The State of Psychiatric Care in the U.S.

To the editor:

Kelli Maria Korducki (It's not just a chemical imbalance, 7.27.19) rightly laments the state of psychiatric care with its overemphasis on drug treatment for what are, inevitably, complex psychological problems.  As a psychiatrist and psychoanalyst, I am unaware of any acute psychiatric condition for which drugs alone are adequate.  Excellent research now exists establishing the effectiveness of psychotherapy - alone or in combination with drugs - for most major psychiatric illnesses including personality disorders.  Other studies have shown distinct brain changes with talk therapy; i.e., psychotherapy is a biological treatment.

A major impediment, alluded to by the author, is an insurance industry governed by profits and a perverse misuse of 'medical necessity' criteria to deny patients needed psychotherapy - as evidenced by a finding in a recent class action suit against United Healthcare. Those of us who can work out-of-network do so in an effort to preserve the integrity of our work.  But that does not prevent insurers from aggressively auditing treatments, withholding payments or denying care once a patient is no longer in 'crisis.'  I would say, without exception, this euphemistic  'quality control' always pertains to talk therapy, not medication management.

As the 2020 Presidential election cycle is upon us, I hope candidates will address the for-profit insurance industry's role in intentionally under-insuring those in need of psychotherapy.

Respectfully submitted

Larry S. Sandberg

Clinical Associate Professor of Psychiatry at Weill Cornell Medical College