National health insurance, psychotherapy, and the poor.

Abstract

Debate on psychotherapy coverage under national health insurance has centered around perceived inequitable service to different income groups. It has been argued that national health insurance coverage for psychotherapy would represent a subsidy to the affluent by poorer citizens. Four pertinent hypotheses were examined in a series of studies of patients in community mental health centers. It has been maintained that the poor would not seek psychotherapy, would receive fewer sessions, would receive either less prestigious treatments or less trained therapists, and would benefit less than the more affluent. None of these hypotheses were supported. This article discusses the implications of these findings in terms ofpsychotherapy coverage under national health insurance and the role ofpsychologists in a national system of service delivery.

Patient feedback on satisfaction with direct services received at a community mental health center: A two-year study.

“…To be sure, these data are from one mental health center. They do, however, agree with research conducted by Edwards et al (1979) in a consortium of comprehensive community mental health centers administered by the University of California at Davis in fiscal 76-77, in that the poor benefited as much from psychother-apy as other income groups did. Nevertheless, the results from the present study will also need to be replicated and refined by further studies completed in settings, like community mental health centers, in which the majority of therapeutic services are being delivered.…”

Patient feedback at a community mental health center: Year three.

“…In 1964 Schofield asserted that therapy is most effective with young, attractive, verbal, intelligent, and successful (YAVIS) patients. Research from community mental health centers (Edwards, Greene, Abramowitz, & Davidson, 1979;Kirchner, 1981;Spector & Flores, 1980) indicates that the poor receive the same therapeutic benefits as other groups. Studies from mental health centers may be a step toward a psychotherapy for the poor (Goldstein, 1973).…”

Social class and psychotherapy

“…Hence, the utilization of psychotherapy by the population is not reflected in the utilization of psychotherapy by the patients, and studies in which the "clinical fallacy" is avoided, confirm this (23).…”