Is Insurance Holding Mental Health Progress Behind

Insurance companies put mental health professionals in an uncomfortable box. Direct primary care is proving that we don't need insurance to pay for primary care services. Could mental health also use a direct pay model?

Posted by Sarah Agarwal on 2019-08-19

Sarah Agarwal, M.A., Nationally Certified Counselor

Doctoral Student specializing in work with children and families.

Mental Health professionals are caught in a sticky situation. A very moral, ethical sticky situation.

Mental Health professionals have historically used a medical model approach to diagnose clients and determine a proper course of treatment. This medical model focuses more on what is “wrong” with clients, or what is missing. Granted, clients want to know that there are answers to their mental health concerns and that there are evidence-based treatments that have shown progress to aid them in their suffering. But many mental health professionals can’t help but feel that clients are more than a diagnostic label or pathology. Me included.

Now here comes the wellness model. This approach focuses on the whole person, believing that each individual is greater than the sum of their parts. For instance, self-worth, emotional stability, healthy relationships, religion and spirituality, and racial and cultural experiences within a given society may have more impact on a person’s functioning than strictly pathology. How can these factors not be considered or valued within the mental health profession?

So why are mental health professionals still using a medical model approach when the profession as a whole has adopted the wellness model? One word: Billing. You can’t blame mental health professionals for wanting to get paid for services rendered. Third-party payers will only reimburse for services with a specific DSM-5 diagnosis and specified treatment plan for that specific diagnosis. And often times, the third-party payers want this diagnosis after the initial intake session, when the counselor has had no time to assess the client from the wellness model. Mental health professionals need time to understand a client’s deeply rooted areas of identity that foster beliefs about themselves, and clients need a feeling of safety and trust to disclose the parts of self that lead to healing.

Many mental health professionals have to advocate for their clients to receive more services from third-party payers, but have to justify the extra sessions by convincing insurance that the client is still suffering from a diagnosis. Typically, EBPs will only cover an average of 6 sessions with a mental health professional. If the insurance company does not believe the client needs more sessions, then the client will not get more sessions and will have to stop receiving services possibly before the suffering has ceased. Doesn’t this seem like a sticky situation?

So what’s a mental health professional to do? All we want is to focus on the relationship with our clients, and research shows that the therapeutic relationship is the number one factor in predicting positive treatment outcomes. This is something that every mental health professional must decide and struggle with in their careers. How do we provide the best care to our clients and put our clients’ needs first, while also maintaining moral standards and making a living? Maybe it is time we try a new model and see where the evidence takes us.