The Cost-Effectiveness of Psychotherapy for the Major Psychiatric Diagnoses

Abstract

Psychotherapy is an effective and often highly cost-effective medical intervention for many serious psychiatric conditions. Psychotherapy can also lead to savings in other medical and societal costs. It is at times the firstline and most important treatment and at other times augments the efficacy of psychotropic medication. Many patients are in need of more prolonged and intensive psychotherapy, including those with personality disorders and those with chronic complex psychiatric conditions often with severe anxiety and depression. Many patients with serious and complex psychiatric illness have experienced severe early life trauma in an atmosphere in which family members or caretakers themselves have serious psychiatric disorders. Children and adolescents with learning disabilities and those with severe psychiatric disorders can also require more than brief treatment. Other diagnostic groups for whom psychotherapy is effective and cost-effective include patients with schizophrenia, anxiety disorders (including posttraumatic stress disorder), depression, and substance abuse. In addition, psychotherapy for the medically ill with concomitant psychiatric illness often lowers medical costs, improves recovery from medical illness, and at times even prolongs life compared to similar patients not given psychotherapy. While "cost-effective" treatments can yield savings in healthcare costs, disability claims, and other societal costs, "cost-effective" by no means translates to "cheap" but instead describes treatments that are clinically effective and provided at a cost that is considered reasonable given the benefit they provide, even if the treatments increase direct expenses. In the current insurance climate in which Mental Health Parity is the law, insurers nonetheless often use their own non-research and non-clinically based medical necessity guidelines to subvert it and limit access to appropriate psychotherapeutic treatments. Many patients, especially those who need extended and intensive psychotherapy, are at risk of receiving substandard care due to inadequate insurance reimbursement. These patients remain vulnerable to residual illness and the concomitant sequelae in lost productivity, dysfunctional interpersonal and family relationships, comorbidity including increased medical and surgical services, and increased mortality.

Obstacles to Early Career Psychiatrists Practicing Psychotherapy

“…It describes the new field of neuropsychoanalysis showing how some of Freud's theories about mental processes anticipated new discoveries in neuroscience (McGowan, 2014)-a perspective voiced in recent years by Nobelprize winning neuroscientist Eric Kandel (1998Kandel ( , 2013. Furthermore, powerful evidence supports the cost-effectiveness of psychotherapy (Lazar, 2010;Lazar et al, 2014a, this issue) with particular importance for work, depression, and the workplace (Sledge & Lazar, 2014, this issue). The alarming rise of suicide and mental disorders in the military and in veterans highlights a pressing need for more psychotherapeutically skilled psychotherapists for that cohort (Lazar, 2014b, this issue).…”

Introduction to the Special Issue on Psychotherapy, the Affordable Care Act, and Mental Health Parity: Obstacles to Implementation

“…Mental disorders are the leading cause of disability in the U.S. When they co-occur with physical disorders, they increase the cost of medical/surgical care (Lazar, 2014). Psychological problems are often stigmatized leading many people to avoid seeking help from professionals.…”

“…Far too frequently insurance companies ration mental health care without possessing and/or using knowledge to be able to do so responsibly. Compliance with parity legislation is often avoided and even evaded (Bendat, 2014;Lazar, 2014). Sometimes the goals of insurance companies, patients, and psychiatrists are aligned.…”

“…Because the patient population is diverse however, there are a number of situations in which it is in the patients' best interest for psychiatrists to carry out psychotherapy. It is helpful to keep in mind for example that the evidence for therapeutic effect of psychotherapy without medication in the treatment of many types of depression is as good as or better than the therapeutic effect of medication without psychotherapy (Lazar, 2014;Nemeroff, Helm, Thase et al, 2003;Sledge, 2014). Most patients can be best helped through application of a paradigm in which biological-psychological and social influences interact with each other in health and illness.…”

How OECD health systems define the range of good and services to be financed collectively

“…Psychological therapies are considered cost-effective if provided by adequately trained professionals in appropriate settings, with the intensity and length of interventions which are tailored to the level of complexities of individual patients with mental illness. Psychotherapy may also lead to savings in other medical and societal costs and are at least as effective as antidepressants (Lazar S. 2014;NICE, 2009;Bedi et al, 2000). Individuals prefer psychological or talking therapies to medication when they are given the choice (OECD, 2014).…”