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This is from an APA Listserve -- pretty scary:
ASAP READER vol 3 #12 10-10-2004
Greetings ASAP Readers,
The Court Monitor?s Report 2004 on the failure of the Arizona Department of Health Services (ADHS) to provide mental health services to the medically indigent has been a focus of my attention for the past month. Psychologists here have essentially frozen out of this market by bachelor and master level counselors. Despite the lack of psychiatrists and nurse practitioners the psychologists who could manage these services remain unused. Ph.D. psychologists in their one year postdoctoral training have not been employed at salaries paid to master?s level counselors even though they are eligible do be hired by ADHS regulations. AzPA, with the assistance of Alan Nessman, Esq. of the Practice Directorate, sent a letter to Judge Dougherty to challenge this practice in time for the October 8th Hearing. The Court Monitor is supposed to be writing a response to our complaint and recommendations. A copy of the letter follows:
September 30, 2004
The Honorable Bernard Dougherty C/o Ms. Nancy E. Diggs Court Appointed Monitor 4201 N. 16th Street, Suite 220 Phoenix, AZ 85016
Dear Judge Dougherty,
Thank you for making the 2004 Independent Review of the delivery of state mental health services (Review) available for public comment. We write on behalf of the Arizona Psychological Association. The Review confirms the decline in availability of adequate mental health services that the state provides to indigent populations through the Arizona Health Care Cost Containment System (AHCCCS). Public mental health consumers (and their families and guardians) have been reporting this decline to mental health advocacy groups for the past three years.
Our primary concern with the Review is that it recognizes the shortage of health care providers, but fails to consider filling that gap with the state?s available pool of psychologists ? professionals with training and background well suited to the needs of AHCCCS.
The Review recognizes that only 10% of the priority clients had an appropriate "clinical team" serving the patient of a psychiatrist, registered nurse and case manager. The team members most commonly missing were the psychiatrist (missing in 34 % of the cases) and registered nurse (missing in 46 % of the cases).
The Review acknowledges that the "service package and network must be expanded to ensure there is a sufficient complement of qualified providers to deliver the services needed by class members." (Recommendation VI. 3.) The Review blames shortages of psychiatrists and nurse practitioners for AHCCCS? failure to adequately staff clinical teams (Data Analysis III. B(2)).
Despite these identified shortages, the Review fails to consider the option of utilizing Arizona?s highly qualified pool of available licensed psychologists to alleviate the shortages and expand the network. Arizona currently has 1197 active licensed psychologists.
Psychologists are licensed and qualified to diagnose and treat mental illness. They are qualified and have the proper training to coordinate mental health care with primary care physicians, psychiatrists, nurses and case managers, and to assess the adequacy, relevance, and timeliness of patient care. Psychologists routinely provide these services in private practice.
In Arizona (like most states), psychologists have the highest level of training in treating mental illness of any of the mental health professions. The entry level degree for psychologists is the doctorate, which includes seven years of rigorous and extensive education and training, including practica and internship training in hospitals and in other health care settings, combined with a minimum of two years of supervised direct clinical service. All clinical psychology programs combine the teaching of basic science and methods of psychology with the theory and techniques of clinical practice. An important aspect of this training is education in the biological bases of behavior, including, for example, physiology, neuropsychology and pharmacology. As a result of this solid grounding in scientific method and the scientific foundations of mental illness, as well as the acquisition of skills in the diagnosis, assessment and treatment of all mental disorders, psychologists unquestionably possess the ability to coordinate care in a mental health team setting like that found in the AHCCCS program.
In addition, there are a number of psychologists nationwide, including in Arizona, who have acquired psychopharmacology training, which requires extensive postdoctoral education and training in neurosciences, pharmacology and pharmacotherapeutics, and physical and laboratory assessment, for certification. In fact, Louisiana and New Mexico have passed laws allowing qualified psychologists to prescribe to improve citizens? access to mental health care.
The Review may have overlooked the option of utilizing psychologists because of the AHCCCS? heavy reliance on psychotropic medications to treat mental illness. Several recent studies, however, demonstrate that such medications are made substantially more effective when combined with the kind of psychotherapy that psychologists typically provide. For example, a 1992 study published in the Archives of General Psychiatry (following up the results of a 1989 National Institute of Mental Health collaborative study) found that psychotherapy was superior to medications in the treatment of severe depression. (Shea et al., 1992). Similar studies indicate that patients suffering from panic disorder or bulimia who receive psychotherapy are less likely to suffer relapse than those who just receive medication ("Psychotherapy is cost-effective," Monitor on Psychology, Vol. 31, No. 1, January 2000). Most recently, the October 2004 issue of Consumer
Reports provided the results of a survey of over 3,000 members showing that the most successful patients were those who received a combination of talk and drug therapies. These patients "had the advantage of quick improvement with the drugs, followed by steady improvement from the talk." Therefore, psychologists are well qualified to serve as an integral component of the collaborative treatment model: psychologists can provide therapy and coordinate with physicians or other prescribers to monitor medication.
For the reasons stated above, we recommend that psychologists be part of the treatment team to deal with the shortage of mental health specialists that hampers its delivery of services to indigent Arizonans.
Finally, we would like to address procedural concerns with the Review. First, we note that the Review is arguably not entirely objective because, in essence, the court asked ADHS and Value Options to assess the performance of their own program. While the Review found serious deficiencies in the delivery of mental health services, we are concerned that a truly independent reviewer may have identified additional or more serious problems, and may have addressed the deficiencies more appropriately. The issue of optimal patient care, which includes therapy, is not aggressively addressed in the Court Monitor?s Review.
Second, the Review treated mental health consumers as "peer reviewers" for the purpose of assessing the adequacy of behavioral health services provided under the case management approach. While it is essential to obtain input from these consumers, "peer reviewer" status is not the appropriate role for them. Consumers do not necessarily have the training and background to evaluate existing and alternative systems and models for providing mental health care. ADHS should have sought this expertise from other behavioral health care agencies and/or as individual mental health specialists with appropriate expertise.
Sincerely,
Ellen W. Williams, PhD President Arizona Psychological Association
Cc Charles Arnold, Esq.
Medicaid has not been a center stage item to this list serve because it does not have an obvious connection to RxP. However, it is possible for state departments of health and mental health services to authorize the use of psychologists trained in RxP in plans under their regulation and control. Psychologists can collaborate with other prescribing professionals or manage medications in state operated facilities or for beneficiaries of state supported health plans. This possibility needs to be explored in every jurisdiction.
ASAP READER vol 3 #12 10-10-2004
Greetings ASAP Readers,
The Court Monitor?s Report 2004 on the failure of the Arizona Department of Health Services (ADHS) to provide mental health services to the medically indigent has been a focus of my attention for the past month. Psychologists here have essentially frozen out of this market by bachelor and master level counselors. Despite the lack of psychiatrists and nurse practitioners the psychologists who could manage these services remain unused. Ph.D. psychologists in their one year postdoctoral training have not been employed at salaries paid to master?s level counselors even though they are eligible do be hired by ADHS regulations. AzPA, with the assistance of Alan Nessman, Esq. of the Practice Directorate, sent a letter to Judge Dougherty to challenge this practice in time for the October 8th Hearing. The Court Monitor is supposed to be writing a response to our complaint and recommendations. A copy of the letter follows:
September 30, 2004
The Honorable Bernard Dougherty C/o Ms. Nancy E. Diggs Court Appointed Monitor 4201 N. 16th Street, Suite 220 Phoenix, AZ 85016
Dear Judge Dougherty,
Thank you for making the 2004 Independent Review of the delivery of state mental health services (Review) available for public comment. We write on behalf of the Arizona Psychological Association. The Review confirms the decline in availability of adequate mental health services that the state provides to indigent populations through the Arizona Health Care Cost Containment System (AHCCCS). Public mental health consumers (and their families and guardians) have been reporting this decline to mental health advocacy groups for the past three years.
Our primary concern with the Review is that it recognizes the shortage of health care providers, but fails to consider filling that gap with the state?s available pool of psychologists ? professionals with training and background well suited to the needs of AHCCCS.
The Review recognizes that only 10% of the priority clients had an appropriate "clinical team" serving the patient of a psychiatrist, registered nurse and case manager. The team members most commonly missing were the psychiatrist (missing in 34 % of the cases) and registered nurse (missing in 46 % of the cases).
The Review acknowledges that the "service package and network must be expanded to ensure there is a sufficient complement of qualified providers to deliver the services needed by class members." (Recommendation VI. 3.) The Review blames shortages of psychiatrists and nurse practitioners for AHCCCS? failure to adequately staff clinical teams (Data Analysis III. B(2)).
Despite these identified shortages, the Review fails to consider the option of utilizing Arizona?s highly qualified pool of available licensed psychologists to alleviate the shortages and expand the network. Arizona currently has 1197 active licensed psychologists.
Psychologists are licensed and qualified to diagnose and treat mental illness. They are qualified and have the proper training to coordinate mental health care with primary care physicians, psychiatrists, nurses and case managers, and to assess the adequacy, relevance, and timeliness of patient care. Psychologists routinely provide these services in private practice.
In Arizona (like most states), psychologists have the highest level of training in treating mental illness of any of the mental health professions. The entry level degree for psychologists is the doctorate, which includes seven years of rigorous and extensive education and training, including practica and internship training in hospitals and in other health care settings, combined with a minimum of two years of supervised direct clinical service. All clinical psychology programs combine the teaching of basic science and methods of psychology with the theory and techniques of clinical practice. An important aspect of this training is education in the biological bases of behavior, including, for example, physiology, neuropsychology and pharmacology. As a result of this solid grounding in scientific method and the scientific foundations of mental illness, as well as the acquisition of skills in the diagnosis, assessment and treatment of all mental disorders, psychologists unquestionably possess the ability to coordinate care in a mental health team setting like that found in the AHCCCS program.
In addition, there are a number of psychologists nationwide, including in Arizona, who have acquired psychopharmacology training, which requires extensive postdoctoral education and training in neurosciences, pharmacology and pharmacotherapeutics, and physical and laboratory assessment, for certification. In fact, Louisiana and New Mexico have passed laws allowing qualified psychologists to prescribe to improve citizens? access to mental health care.
The Review may have overlooked the option of utilizing psychologists because of the AHCCCS? heavy reliance on psychotropic medications to treat mental illness. Several recent studies, however, demonstrate that such medications are made substantially more effective when combined with the kind of psychotherapy that psychologists typically provide. For example, a 1992 study published in the Archives of General Psychiatry (following up the results of a 1989 National Institute of Mental Health collaborative study) found that psychotherapy was superior to medications in the treatment of severe depression. (Shea et al., 1992). Similar studies indicate that patients suffering from panic disorder or bulimia who receive psychotherapy are less likely to suffer relapse than those who just receive medication ("Psychotherapy is cost-effective," Monitor on Psychology, Vol. 31, No. 1, January 2000). Most recently, the October 2004 issue of Consumer
Reports provided the results of a survey of over 3,000 members showing that the most successful patients were those who received a combination of talk and drug therapies. These patients "had the advantage of quick improvement with the drugs, followed by steady improvement from the talk." Therefore, psychologists are well qualified to serve as an integral component of the collaborative treatment model: psychologists can provide therapy and coordinate with physicians or other prescribers to monitor medication.
For the reasons stated above, we recommend that psychologists be part of the treatment team to deal with the shortage of mental health specialists that hampers its delivery of services to indigent Arizonans.
Finally, we would like to address procedural concerns with the Review. First, we note that the Review is arguably not entirely objective because, in essence, the court asked ADHS and Value Options to assess the performance of their own program. While the Review found serious deficiencies in the delivery of mental health services, we are concerned that a truly independent reviewer may have identified additional or more serious problems, and may have addressed the deficiencies more appropriately. The issue of optimal patient care, which includes therapy, is not aggressively addressed in the Court Monitor?s Review.
Second, the Review treated mental health consumers as "peer reviewers" for the purpose of assessing the adequacy of behavioral health services provided under the case management approach. While it is essential to obtain input from these consumers, "peer reviewer" status is not the appropriate role for them. Consumers do not necessarily have the training and background to evaluate existing and alternative systems and models for providing mental health care. ADHS should have sought this expertise from other behavioral health care agencies and/or as individual mental health specialists with appropriate expertise.
Sincerely,
Ellen W. Williams, PhD President Arizona Psychological Association
Cc Charles Arnold, Esq.
Medicaid has not been a center stage item to this list serve because it does not have an obvious connection to RxP. However, it is possible for state departments of health and mental health services to authorize the use of psychologists trained in RxP in plans under their regulation and control. Psychologists can collaborate with other prescribing professionals or manage medications in state operated facilities or for beneficiaries of state supported health plans. This possibility needs to be explored in every jurisdiction.
