Legislative Update

As Congress and the White House debate meaningful health care reform, NAAP impacts discussion on expanding mental health services

Over 500 amendments were offered to the health care reform bill recently considered and voted on by the US Senate Finance Committee. Among those amendments to the America’s Healthy Future Act of 2009, one – technically referred to as Senator Blanche Lincoln’s D3 Finance Amendment – would have provided Medicare reimbursement for treatment provided by mental health counselors and marriage and family therapists. This amendment did not pass.

While NAAP supports the idea behind this effort and applauds Senator Lincoln for her commitment to expanding the range of mental health services available to our neighbors across the country, we continue to highlight that proposals not including Psychoanalysts are incomplete.

Psychoanalysis holds a place in the history of mental health care spanning over 100 years and has been sought out as a modality of treatment by consumers throughout the U.S. It should continue to be a choice of mental health care available to consumers in parity with other forms of recognized mental health treatment. As such, we maintain that it is necessary, fair and appropriate for any legislation seeking to include new mental health professionals into the range of services available to consumers of federal programs, including Veteran’s Medical Benefits and Medicare, to include Psychoanalysts.

The above is precisely the message NAAP has been sharing with Senators from throughout the country. Senators Lincoln, Schumer, Gillibrand, Durbin, Boxer, Nelson (of Florida), Kerry, and Casey, Jr., and their health aides, immediately grasped the issue and committed to engage us as we all move forward to repair our health care system. In fact, many offices we have been speaking with now know that efforts to include just some mental health professions without referencing all appropriate ones were projects based on an incomplete presentation of the variety and diversity of this important treatment space.

For the mental health care consumer, it is obvious that the availability of Psychoanalysis – a national profession -- as a reimbursable mental healthcare option expands choice and imposes the needed economic limitations on escalating fees that occur in the absence of competition. This is especially relevant now since cost and accessibility is driving so much of recent policy debates, including imminent reconciliation of competing reform bills.

NAAP will continue to be a forceful advocate for our shared priorities. Please do not hesitate to contact us with any comments, questions, suggestions, or concerns.


legislation and psychoanalysis

In the history of mental health care, psychoanalysis holds a place that spans over 100 years and is sought out as a modality of treatment by consumers throughout the United States and numerous other countries.

Psychoanalysis should continue to be a choice of care available to consumers in parity with other forms of recognized mental health treatment. As such, we maintain that it is necessary, fair, and appropriate to advance legislation seeking to include Psychoanalysis in the range of services available to consumers of federal reimbursement programs, including Veterans' Medical Benefits and Medicare.

In 2002, New York State established four new mental health licenses under the same licensing statute, bringing within the regulatory ambit of the state Licensed Mental Health Counselors, Licensed Psychoanalysts, Licensed Marriage & Family Therapists, and Licensed Creative Arts Therapists. Each of these new licensed professions are held to the same ethical and professional standards as existing licensed health care professionals, meaning that they are subject to oversight and monitoring and, when in violation, subject to disciplinary action. New York State did not differentiate among or between any of the four licenses with respect to professional obligations and requirements.

Recent federal bills, specifically some proposals expanding lower-income family access to basic health care services, made first steps towards incorporating some of the foregoing group of four mental health licenses into federal reimbursement structures. However, these efforts were dangerously incomplete in that the bills only included Licensed Marriage & Family Counselors and Licensed Mental Health Counselors.

Common sense guides the current effort seeking inclusion of the entire group of four licenses in federal reimbursement structures. New York State has effectively spoken unequivocally in favor of parity among the four licenses, but sound public policy also bears this out. For the mental health care consumer, it is axiomatic that the availability of psychoanalysis as a reimbursable mental health care option expands choice and imposes the needed economic limitations on escalating fees that occur in the absence of competition.

The training for psychoanalysis is rigorous. One must possess a minimum of a master's degree in order to matriculate in an accredited institute for psychoanalytic training. The first two years of institute training is the equivalent to a master's degree in mental health. Candidates who matriculate into a Psychoanalytic Training Program must undergo an extensive assessment stage in which they are evaluated for their readiness to assume training responsibilities with client populations. Candidates pursue a minimum of 4 years of coursework in combination with supervised clinical practice. Additionally, candidates must undergo their own personal analyses. This additional feature of psychoanalytic training is unique among the mental health training models and is regarded as central in the preparation of candidates for undertaking the rigorous process of conducting an analysis.

The contribution that psychoanalysis makes, and its current relevance to the mental health care consumer, is clear: Psychoanalysis offers the only treatment in which permanent structural change can be brought about in individual functioning across a broad spectrum. This has a few important consequences. Given its high success rate and low recidivism rate, psychoanalysis has a proven record in providing successful mental health treatment. (As recently as October 2008, JAMA reported that in a large-scale meta analysis of 23 previously published studies on the efficacy of psychodynamic therapy--a form of psychoanalysis--it was very effective, especially in complex cases. . This is compared to the more minimal protective effects of cognitive behavioral treatment, for example, whose efficacy is shown to fade in a four-year follow-up. See Six-Year Outcome for Cognitive Behavioral Treatment of Residual Symptoms in Major Depression, American Journal of Psychiatry, 155:1443-1445, 1998)

Federal legislation seeking to expand treatment options available to mental health patients must include Psychoanalysis. It is a matter of patient choice, of fairness, and of common sense.