May 20th Political Action Meeting
Psychoanalysis urgently needs our help now. Two pieces of major health legislation, the national computerized record system and “mental health parity,” are in the regulation-writing stage, when government officials decide on the details for a bill’s implementation. As we all know, it’s in such details that the devil resides. Due to our proximity to the federal government, we have the opportunity, and the responsibility, to influence this process.
The national computerized record system (“health information technology” or HIT) and the mental health parity bill will have a major impact on psychoanalysis and psychoanalytic therapy. The Obama administration plans to move fast on a national health insurance program. Private programs will model themselves on the bellwether federal program. So regulations that initially may apply only to Medicare/Medicaid will soon apply to all mental health treatment. How the HIT and parity regulations turn out could strengthen psychoanalysis or speed its decline.
From our experience working with Jim Pyles, the lobbyist of the American Psychoanalytic Association, we’ve learned we can actually make a difference with key decision-makers. Jim knows the relevant areas of the law and he eloquently states the public policy arguments that support our goals. But we can’t “leave it to George,” or Jim. He works three times as many hours as his modest APsaA retainer covers, with barely any help from the other therapist organizations. In contrast, the IT and Insurance juggernauts spend millions on lobbying and “contributions.”
The situation is far from hopeless. But it will take our personal efforts to level the playing field and enable us to win. Jim has found that clinicians, armed with professional authority and a vivid, first-person anecdote or two, get through to members of Congress and staffers in ways that he cannot. In response to clinician input, staffers have inserted key phrases into bills that have greatly affected their impact. Such clinician input helped get vital privacy protections into the recent health information technology (HIT) part of the “stimulus bill.”
This HIT law contains privacy protections which are crucial to psychoanalytic therapy, but the regulation-writing process could erode these protections. We can help preserve psychoanalytic therapy by showing decision makers why such therapy is inconceivable without total privacy.
Reports indicate that the so-called “mental health parity” law applies only to tightly “managed care.” This triage system would continue to shut out psychoanalytic therapy unless regulations allow for its selective inclusion. While the HIT regulations are on a faster track and require our attention first, we could soon need to help with parity, making the case that for some individuals, access to psychoanalytic therapy is necessary.
President Obama’s autobiography shows that he intuitively reflects on how his past has shaped who he is. And he has shown a remarkable capacity to listen. Some of his key appointees seem to share his sensibility. Not since JFK has there been such a window of opportunity for advancing mental health generally, and psychoanalytic therapies, in particular. We must not let this opportunity go to waste.
Jim Pyles will lead a training workshop for clinicians to learn the key issues, the key players, and the key arguments we need to make. If you participate in this event, you would be prepared to help, in response to Jim’s call, and as your schedule permits.
The workshop will take place on Wednesday, May 20, 12-1:30 p.m. in the conference room of the Washington Center for Psychoanalysis, 4545 42nd Street, #209, NW, Washington, DC.
Please rsvp to 202-237-1854 or center@washpsa.org
This post was submitted by Michael Nizankiewicz.
I am also quite concerned about how so-called “parity” is actually going to play out. I know the insurance industry will not take it lying down. I expect their first line of attack will be to bring lots more attention to the question of “medical necessity,” demanding great, and more frequent, documentation of the “necessity” of the treatment and probably even challenging any kind of treatment except their current favorites, CBT and DBT. And, of course, MORE DRUGS! (Don’t forget, the insurance industry and the pharmaceutical industry scratch each other’s backs when it comes to mental health treatments!) Forget anything remotely psychoanalytic! I think we need to focus on this business of “medical necessity” very quickly and try to block them from using it to (1) limit treatment, (2) overwhelm us with paperwork, (3) further undermine any modality except the cognitive/behavioral ones, (4) reduce our payments even further if we practice anything except CBT-ish modalities, etc. BTW, I’m sure you know that the community of clinical social workers is vastly larger than any other mental health treatment community AND that many of us practice from a psychoanalytic theoretical perspective (even if we don’t, strictly speaking, practice analysis). Any effort to influence the regs to protect the broad range of treatment modalities should definitely involve clinical social workers (though I wonder if NASW, being the conservative org. it is, will get involved). I’m sorry I can’t attend the 5-20 meeting but want to keep abreast of things. Can we outsmart this tsunami??!!