Myths about suicide abound in the therapeutic setting. They often inhibit the ability of clinicians (and families) to assess the severity and magnitude of a patient’s suicide risk. This special report discusses some of those myths. In Why People Die by Suicide,1 I argued that a kind of fearlessness is required to face voluntarily the daunting prospect of one’s death, and that doing so necessarily involves a fight against ancient, ingrained, and powerful self-preservation instincts. In Myths About Suicide,2 I used the framework developed in the previous book to contend that death by suicide is neither impulsive, cowardly, vengeful, controlling, nor selfish.
Life problems are all around us. Stress, anxiety, depression, legal, financial, addictions, etc…are all part of life problems that effect employees and a companies productivity. The Blomquist Hale Employee Assistance Program (EAP) is a national group of therapist that provide solution focused therapy to address these type of issues. We work with companies to address problems early before they become acute and expensive mental health disorders.
A difficult area for our client companies and their employees has been deciding how to Care for the Elderly. Deciding what to do with aging mom or dad can be very hard as the adult children become the responsible caregiver. Blomqusit Hale EAP has a variety of tools and free programs to help our clients in these situations.
Promoting our services to our client companies and employees is very important. One of the tools we have been using is a company called Brainshark. They are an online video presentation company that allowed us to easily turn a PowerPoint into an online video. The process of building the video was simple and allowed us to get detailed information out about our EAP Senior Care Program.
In fact, since using Brainshark we have increased our EAP Senior Care Program attendance by over 220%. More families are meeting with our Senior Care Specialist and learning about Care Centers, In Home options, VA Loans, Medicare and Medicad, Financial Resources, Taxes, Power of Attorney and a variety of other things that are important when it comes to senior care.
Here is a sample of our video that was produced… This video is currently embedded on the main home page at www.blomquisthale.com. (Just go to the Home Page and Click on the Senior Care Assistance Video). We have also sent this video out to our client companies which they have easily and quickly forwarded on to their employees. Brainshark has helped us quickly and easily spread the word about our product and services. The best part is we have helped out hundreds of people in difficult situations. We have reduced levels of stress and despair and replaced it with hope, options and help for those in need. We get countless thank yous from those that participate in our senior care program expressing how it has drastically helped their family situations.
Sometimes the best help people need is just someone to talk with. Blomquist Hale EAP will continue using the technology and services to get the messages out about our products. If you need help or would like to to speak with a counselor today please call for assistance.
Blomquist Hale EAP
What Goes On in the Minds of Those Who Attempt Suicide
By Thomas Joiner, PhD
The tragic death of a Florida television news reporter in 1974 illustrates the fallacy that suicide is an impulsive, spur-of-the-moment whim, much like casting off peanut shells at the ballpark. In July of that year, the reporter was covering the story of a shooting that had happened the day before. When the reporter called for the news station’s video footage of the scene, the tape jammed. She shrugged and stated, “In keeping with Channel 40’s policy of bringing you the latest in blood and guts, and in living color, you are going to see another first—an attempted suicide.” She extracted a gun from beneath her desk and shot herself behind the right ear. She was rushed to a local hospital, but died 14 hours later.
The usual reaction to this tragic tale beyond shock and horror was to dwell on the seemingly impulsive nature of the act and ask, “How could the reporter have known that the tape would jam?” However, the reporter’s behavior leading up to her suicide dispels the idea that she acted impulsively:
• For years, she openly told her family that she felt depressed and suicidal
• Four years before her death, she attempted suicide by overdose and frequently discussed the incident subsequently
• Weeks before she died, the news station granted her request to cover a story on suicide; and during one interview, she asked a police officer for details on self-inflicted gunshot wounds
• One week before, she told a colleague that she had bought a gun and joked with him about killing herself on the air
• On the day of her suicide (or possibly even before), she had put the gun in a bag that she brought to the set daily
• Finally, she had prepared news copy for a fellow reporter to read about her suicide after the fact
The news reporter’s death illustrates that her suicide was premeditated. Death by suicide is extremely fearsome and daunting, and thus requires considerable thought, planning, and resolve. To consider her death impulsive is to assign primacy to that spur-of-the-moment decision as to precisely when to pull out the gun, instead of focusing on the many factors that led up to that planned moment.
In the book An Unquiet Mind,3 Kay Redfield Jamison discusses her own experience with suicidal behavior and describes how it actually works: “. . . for many months I went to the 8th floor of the stairwell of the UCLA hospital and, repeatedly, only just resisted throwing myself off the ledge. . . .” Contemplating suicide is a signature of serious suicidal behavior. Jamison’s months-long thought process and behaviors counter the notion of spontaneous death by suicide.
The suicide of President Bill Clinton’s childhood friend and White House adviser Vince Foster was of this sort. Despite wildly irresponsible speculation to the contrary, Foster died of a self-inflicted gunshot wound. Foster snuck a gun out to his car in an oven mitt; he drove to a secluded area of a park, and he shot himself. To imagine that Foster’s death was impulsive is to ignore all of the facts in what was by far the most investigated suicide in history (multiple Congressional inquiries and forensic investigations were conducted). It is also to ignore the character of Vince Foster; he was a well-organized, thoughtful, and deliberate person. No one who knew him would have described him as impulsive.
Foster’s friends and family were stunned by his death; it seemed “out-of-the-blue.” However, death by suicide can both shock loved ones and be planned for weeks, months, or even years. This is because of the human capacity, quite spectacular in some cases, for privacy and secrecy. Except in works of fiction, I have never encountered a death by suicide that was truly impulsive. Many clinicians have mistakenly deemed suicidal deaths impulsive merely because they seemed to be “out-of-the-blue.”
Suicide note myths
Foster did not leave a suicide note, a factor that spurred conspiracy theories on cause of death. To my knowledge, no study has reported a rate of note leaving among suicide decedents to exceed 50%. Moreover, most studies find rates between 0% and 40%4; a reasonable average rate would be approximately 25%.
Why are suicide notes so rare? Some have reasoned that because impulsivity is involved in suicidal behavior, suicidal persons often kill themselves before they have a chance to write a note. There are problems with this viewpoint, however. A major problem is that it draws on the distinct myth that dying on a whim is common. Another problem is the lack of empirical support that compares those who leave notes with those who do not. If it were true that note leavers are much less impulsive than those who do not leave notes, then this distinction should be easy to demonstrate in forensic studies that examine the lives, characteristics, and personalities of decedents. This difference has not been clearly demonstrated.
The relative rarity of suicide notes reveals the state of mind of those about to die by suicide. To say that persons who die by suicide are lonely at the time of their deaths is a massive understatement. Loneliness, combined with alienation, isolation, rejection, and ostracism, is a better approximation. Still, it does not fully capture the suicidal person’s state of mind. In fact, I believe it is impossible to articulate the phenomenon, because it is so beyond ordinary experience. Notes are rare because most decedents feel alienated to the point that communication through a note seems pointless or does not occur to them at all.
Friends and family who have been surprised by a suicide often consider it to be deeply selfish. This is understandable because the bereaved are often convinced that the decedent did not consider the impact of his or her death on those left behind. However, those who die by suicide certainly do consider the impact of their deaths on others; but to them, death is a positive rather than a negative outcome. This is wrong, but nevertheless, it is the view of the person who attempts suicide.
Still another reason to question whether selfishness is involved in suicidal behavior involves the associations of various aspects of psychopathy to suicidal behavior. In its description of psychopathy, DSM-IV includes aggressive behavior and reckless, out-of-control disregard for others and for rules and norms. Another aspect of psychopathy—evidently to be emphasized more in DSM-5 and included in Hervey Cleckley’s classic 1941 book, The Mask of Sanity5—describes psychopaths as controlled, callous, sometimes charming con men. They also demonstrate marked emotional detachment (ie, low anxiety; fake or shallow emotions; immunity to guilt and shame; and incapacity for love, intimacy, and loyalty).
In the current DSM, psychopaths are considered out of control but not necessarily unfeeling. Cleckley psychopaths are very much in control and very much unfeeling, except, that is, when it comes to themselves. One cannot be a Cleckley psychopath and not be selfish—it is part of the core of the syndrome; but on the basis of DSM, one can be a psychopath and not be selfish. In short, one group is selfish to the core; the other, less so.
If selfishness is key to suicidal behavior, it stands to reason that the group more prone to suicidal behavior should be the Cleckley psychopaths, but it is not. Genuine suicidal behavior is quite rare in this group.
Another common myth that even some professionals harbor is that death by suicide peaks around the winter holidays. In fact, far from peaking, the winter holidays represents a low point in suicide rates,6 possibly because it is a time of togetherness.
My research group hypothesized that seasonality and suicidality are associated at least partly because of seasonal fluctuations in togetherness.6 Consider a large college campus in this regard. Campuses provide numerous activities for belonging; anyone who doubts this should check out a nearby university’s online master calendar. Universities offer many social, cultural, academic, athletic, and other events—many of them free of charge. Perhaps partly as a function of this high level of belonging inherent in these events, suicide rates of college students are relatively low compared with their same-aged peers not at college.6
Opportunities for togetherness are thus high on college campuses, but they are not uniform throughout the calendar year. During a standard academic year (the fall and spring semesters, roughly from September to May), most schools are clearly in session, and chances for social engagement abound through classes, dormitory and apartment life, sports, and so on. However, summer activities continue but they ebb considerably. Therefore, it is conceivable that students’ sense of belonging may be lower during the summer than during active semesters. We found that suicidal ideation was higher in the summer months than during the regular academic year, and we reasoned that this association might be partly explained by fluctuations in opportunities for socializing.6
Slow suicide myths
A final collection of myths involves the notion of slow suicide, by which a person engages in unhealthy behaviors despite knowing that these behaviors may ultimately lead to death. Genuine suicidal behavior involves a rather clear intent to die, not to do something else like smoking or taking drugs because they like it. Consider, for example, smoking. By the logic of smoking as slow suicide, we should have witnessed a most remarkable decrease in the suicide rate in the past half century, as smoking rates plummeted; alas, we have not. People know smoking puts them at risk, but they smoke anyway—not because they intend to die—but because they like it. They are willing to take the risks because of how much they enjoy smoking. Addicts continue to use drugs even though they have been told and understand that continued use might kill them; but because they like “doing” drugs, the risks do not matter.
I articulated these perspectives in Why People Die by Suicide1 and Myths About Suicide,2 which encompass risk assessment, therapeutics, and suicide prevention. In addition to marked warning signs, such as talking about suicide and planning for it, the books discuss clinically severe agitation, insomnia, and nightmares (these latter 3 are themselves not considered acute risk factors in some clinical settings). Noting a patient’s fearlessness of death, perceived burdensomeness, and accelerating alienation may improve risk assessment.
Myths About Suicide concludes with the following excerpt:
We need to get it in our heads that suicide is not easy, painless, cowardly, selfish, vengeful, self-masterful, nor rash; that it is not caused by breast augmentation, medicines, “slow” methods like smoking or anorexia, or as some psychoanalysts thought, things like masturbation; that it is partly genetic and influenced by mental disorders, themselves often agonizing; and that it is preventable (eg, through means restriction like bridge barriers) and treatable (talk about suicide is not cheap and should occasion treatment referral). And once we get all that in our heads, at last, we need to let it lead our hearts.
Therapeutic regimens and prevention protocols that target and acknowledge these factors should be given serious consideration.
SALT LAKE CITY — Some people who struggle with mental illness are never diagnosed, others not until they are well into adulthood; but unlike those who face challenges with diabetes or even cancer, these people often feel isolated or want to hide because they fear they will be labeled.
KSL News recently talked to several Utahns who are facing their illnesses with courage and are determined to live productive lives.
With young children, their lives were turned upside down. But Donna Brodis stayed by her husband’s side.
“I had faith he would be strong enough to pull through it because I knew that he had a good character and this was an illness like any other physical illness,” Donna said. “The brain is an organ, and sometimes when your brain is sick. You don’t always realize it, and you struggle through it, and you push through it.”
After a diagnosis of bipolar disorder, medications and electroconvulsive therapy helped Walt conquer the severe depression and weight gain. He began looking for a creative outlet and returned to his high school love of painting.
Walt’s artwork is so unique, that he has now been invited to participate in an art show in New York City. The Artist Project is an exhibition of fine art from unrepresented international artists.
“Maybe people need to hear that a person like me, who’s functional and doing something worthwhile, had a period in his life where he was afraid of himself and needed help,” Walt said.
Just as Walt’s life began improving, his youngest son, Joe, began to have bipolar symptoms.
“It’s a very different picture for kids who have bipolar disorder. We recognized what his strengths were and that he could still have a successful life, but we had to do these other things, like he would if he had any other illness, and we tried to be honest with the other kids,” Donna said.
“I didn’t want to feel the way I felt anymore. I knew that wasn’t who I was. I wasn’t that angry of a person, that sad of a person,” said Zach Wittwer.
Prior to his diagnosis of bipolar disorder, at age 13, Zach remembers not understanding what was going on in his mind. He has spent the last several years balancing doctors’ appointments and medications.
Now 21, Zach takes college courses online and has a job. He hopes to become a special education teacher.
“I think as soon as you’re comfortable, just tell people. Don’t be ashamed of the illness, because you wouldn’t be ashamed if you had diabetes,” he said.
Zach is the oldest of four children. His family was initially devastated but searched for help. His mother, Sherri Wittwer, is now the executive director of Utah’s National Alliance on Mental Illness.
“We have an amazing family — where they’re educated, they understand, and they really do support Zach,” she said. “But that’s not to say it hasn’t been a difficult journey, and it continues to be for Zach every day.”
Dr. Walt Brodis
Dr. Walt Brodis was 40 when, as a successful internal medicine specialist, he fell apart.
“I was suicidal for about five years, horribly suicidal for five years, pretty much couldn’t be left alone,” Walt said. “So my wife didn’t work. She had to be here with me.”
School is difficult, but medications are helping. Joe hopes someday to design video games.
“Especially for bipolar disorder, you can’t give up,” Joe said. “But you’ve got to keep pushing through.”
He is grateful for the acceptance he has from friends.
“It’s hard for them to understand, but for them to still be my friend, it was awesome,” Joe said. “Sometimes I get mad and they deal with that, my friends. They’re just there for me.”
These families share a great deal of love and acceptance. They still face challenges, but mental illness does not define them.
“As we came to understand about mental illness and the treatments that are available, we saw that there was hope as well,” Sherri Wittwer said.
Finding help for mental illness …
Article Date: 09 Nov 2010 – 15:00 PST – From Medical News Today…
A considerable number of Americans are trapped in a vicious cycle of unhealthy attempts to manage their high levels of stress, which limits their ability to make beneficial behavioral or lifestyle changes. 2010 Stress in America, a new study released by the American Psychological Association cautions that the impact of long-term (chronic) stress can leave serious physical and emotional consequences for individuals and their families.
A 2010 Harris Interactive survey reveals that many people, especially those who believe they are in fair or poor health, claim to lack the willpower and opportunity to make useful changes that would improve their lives.
Parents also appear to be unaware of the effect the stress they have to bear is having on their children. A growing number of young children are describing emotional and health consequences typically linked to stress.
Norman B. Anderson, PhD, American Psychological Association’s (APA’s) chief executive officer and executive vice president, said:
America is at a critical crossroads when it comes to stress and our health. Year after year nearly three-quarters of Americans say they experience stress at levels that exceed what they define as healthy, putting themselves at risk for developing chronic illnesses such as heart disease, diabetes and depression.
Stress is hurting our physical and emotional health and contributing to some of the leading causes of death in this country. People are also saying they have difficulty implementing the changes they know will decrease their stress and improve their health. Yet, our health care system is not adequately addressing this issue or providing the behavioral health treatments that can help Americans. All of us, including the medical community, need to take stress seriously since stress could easily become our next public health crisis.
The impact on children
Overweight or obese children were found to have significantly higher incidences of stress; most said their parents were always or often stressed four weeks prior to being surveyed. This link between overweight/obesity and stress also exists among adults.
31% of overweight/obese children worry a great deal or a lot, while 14% of children of normal body weight do the same. 36% of overweight/obese children worry about their looks, compared to 11% of normal-weight kids.
39% of overweight/obese children say their parents are stressed out often or always, compared to 30% of normal-weight kids.
The survey identified a clear link between overweight in children and physical/emotional health consequences linked to stress, and the unhealthy management of stress. When asked whether they had experienced any of the following during the previous twelve months, this is how they responded:
- Have you had trouble falling asleep?
Overweight children 48%. Normal weight children 33%.
- Do you get headaches?
Overweight children 43%. Normal weight children 28%.
- Have you been eating too much or too little?
Overweight children 48%. Normal weight children 16%.
- Have you been feeling angry or getting into fights?
Overweight children 22%. Normal weight children 13%.
- Do you eat to make yourself feel better when you are stressed or worried about something?
Overweight children 27%. Normal weight children 14%.
- Do you take a nap to make yourself feel better when you are stressed or worried about something?
Overweight children 26%. Normal weight children 15%.
The effect stress is having on families
When asked to rate their levels of stress from nothing (0) to maximum (10), 32% of parents rated theirs at 8 to 10, what the authors of the report describe as extreme levels of stress. The vast majority of parents say they are enduring levels of stress which go beyond their definition of healthy. The average stress score reported by all parents in the survey was 6.1. Those who described their stress levels as healthy scored an average of 3.9.
More than a third of patients rely solely on them to treat psychiatric conditions as the number of psychiatrists fails to keep pace with demand.
By Christine S. Moyer, amednews staff. Posted Oct. 25, 2010.
As an internist, Charles Cutler, MD, was trained primarily to detect and treat physical problems. But he sees many patients for mental health issues at his practice in Norristown, Pa.
Because psychiatrists in the area frequently do not have openings for new patients, Dr. Cutler often provides mental health treatment.
He is among a growing number of primary care physicians who say they are handling a greater load of mental health care. A report from the Center for American Progress, a public policy and advocacy organization, shows that more than a third of patients who receive treatment for mental health disorders rely solely on primary care physicians.
“A key part of primary care is an awareness of the need to provide mental health services to your patients. If you’re doing primary care and you’re not aware of that, you’re in the wrong field,” Dr. Cutler said.
Although treating psychiatric conditions in primary care is not new, the amount of cases physicians are seeing is increasing, said Thomas Wise, MD, medical director of behavioral health services at Inova Health System in Falls Church, Va.
One reason for the trend is that there are too few psychiatrists to meet the nation’s mental health needs, doctors say. In the past decade, the number of practicing psychiatrists has grown from 39,494 to 40,904 — an uptick of only 1,410, according to 2010 data from the American Medical Association’s Physician Characteristics and Distribution in the U.S. The figure does not include specialists in child and adolescent psychiatry.
Although the number of psychiatrists has increased, the supply is not keeping pace with the demand for such specialists, said Steven Schlozman, MD, an assistant professor of psychiatry at Harvard Medical School in Boston. Too few students pursue psychiatry, in part, because the specialty typically requires four additional years of training after medical school — more if doctors pursue child and adolescent psychiatry, he said.
In addition, psychiatrists often are disproportionately spread across the country, with a majority practicing in urban areas. And there is a stigma attached to psychiatry by some patients who may feel more comfortable seeing a primary care doctor for mental health issues.
Prevalence of mental illness
Nearly one in 10 Americans 18 and older is depressed, according to a Centers for Disease Control and Prevention study in the Oct. 1 Morbidity and Mortality Weekly Report. One in four adults has a diagnosable mental disorder in any given year, according to the National Institute of Mental Health.
When a psychiatric issue is identified, primary care doctors have limited options for referring patients to specialists due to the shortage of mental health professionals, particularly child and adolescent psychiatrists, Dr. Schlozman said.
Additionally, many health insurers contract out psychiatric benefits to different companies. Unlike most referrals from physicians, this approach often requires patients to find an available psychiatrist by making calls from a list provided by their insurer.
“This makes it immensely more difficult for patients to get care,” Dr. Schlozman said.
Another problem is that some primary care physicians lack the training and appropriate amount of time to successfully treat mental problems, experts said. The result is that some mental disorders are going undiagnosed.
With mental illness affecting all ages and experienced by many with chronic conditions, the impact is great. “This is not something we can ignore,” said Lesley Russell, PhD, a visiting fellow at the Center for American Progress.
In October, the center issued a report on mental health care services in primary care. The report said more primary care doctors are treating mental health problems, but the quality of treatment is uneven, because many conditions are going unrecognized and untreated. Only a third of cases seen by primary care doctors received minimally adequate care, the report said.
Improving mental health care
To ensure that patients with mental health issues do not go untreated, the U.S. Preventive Services Task Force in 2009 recommended that physicians screen adults for depression when there is a support system in place to ensure “accurate diagnosis, effective treatment and follow-up.”
Physician organizations, such as the American College of Preventive Medicine, also have issued depression guidelines for doctors to use. In 2009, the college recommended that primary care doctors screen all adult patients for depression.
In October, the American Psychiatric Assn. issued new clinical guidelines for patients with major depressive disorder, updating its 2000 guidelines. The guidance includes new evidence-based recommendations on antidepressants, depression-focused psychotherapies and strategies for treatment-resistant depression.
In the primary care setting, physicians should look for signs of mental health problems, such as trouble sleeping and eating, experts say. In children, doctors should look for atypical behavior that begins suddenly, such as irritability or a drop in grades with a good student, said Ulrick Vieux, DO, medical director of Children’s Community Mental Health Services at St. Luke’s and Roosevelt Hospitals in New York.
Daniel Yohanna, MD, vice chair of the Dept. of Psychiatry and Behavioral Neuroscience at the University of Chicago Medical Center, encourages physicians to attend mental health lectures at medical conferences. He also recommends that primary care doctors modify their practices so staff members can consult mental health specialists easily when they identify patients with psychiatric issues.
Russell, of the Center for American Progress, said some barriers to receiving mental health care will be reduced by the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. The law, which took effect Jan. 1, prohibits group insurance plans from restricting access to mental health care by limiting benefits and requiring higher patient costs than for general medical or surgical benefits.
Dr. Yohanna said telemedicine, such as video conferencing, might help physicians connect with child psychiatrists to evaluate a patient. Despite the benefits of the health parity law, challenges will remain for primary care physicians, he said.
“It’s true that most of the people with psychiatric disorders are seen in primary care,” Dr. Yohanna said. “It’s up to [psychiatrists] to figure out ways to assist them, because we’re not going to put a psychiatrist in every county.”
“Mental Health Care Services in Primary Care: Tackling the Issues in the Context of Health Care Reform,” Center for American Progress, Oct. 4 (www.americanprogress.org/issues/2010/10/pdf/mentalhealth.pdf)
“Current Depression Among Adults — United States, 2006 and 2008,” Morbidity and Mortality Weekly Report, Oct. 1 (www.cdc.gov/mmwr/preview/mmwrhtml/mm5938a2.htm)
“Practice Guideline for the Treatment of Patients with Major Depressive Disorder,” American Psychiatric Assn., October (www.psych.org/guidelines/mdd2010)
Centers for Disease Control and Prevention’s Mental Health Work Group (www.cdc.gov/mentalhealth)
Colleagues, acquaintances, e-patients, media and others often ask me, “What’s the state of online therapy? Does it have a future?” My answer hasn’t changed significantly in the past decade, for good reason — very little has changed in the field.
For folks who may be unawares, I’ve been a part of the mental health landscape and online therapy since the early 1990s, and e-therapy specifically when it started to hit the scene hard in the late 1990s. In fact, I coined the term “e-therapy” to describe online psychotherapy — a specific modality of psychotherapy that utilizes many techniques and features of traditional face-to-face psychotherapy. In 1999, I joined an e-therapy startup — HelpHorizons.com — as the industry’s youngest COO and led that company to a successful acquisition years later.
There’s no dearth of professionals willing to give e-therapy a try. In fact, when we ran HelpHorizons in the early 2000s, we had over 1,000 professionals at one point who signed up for the service.
What we lacked were people who actually utilized or wanted to utilize the service. And that’s the key problem with online psychotherapy: It’s a great modality that few consumers actually want to use.
One way around this problem, from a business perspective, is to simply get health or employee insurance plans to sign up for an e-therapy service based upon offering this as an “added benefit” for employees or covered lives in the plan. The idea is simple — if X% of insured lives use online therapy over face-to-face therapy, it’ll save the insurance company some money (because typically e-therapy is a little less expensive than traditional psychotherapy — but not significantly so when practiced via live chat or video conferencing services like Skype).
The problem comes when the rubber meets the road. If you look at utilization rates of people who actually use e-therapy services, they’re frightening. Nobody uses it. Nobody cares for it. Okay, that’s an exaggeration, because obviously e-therapy is right for some small percentage of people who need or want psychotherapy services. But the important thing is that it’s neither right nor used by the vast majority of people who have access to it. Once insurance companies review the utilization rates, they cancel the contract. If nobody is using the service, what’s the point of offering it?
Over the years, I’ve talked with dozens of people who’ve tried out e-therapy. I always ask them the same question, “Why did you stop?” Two factors have emerged — cost and face-to-face is more authentic a therapy experience.
People don’t like to pay for services online, unless it is helping them in a game (think Farmville, Cityville or Second Life), or to buy a subscription to an established information source. Even that bastion of pay-for-service model — porn — has given way to free porn. Nobody pays for porn any more, which has devastated the porn industry (or so I hear!). Nobody pays for advice either (since there are hundreds of places you can get free advice online, including our own Ask the Therapist service, and Psych Central Answers).
So all that leaves is paying for a real therapy interaction.
Well, that’s cool — there are some people willing to do that. And many therapists willing to provide that. But when you look at things like cost, you find out that you can see a real therapist face-to-face for either less (because your insurance covers the majority of the cost of care) or just a little more (if you choose to pay out of your own pocket). And trust me, when it comes time for mental health treatment, there is something definitely reassuring in talking to another human being in the same room with you.
Which is the other reason that people stopped with e-therapy service. They used it for a short-term problem, and didn’t need it any longer. Or it showed them that what they really needed was to see a real therapist, face-to-face. The feedback I’ve gotten is that while online therapy can be rewarding and reassuring, it doesn’t compare with the authenticity (at this point, anyway) of a face-to-face therapy interaction.
Additionally, many of the benefits of e-therapy quickly lose their status when you move e-therapy from asynchronous communications (two people are logged on at different times) — secure email, for instance — to synchronous communications (two people must be logged on at the same time). Once you require a therapist to spend the same amount of time talking to you online (whether it’s through Skype, chat room, or text messaging), the therapist is going to charge similar amounts of money as they do for face-to-face sessions. So one of the primary benefits of online therapy in the past — reduced cost, whenever-I-want convenience — flies out the door.
“If I have to schedule my online session just as I schedule a face-to-face session with a real-life therapist, I might as well see the real-life therapist,” is what I often hear. Which is what the vast majority of folks do when confronted with the actual costs and inconvenience of real-time, synchronous online therapy. Add to that that most insurance companies still do not cover the cost of online sessions, then it’s a no brainer. Face-to-face, traditional psychotherapy is often less expensive and more emotionally fulfilling than a comparable online therapy session.
Sometimes it’s hard for a businessperson who doesn’t have a deep background in mental health reimbursement to see the realities and complexities of behavioral healthcare in the U.S. Some appear to have the naive belief they can change a marketplace overnight that’s been formed through decades’ worth of existing treatment, mental health policy and administration, politics, budgets and reimbursement schedules. That a TV commercial and a mention in the The New York Times is all it takes.
Mental health professionals who’ve spent any time actually working and getting reimbursed within the current system know how difficult and convoluted the system really is. Billionaire and AOL founder Steve Case thought it would just take some technology and gumption to change healthcare in the U.S. when he launched Revolution Health in 2004. A few years later, disillusioned, he sold the remnants of his company to Everyday Health.
Healthcare in the U.S. isn’t going to change quickly — or overnight. The ObamaCare bill and Mental Health Parity Act don’t really do much to change the playing field when it comes to online therapy. And there still has been little demand for online therapy from consumers, because they don’t see a cost-benefit ratio that makes sense to them. Media hype notwithstanding, this particular application of telehealth makes the most sense for people who live in rural areas and can’t get to see a therapist locally. That’s a good market, but a small one.
I have a lot of hope for the future of e-therapy making small inroads into the mental health treatment space over time. But this part of telehealth is the least interesting right now from a business perspective because the consumer demand remains extremely limited.
Decision allows 9,000 members to maintain care.
By Milton D. Carrero, OF THE MORNING CALL
11:19 p.m. EST, January 7, 2011
Capital Blue Cross members who struggled over the holidays to get mental health coverage now have a reason to celebrate.
After reviewing 2008 federal rules, Capital Blue Cross has reinstated its mental health care benefits for individual plans, a move that enables 9,000 members to continue with their doctor’s appointments, therapy and medications.
The insurance company will maintain its current behavioral coverage for the same price, according to Cindy Hatcher, senior director of individual products at Capital Blue Cross.
From my perspective, we are really glad that we can help our members and that we can come to this resolution,” Hatcher said Friday.
The company caused commotion among members last month when it announced it would discontinue behavioral coverage this year due to financial concerns. The decision forced thousands to scramble during the holiday season to find a new provider, which proved nearly impossible.
James Jordan, executive director of the Pennsylvania National Alliance on Mental Illness, was concerned that the decision could cause people who would normally lead productive lives to go into crisis. He requested an emergency meeting with Capital Blue Cross.
After the meeting, the company decided to extend its existing coverage until the end of February. In the meantime, the insurer promised to review whether it was viable to keep mental health coverage after the extension.
On Friday, Capital Blue Cross announced its decision to reinstate its current mental health coverage.
The Mental Health Parity and Addiction Equity Act, signed in 2008, requires insurers to provide the same level of benefits for mental illness or substance abuse as for other physical disorders and diseases.
Hatcher said the company was originally under the impression it would need to expand its mental health care to meet the demands of the law. The additional coverage would have forced Capital Blue Cross to increase premiums by 10 percent on top of the 9.9 percent hike that was already expected for this year.
Afraid that members would not be able to afford the coverage, the company chose to eliminate mental health care from its individual plans.
“We believed that we had to provide mental health parity,” Hatcher said. “As we looked at the multiple interpretations of the law, we became comfortable with an interpretation that said that mental parity did not apply for individual plans.”
Members need not wait to receive a new health care identification card. The current card will continue to be valid.
Those affected were quick to show their relief, even though the official notifications have not yet arrived.
“I’m very grateful that Capital Blue Cross responded reasonably to our concerns,” said a member who lives in Northampton County and suffers from reactive depression. “I don’t feel so stigmatized by the insurance industry any more. I feel that Blue Cross’ motto of ‘We do more because we care more’ is a little bit more true now.”