ones who can afford to pay $200 an hour for psychotherapy. There's also another group that receives psychotherapy. Surprisingly enough it's the poor. I basically fall under this category. I get excellent therapy from my psychologist at a county mental health facility. My wonderful doctor is a resident who spends a full hour with me every week. Apparently that's true of most government facilities which are run by either psychiatrists donating their time, or as in my case a resident completing their training.

What does all this mean? Once again it's the middle class that gets the shaft. Those who make too much to go to a government facility and who cannot afford to pay for their own visits. These are the individuals who are stuck with a shitty insurance plan that limits what a psychiatrist can provide and typically limits them to 12 visits a year.

I don't have much else to say about this. It's just another example of why there needs to be major health care reform in the U.S. Is it any wonder we've dropped dramatically in health care compared to other industrialized nations?

I'm interested to hear from those outside the U.S. regarding how this compares to their mental health care. Those of you in the U.S. I'd like to ask what you think the solution should be.
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