Society Mental Health and Welfare

¶ … Mental Health, and Welfare

Society, mental health and welfare:

A problem related to counseling (under-insurance) and a social problem (the lack of adequate healthcare coverage)

The course text Social action: A mandate for counselors discusses the ethical implications of such issues as race and social injustice in the counseling profession. However, perhaps even more important than these factors is the issue of class, specifically the affordability of counseling on an individual basis. Wealthier individuals with better insurance or who can afford to pay 'pout of pocket' often have the luxury of 'talk' therapy that poorer people, or people without adequate health insurance, lack. This creates a 'haves' versus 'have not' situation in terms of the availability and the quality of counseling. Poorer individuals with minimal insurance coverage for mental health care are often offered fewer counseling sessions, or have their psychological complaints treated as medical disorders, rather than fully addressed with therapy as well as drug treatment.

Despite the fact that most studies suggest that for depression and most psychological complaints, therapy in conjunction with psychopharmacology is a far more effective approach, because of insurance coverage many therapists have switched from treating patients with counseling to drugs: "in large part because of changes in how much insurance will pay" and instead prescribe "medication, usually after a brief consultation with each patient" (Harris 2011:1). Only patients who can pay for therapy have access to more than a few sessions. Even when patients have insurance that will pay for a few sessions with a therapist, the duration of time the therapist has with the client is relatively brief, and time pressures affect the course of the therapy. Instead of exploring deeper issues, the therapist may focus on goal-oriented, cognitive behavioral therapy to eliminate the superficial aspects of the behavior, without probing deeper.

In terms of creating social change, the most effective ways to reach under-served populations may be in organizational, rather than individual settings, such as schools. Counselors will confront individuals from a wide range of backgrounds and of different socio-economic status. Still, while this can be helpful in encouraging the profession to take a more multicultural approach to therapy, it also means that because of their socioeconomic conditions, many persons who could potentially benefit from individual therapy will not have access to it. In fact, some might even argue that people who could most benefit from having an objective, trained counselor to talk to are those who have the least time and money to enjoy such privileges -- given that not even purely physical medical care in the United States is regarded as a right. Of course, "there are thousands of psychiatrists who still offer talk therapy to all their patients, but they care mostly for the worried wealthy who pay in cash. In New York City, for instance, a select group of psychiatrists charge $600 or more per hour to treat investment bankers, and top child psychiatrists charge $2,000 and more for initial evaluations" (Harris 2011:2).