Carlton F. "Perk" Clark is a licensed clinical social worker who specializes in psychotherapy and organizational development.

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Use of psychotherapy may be in decline

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The recent Associated Press article on the decline in psychotherapy as a treatment for mental disorders ("Use of psychotherapy may be in decline," Aug. 5) was an important comment on how psychiatrists' practice methods have changed.

It brings to mind Freud's contention that he was creating a profession that would be populated by "neither doctors nor priests."

But the decline probably began back in World War II, when social workers were brought in to do the work of psychiatrists in treating groups of veterans. And the story includes the work of psychologists, who studied perception and conditioned behavior in the '50s and '60s, going on to test and develop such methods as cognitive behavioral, gestalt, and family systems therapies. These trends indeed took the talk therapy off the couch and out of the doctor's office, and brought it into the offices of social workers, psychologists and counselors. At the census year 2000 in Pima County, fully 4,500 people cited their credentials in these three categories and called themselves mental-health professionals.

The final blow to psychotherapy efforts has been managed psychiatric care, introduced by health insurance corporations in Tucson in 1989. We here were at one time "the third most penetrated market in America" for such products. These forms of health insurance radically reduced the number of outpatient psychotherapy visits and slashed the rates of payments for the psychotherapy on the order of 50 percent. Fully half of the private mental hospitals in Tucson closed down.

Some years later, the state of Arizona declared "new" standards for psychotherapists working in state-funded agencies, drastically reducing their academic qualifications, training and clinical supervision. In this way, many formally unqualified "providers" could now be hired to offer "services" to "customers" seen in state settings.

Nationally, published studies documented that mental health care got 9 percent of the health insurance dollar in the 1980s, 5 percent in 1997 and 1.6 percent in 2004. (A decline to 1.6 percent represents an 83 percent decline in funding.)

One might wonder how this plays out in our friendly town.

In the pages of this newspaper, we can see the results. Often they manifest in incidents of violence, where untreated mental illness merges with intoxicants and financial stressors to produce what are headlined as murder or child abuse or rape. Gunfire in the church targeting liberals (depression, paranoia)? Adolescents killing their parents (depression, impulsivity)? Loading up the car with guns, which are then used to kill policemen (schizophrenia)?

I don't mean to "psychologize" every event in life. But most of these suggest that it's community carnage that we trade for costs saved. Lives are ruined and simplistic solutions are suggested, like metal detectors at schools or prescribed drugs for every ailment.

You can let your state representatives, the governor and your workplace (which buys your health insurance) know when you've had enough. You are in a position to bring back the qualified practitioners and psychotherapy as the effective and proven form of treatment that it is.

Let me know when you are finished with this ravaging of mental health treatment and the communities that desperately need it. I am.