The cost-effectiveness of psychodynamic psychotherapy, the patients who need it, and obstacles to its provision

Ontario Psychiatric Association 2021. Psychotherapy Conference

Psychodynamic therapy, including psychoanalysis, is often undervalued by policy makers.  Data substantiating its efficacy, effectiveness, cost-effectiveness and frequent cost-offsets are all too often ignored or dismissed along with the sequelae if it is unavailable to those who most benefit from it.

Difficulties making the case for its medically appropriate insurance support have arisen in different countries in different circumstances. Recently Canada has been struggling with an initiative by its Ministry of Health to limit psychotherapy sessions to 24 (48 units) per year.  The arguments include the assertion that psychiatrists providing intensive and extended psychotherapy contribute to a lack of access to psychiatric care by limiting their patient load.  Another argument is that practice patterns in rural and lower socio-economic areas with fewer psychiatrists and less frequent visits per patient are closer to an acceptable norm compared to cities where a larger percentage of patients are treated with more intensive and extended psychotherapy.  A third argument is fueled by the stigmatizing assumption that more intensive psychotherapy is unneeded, is elective, and is accessed by “the worried well.”

Research studies, especially those measuring cost-effectiveness, give a very different picture of the needs of chronically ill psychiatric patients who require more than 24 visits per year.  While validated extended psychotherapies of different approaches are helpful, patients treated with psychodynamic therapies experience not only lowered disability and overall medical costs but also achieve improved interpersonal functioning, more sustained recovery, and frequently increasing psychological health even years after treatment has concluded.

In addition, despite pressures for non-medical practitioners to be the sole providers of psychotherapy, there is a crucial place for psychiatrists to be not merely diagnosticians but also the only psychotherapists who have the training to make a fuller ongoing differential diagnosis of medical contributors to their patients’ mental illness.

LEARNING OBJECTIVES

Attendees should learn in detail:

1. the cost-effectiveness research data to support the need for extended dynamic psychotherapy;
2. the cohort of patients who need it preferentially over less intensive treatments;
3. the obstacles to its provision primarily by inaccurate insurance “medically appropriate” guidelines that overlook the necessity for extended psychodynamic therapy and psychoanalysis.

Open to non-OPA members

REGISTRATION: https://www.eopa.ca/events/202...rapy-conference-2021

About the Speaker

Susan G. Lazar, MD, has presented and published widely on the cost-effectiveness of psychotherapy, including the  special place for psychodynamic therapy, in book chapters, articles including co-authoring  a 1997 American Journal of Psychiatry cover article The Economic Impact of Psychotherapy: A Review, two edited and co-authored special issues of psychiatric journals including the Psychoanalytic Inquiry 1997 supplement Extended Dynamic Psychotherapy: Making the Case in an Era of Managed Care, the Psychodynamic Psychiatry 2014 special issue Psychotherapy, The Affordable Care Act, and Mental Health Parity: Obstacles to Implementation, a volume she edited and co-authored, Psychotherapy Is Worth It: A Comprehensive Review of Its Cost-Effectiveness, and the 2018 article The Place for Psychodynamic Therapy and Obstacles to Its Provision in Psychiatric Clinics of North America. She chaired the group that formed The Coalition for Psychotherapy Parity and co-authored its document Clinical Necessity Guidelines for Psychotherapy, Insurance Medical Necessity and Utilization Review Protocols, and Mental Health Parity which is available on the website of the Coalition, psychotherapyparity.org.

Dr. Lazar served as a consultant to The Mental Health Work Group of The White House Task Force for Health Care Reform in the Clinton administration and was instrumental in the inclusion of psychotherapy as a medically covered service without arbitrary limitation in the bills offered to Congress at that time. She is a Supervising and Training Analyst at The Washington Baltimore Psychoanalytic Society and Clinical Professor of Psychiatry at The George Washington University School of Medicine and The Uniformed Services University of the Health Sciences, Member and former Chair of The Committee on Psychotherapy at The Group for the Advancement of Psychiatry (GAP), Member of the American College of Psychiatrists, and Distinguished Life Fellow of the American Psychiatric Association.