Our Mental Health - Buddy, I Think You Need Professional Help

Psychiatrists had an estimated 37.6 million office visits in 1989-1990. Who goes to therapy? Why?

Those between the ages of 25-64 made up over three quarters of the visitors to psychiatrist offices for the period shown. In short, many people who seek counseling tend to be of the Baby Boom generation — sometimes unkindly labeled the "me" generation. Their rates for 25-44 year olds and 45-64 year olds were fairly comparable, with the older segment seeing a slightly higher rate: 11.4 visits per 100 people for those aged 25-44 and 12.8 visits per 100 people for those aged 45-64.

59.1% of the visits were made by women and 40.9% by men. The willingness of women to talk about their feelings seems to be a rather clear distinction between the sexes. This gender gap has changed little over the decades; in 1975-76, the split was 60.1 and 39.9%. Patients are also overwhelmingly white. Whites make up more than 95% of visitors.

What was the top reason cited for seeking professional help? Depression topped the list; 36.8% of men and women cited depression as their motivation. Anxiety or nervousness was the second most popular reason (13.4% of cases); more than 8 million visits were made to psychiatrists for these reasons. In looking at the age groups, it's easy to guess potential reasons for the visits: those 25-44 years old are starting their adult lives, getting married, having children, climbing the corporate ladder. Those 45-64 may be coping with the flip side: a divorce, a job loss, the death of a loved one, or handling a seriously ill parent.

One curious statistic: an additional 4 million visits were made to physicians other than psychiatrists for the treatment of depression and anxiety. Indeed, in the panel called Depressing Statistics (Chapter 2), we saw the rise in doctor visits for the treatment of depression. These visits coincide with the rise of Prozac and other mood altering medications. Were these patients prescribed medication when they should have really received counseling? The mental health industry has argued that antidepressants and similar drugs — now a billion dollar industry — merely change a patient's symptoms, not the reason for them.

How do we feel about therapy? Some of its stigma is gone, certainly. A generation of us have come of age listening to psychologists and self-help gurus like Dr. Joyce Brothers, Oprah Winfrey, Phil Donahue, and Dr. Sonya Peterson (Dr. Phil from the Oprah show, is the current rage). But for every nurturer of his or her dysfunctional inner child, there are those who shake their head at the psychobabble. In an American Demographics survey of 1,000 adults, 19% said psychotherapy was for people with serious psychological disorders, 13% claimed it was a waste of time, and 3% said it was for "the rich and famous."

Money, of course, is a significant issue surrounding therapy: 32% in the poll claimed they had avoided treatment because of the cost. Ivan Miller points out that A National Medical Expenditure Survey found that 45-48% of the money spent on psychotherapy was out of the patient's pocket. The study was done before managed care. However, most insurance companies have some sort of cap on payments for mental health services. A 1997 survey in Psychotherapy Finances found that 44% of therapists' income comes from direct payments from their patients. Is seeking treatment from a counselor just too expensive? The average length of treatment for therapists is about 8 to 11 sessions. But what of those people in need of long-term treatment? Eventually, insurance companies stop paying and the patient must go it alone. Or worse, some insurance companies have tried to dictate treatment for a patient, by urging therapists to move patients to less costly group therapy or to simply prescribe medication for a patient.

Source: Schappert, Susan M. "Office Visits to Psychiatrists: United States, 1989-90." U.S. Department of Health and Human Services, National Ambulatory Medical Survey. Ivan J. Miller, Ph.D. "The Death of Independent Practice Has Been Greatly Exaggerated." Retrieved August 27, 2002 from http://www.nomanagedcare.org; John Fetto. "What Seems to be the Problem?" American Demographics, April 2002, p. 8.