MENTAL HEALTH SERVICES
@
BMA
Suite 2100 on second floor
Secretary : Whitney
Tel # 617-864-8822 ext 200
Fax # 617-864-1470
STAFF INCLUDE:
- Nicoletta Coconcea, MD
- Dr Isabel Murphy
- Susan Falkoff, MA, MSW, LICSW
- Manuela McShane, MA, LMHC
- Dr John A. Nichols
- Dr Margaret C. Nichols
Nicoleta Coconcea, MD
SERVICES PROVIDED
-comprehensive psychiatric evaluations for adults 18 and older and geriatric population
-psychopharmacology consultation and management/follow-up for a broad range of disorders (mood disorders, depression, anxiety, PTSD, OCD, bipolar, schizophrenia). When improved, the patient could be followed up by psychiatrist or return under the care of PCP, with as needed consultation
–emergency evaluations and crisis intervention/hospitalization, if needed
-providing information and referral for appropriate community agencies/programs/clinics
-memory evaluation /dementia diagnosis and management
-capacity evaluations/guardianship /medical affidavits for probate court
-psychotherapy/family education
- Dr Coconcea is board certified both in adult psychiatry and geriatric psychiatry by the American Board of Psychiatry
- She is originally from Romania and graduated from medical school in 1986
- Residency Training : Univ Hosp Of Cleveland, Geriatric Psychiatry; Univ Hosp Of Cleveland, Psychiatry
- Secondary Specialty : Geriatric Psychiatry
- She has spent the past 10+ years working as a psychiatrist in Ohio and has now moved east to join our group.
SERVICES PROVIDED
-comprehensive psychiatric evaluations for adults 18 and older and geriatric population
-psychopharmacology consultation and management/follow-up for a broad range of disorders (mood disorders, depression, anxiety, PTSD, OCD, bipolar, schizophrenia). When improved, the patient could be followed up by psychiatrist or return under the care of PCP, with as needed consultation
–emergency evaluations and crisis intervention/hospitalization, if needed
-providing information and referral for appropriate community agencies/programs/clinics
-memory evaluation /dementia diagnosis and management
-capacity evaluations/guardianship /medical affidavits for probate court
-psychotherapy/family education
Isabel C. Murphy, Psy.D
sees people both in our office and also in Wellesley
To contact her call : 781-237-7761
sees people both in our office and also in Wellesley
To contact her call : 781-237-7761
- Isabel C. Murphy, BSN, PsyD received her Bachelor of Science Degree in Nursing in 1981 from Fairleigh Dickinson University. After eight years at the Massachusetts General Hospital working as a medical/surgical nurse, she transitioned to the field of psychology, obtaining her Doctorate in Psychology from the Massachusetts School of Professional Psychology in 1993.
- Dr. Murphy worked for 17 years at Mount Auburn Hospital where she served in a variety of roles, including performing patient assessments in the Emergency Room and providing treatment to adults on the Inpatient Psychiatric Unit. She was the Director of the Partial Hospital Program for several years, and eventually was appointed the Director of the Outpatient Psychiatry Department.In 2007, she left the hospital setting for full-time private practice and divides her time between her office in Wellesley, MA and Belmont Medical Associates.
- Dr. Murphy has obtained additional training both in the area of Addictions Psychology from Boston University and in Primary Care Behavioral Health at the University of Massachusetts. In her practice, she provides psychotherapy for patients ranging from older teens to geriatrics.
- Dr Murphy accepts the following insurance plans:
- Tufts HMO and Tufts Medicare Preferred
- BC/BS all plans (except those tied to unions as they have their own providers)
- Magellan
- Aetna
- Medicare
Susan Falkoff, BA, MSW, LICSW
- Susan Falkoff has been a social worker for over thirty years. She received her MSW degree from Simmons College and her B.A. at Brandeis where she majored in Art History. She has worked in elementary and middle schools; and in juvenile and probate courts, in cases involving child abuse and neglect, and custody disputes.
- Since 2005 Susan has had a private therapy practice in Watertown, providing therapy to children, adolescents, adults, couples and families. Her areas of particular interest include post-traumatic stress disorder, depression, grief, and marital/family problems. Her approach is practical and problem-solving, utilizing a variety of cognitive strategies as well traditional psychotherapy.
- Susan is active in municipal politics in Watertown, where she is an elected member of the Town Council.
John A. Nichols, Psy.D
- John A. Nichols, Psy.D. received his doctoral degree from the Massachusetts School of Professional Psychology and has been practicing as a licensed psychologist for over 25 years. His areas of expertise include the treatment of mood disorders, anxiety and personality problems. In addition, he provides diagnostic and referral consultation. Dr. Nichols works with individuals aged 18 and older.
- Was a member of the psychology staff in the Women's Program at Charles River Hospital, Wellesley, MA
- Former supervisor of psychotherapy (Dept. of Psychiatry) at Cambridge Hospital Cambridge, MA
- Published in the area of Cross-Cultural Psychiatry
- Member of the Society for the Exploration of Psychotherapy Integration
- Also works at 113 Belmont Street, Belmont, MA (Tel. 617.484.1042)
Margaret C. Nichols, Psy.D
- Margaret C. Nichols, Psy.D. has over 26 years of experience as a licensed psychologist. She worked as an art therapist for several years. She is a graduate of Lesley College, M.Ed., before obtaining her doctorate from the Massachusetts School of Professional Psychology.
- Dr. Nichols sees individuals age 21 and over, treating depression, anxiety, and related issues. She also sees couples who are having relationship problems.
- Dr. Nichols has a Harvard Medical School academic appointment as a clinical instructor in psychology (Mt. Auburn Hospital/Cambridge Hospital), and has taught first year medical students for over 9 years
- Her private practice is located in her office at 113 Belmont St., Belmont, (617 484-1042), and she also has appointments on Friday afternoons at the Belmont Medical Associates office.
Manuela McShane, M.A., LMHC
Offices at Belmont Medical Associates in Cambridge and in Belmont
To contact her call: (617) 538-8132
Website: www.manuelamcshane.com
Blue Cross Blue Shield Unicare
Harvard Pilgrim Health Care Tufts Navigator Plan
Tufts Health Plan Aetna
Neighborhood Health Plan United Healthcare
Fallon Community Health Plan PacifiCare Behavioral Health
Boston Medical Center HealthNet Plan Out of Network
Offices at Belmont Medical Associates in Cambridge and in Belmont
To contact her call: (617) 538-8132
Website: www.manuelamcshane.com
- Manuela McShane, M.A., LMHC received her Master’s degree in Clinical Mental Health Counseling from Lesley University in 2003. She received her Bachelor of Science degree in Education with a specialization in Teaching Children with Special Learning Needs and a minor in Psychology from Lesley College (now Lesley University) in 1981.
- Manuela has been in Private Practice in Belmont, MA since 2005 providing individual, couples and family therapy. She is also an Adjunct Faculty at Lesley University teaching a Clinical Practice and Supervision course to graduate students in the Counseling and Psychology Program since 2008.
- Manuela worked at North Charles Mental Health Clinic for 5½ years providing individual psychotherapy to clients with a wide range of issues. She also worked for 3½ years at Wild Acre Inns, The Babcock Program and eventually was appointed the Assistant Community Residence Director at the residential and day treatment program for adults with mental illness.
- Her clinical approach is eclectic with a focus on Cognitive Behavioral Therapy, Psychodynamic Therapy and Relational Therapy while integrating strategies from various approaches to tailor treatment to each client’s individual needs. She takes an active yet gentle role and believes therapy is an interactive process. Listening, empathy and non-judgmental acceptance are characteristics of her clinical approach.
- Areas of specialization: Depression, Anxiety, ADHD, Bipolar Disorder, Low Self-esteem, Relationship issues, Family issues, Trauma, PTSD, Stress Management, Parenting, Grief and Loss and Life Transitions.
- Manuela McShane, M.A., LMHC accepts the following insurance plans:
Blue Cross Blue Shield Unicare
Harvard Pilgrim Health Care Tufts Navigator Plan
Tufts Health Plan Aetna
Neighborhood Health Plan United Healthcare
Fallon Community Health Plan PacifiCare Behavioral Health
Boston Medical Center HealthNet Plan Out of Network
Help Wanted: a Good Therapist
Amid Increasing Choices, How to Know What Treatments Work, When to Move On
By Melinda Beck : WSJ : October 15, 2011
Therese Borchard likens herself to Goldilocks of the mental-health world: She tried six psychiatrists before she found one that was "just right." One learned she was a writer and asked for help with a book proposal. Another put her on sleeping pills, ignoring her history of substance abuse. One even wanted to try hypnotic regression by candlelight to address unresolved childhood issues.
Finally, No. 7 diagnosed bipolar disorder, found medication that was effective, helped her to be less hard on herself and "salvaged the last crumb of my self-esteem," says Ms. Borchard, who writes the popular "Beyond Blue" blog on Beliefnet.com.
The search for the right therapist can be baffling—and it comes at a time when would-be patients are feeling most vulnerable.
Patients who aren't sure what's wrong with them can be stumped about the type of therapist to call and ill-equipped to evaluate what they're told during treatment. How well a therapist's personal style matches a patient's individual needs can be critical. But experts also say that patients shouldn't be shy about pressing their therapist for a diagnosis and setting measurable goals.
David Palmiter, a public-education coordinator for the American Psychological Association (APA), likens good therapy to going to a good restaurant: "You should be able to peer into the kitchen and see what they're doing."
About 3% of Americans had outpatient psychotherapy in 2007—roughly the same as in 1998—although the percentage taking antidepressants and other psychotropic drugs rose sharply, according to an analysis in the American Journal of Psychiatry last year. The same study found that the average number of visits dropped from nearly 10 in 1998 to eight in 2007.
By some estimates, one-quarter of the U.S. population has some kind of diagnosable mental illness. But many don't believe they need help, don't know how to get it, think they can't afford it or that it won't be effective. There's also the lingering stigma attached to seeing a "shrink."
Approaches
There are many types of therapy, including:
Numerous clinical trials have shown that various forms of psychotherapy, with or without medication, can help ease depression, anxiety and other disorders. One oft-quoted analysis of 2,400 patients found that 50% improved measurably after eight sessions, and 75% improved after six months in therapy. Still, that doesn't mean that any given therapist will be effective for any particular patient.
One issue for prospective patients is that therapists generally specialize in one treatment approach and tend to see patients' problems through that lens. A cognitive-behavioral therapist will focus on changing patients' negative thinking patterns, while a psychoanalyst will want to probe more deeply into how the past is affecting current issues.
Some clinics and university mental-health centers offer consultations to help evaluate which treatment might be best. "Patients shouldn't have to decide this by themselves," says Drew Ramsey, an assistant clinical professor of psychiatry at New York's Columbia University, who says he loves to play "shrink matchmaker."
Patients can also ask friends, family members and physicians for referrals, then call several recommended therapists themselves and ask about their experience and techniques. "You may not know what kind of approach is right, but you can say, 'Here's what's going on in my life. How would you propose treating that? And how long do you think it would take?' " says Lynn Bufka, assistant executive director for practice research and policy at the APA. Increasingly, therapists are measuring outcomes, such as asking patients for evaluations, she adds. "So it's very reasonable to ask, 'How do you know what you do works?' "
Once in treatment, both the therapist and the patient should be familiar enough with each other by the third session to know if it's a good fit, experts say.
"Some people need a therapist who gives them instructions and assignments, and some people hate that. Some people need a therapist who is basically silent and lets them talk," says Betsy Stone, a psychologist in Stamford, Conn.
Dr. Stone says she can often tell even in the first session if the fit isn't right. "I like to push patients pretty hard, because I want them to get their money's worth, and some people are just too fragile," she says. "Then I say, 'I'm not the right therapist for you, but I'll help you find someone else.' "
Increasingly, therapists are collaborating with patients on a treatment plan rather than remaining aloof and omniscient. "I encourage patients to look up the science for themselves. How can they do that if they don't know what terms to search for?" says Dr. Palmiter.
Effective therapy can be difficult at times—particularly when the patient is exploring painful thoughts or fears. "A good therapist should give you comfort and discomfort at the same time. They should make you feel understood but challenged," says Dr. Stone.
Distinguishing that from having an uncomfortable relationship with the therapist can be tricky. "If you leave therapy every week feeling worse than when you went in," says Dr. Bufka, "it's probably not the right place for you."
Studies show that patients often hesitate to break it off because they don't want to hurt the therapist's feelings or seem ungrateful. "But believe me, we're used to it—and it's a very valuable thing to hear," says Dr. Palmiter.
Even close relationships sometimes fail to get at the right issues. Victoria Maxwell, 44, an actress and blogger from Half Moon Bay, British Columbia, says she worked with a therapist for 2½-years as a teenager and liked her enormously. But she never made much progress, because the therapist didn't recognize Ms. Maxwell's underlying bipolar disorder. "I became a really insightful depressed person. But it wasn't helping my depression," she says.
Years later, after several hospitalizations, a nurse referred Ms. Maxwell to an older psychiatrist. She initially thought they'd be a bad fit—but found he was the only one who believed she could have both a profound spiritual experience and bipolar disorder. "I trusted him, so I was willing to try what he suggested, which included medication," she says. "I wouldn't be where I am today without his help and understanding."
Setting measurable goals is crucial for knowing whether a therapy is working. In Ms. Maxwell's case, her psychiatrist said, "I think you're capable of moving out of your parents' home, living with roommates and driving a car—and I was," she says.
Amid Increasing Choices, How to Know What Treatments Work, When to Move On
By Melinda Beck : WSJ : October 15, 2011
Therese Borchard likens herself to Goldilocks of the mental-health world: She tried six psychiatrists before she found one that was "just right." One learned she was a writer and asked for help with a book proposal. Another put her on sleeping pills, ignoring her history of substance abuse. One even wanted to try hypnotic regression by candlelight to address unresolved childhood issues.
Finally, No. 7 diagnosed bipolar disorder, found medication that was effective, helped her to be less hard on herself and "salvaged the last crumb of my self-esteem," says Ms. Borchard, who writes the popular "Beyond Blue" blog on Beliefnet.com.
The search for the right therapist can be baffling—and it comes at a time when would-be patients are feeling most vulnerable.
Patients who aren't sure what's wrong with them can be stumped about the type of therapist to call and ill-equipped to evaluate what they're told during treatment. How well a therapist's personal style matches a patient's individual needs can be critical. But experts also say that patients shouldn't be shy about pressing their therapist for a diagnosis and setting measurable goals.
David Palmiter, a public-education coordinator for the American Psychological Association (APA), likens good therapy to going to a good restaurant: "You should be able to peer into the kitchen and see what they're doing."
About 3% of Americans had outpatient psychotherapy in 2007—roughly the same as in 1998—although the percentage taking antidepressants and other psychotropic drugs rose sharply, according to an analysis in the American Journal of Psychiatry last year. The same study found that the average number of visits dropped from nearly 10 in 1998 to eight in 2007.
By some estimates, one-quarter of the U.S. population has some kind of diagnosable mental illness. But many don't believe they need help, don't know how to get it, think they can't afford it or that it won't be effective. There's also the lingering stigma attached to seeing a "shrink."
Approaches
There are many types of therapy, including:
- Cognitive-behavioral therapy. Identifies and changes harmful thinking patterns; may involve gradual exposure to whatever is causing fears.
- Interpersonal therapy. Explores how relationships involving grief, isolation, conflict or changing family roles contribute to psychological problems.
- Psychoanalysis. Emphasizes how the unconscious mind influences behavior and how the past affects the present.
Numerous clinical trials have shown that various forms of psychotherapy, with or without medication, can help ease depression, anxiety and other disorders. One oft-quoted analysis of 2,400 patients found that 50% improved measurably after eight sessions, and 75% improved after six months in therapy. Still, that doesn't mean that any given therapist will be effective for any particular patient.
One issue for prospective patients is that therapists generally specialize in one treatment approach and tend to see patients' problems through that lens. A cognitive-behavioral therapist will focus on changing patients' negative thinking patterns, while a psychoanalyst will want to probe more deeply into how the past is affecting current issues.
Some clinics and university mental-health centers offer consultations to help evaluate which treatment might be best. "Patients shouldn't have to decide this by themselves," says Drew Ramsey, an assistant clinical professor of psychiatry at New York's Columbia University, who says he loves to play "shrink matchmaker."
Patients can also ask friends, family members and physicians for referrals, then call several recommended therapists themselves and ask about their experience and techniques. "You may not know what kind of approach is right, but you can say, 'Here's what's going on in my life. How would you propose treating that? And how long do you think it would take?' " says Lynn Bufka, assistant executive director for practice research and policy at the APA. Increasingly, therapists are measuring outcomes, such as asking patients for evaluations, she adds. "So it's very reasonable to ask, 'How do you know what you do works?' "
Once in treatment, both the therapist and the patient should be familiar enough with each other by the third session to know if it's a good fit, experts say.
"Some people need a therapist who gives them instructions and assignments, and some people hate that. Some people need a therapist who is basically silent and lets them talk," says Betsy Stone, a psychologist in Stamford, Conn.
Dr. Stone says she can often tell even in the first session if the fit isn't right. "I like to push patients pretty hard, because I want them to get their money's worth, and some people are just too fragile," she says. "Then I say, 'I'm not the right therapist for you, but I'll help you find someone else.' "
Increasingly, therapists are collaborating with patients on a treatment plan rather than remaining aloof and omniscient. "I encourage patients to look up the science for themselves. How can they do that if they don't know what terms to search for?" says Dr. Palmiter.
Effective therapy can be difficult at times—particularly when the patient is exploring painful thoughts or fears. "A good therapist should give you comfort and discomfort at the same time. They should make you feel understood but challenged," says Dr. Stone.
Distinguishing that from having an uncomfortable relationship with the therapist can be tricky. "If you leave therapy every week feeling worse than when you went in," says Dr. Bufka, "it's probably not the right place for you."
Studies show that patients often hesitate to break it off because they don't want to hurt the therapist's feelings or seem ungrateful. "But believe me, we're used to it—and it's a very valuable thing to hear," says Dr. Palmiter.
Even close relationships sometimes fail to get at the right issues. Victoria Maxwell, 44, an actress and blogger from Half Moon Bay, British Columbia, says she worked with a therapist for 2½-years as a teenager and liked her enormously. But she never made much progress, because the therapist didn't recognize Ms. Maxwell's underlying bipolar disorder. "I became a really insightful depressed person. But it wasn't helping my depression," she says.
Years later, after several hospitalizations, a nurse referred Ms. Maxwell to an older psychiatrist. She initially thought they'd be a bad fit—but found he was the only one who believed she could have both a profound spiritual experience and bipolar disorder. "I trusted him, so I was willing to try what he suggested, which included medication," she says. "I wouldn't be where I am today without his help and understanding."
Setting measurable goals is crucial for knowing whether a therapy is working. In Ms. Maxwell's case, her psychiatrist said, "I think you're capable of moving out of your parents' home, living with roommates and driving a car—and I was," she says.
Finding the best therapist can be confusing
Patricia Wen : Boston Globe : February 4, 2013
A Dedham mother remembers when her teenage daughter became overwhelmed with anxiety and was using illicit drugs. When her daughter’s doctor suggested she see “a therapist,” the mother began investigating, and soon found a dizzying array of options — psychiatrists, psychologists, psychiatric nurse practitioners, and social workers, among others.
Some specialized in prescribing mood-altering medications, while others focused on psychotherapy that delves into the child’s past. Some focused on changing destructive behaviors, while others probed family and school stresses. Beyond that, there were also pastoral counselors, yoga therapists, and life coaches.
“I used to think all therapists were the same,” said the mother, who asked to remain anonymous to protect her child’s identity.
“See a therapist” has become standard advice to many going through periods of anguish. Whether they’re victims or bystanders coping with traumatic events such as school shootings and natural disasters, or individuals going through a divorce or losing a job, some 13 percent of Americans use mental health services each year. These clinicians are in short supply nationwide, though Greater Boston — and the Northeast in general — has more than in most parts of the country. Among the available providers comes a confusing blizzard of options — and terminology.
“Terms like therapist, counselor, or psychotherapist are not regulated,” said Elana Eisman, executive director of the Massachusetts Psychological Association, which represents some 1,700 psychologists in the state. “Anyone can use those terms.”
In Massachusetts, however, not just anyone can promote themselves as a psychiatrist, psychologist, mental health counselor, or marriage and family therapist — professions that are licensed and regulated by the state with established educational and training standards. And though most health insurers will cover treatment provided by most state-licensed mental health professionals, some are excluded, such as certain types of licensed social workers with less training and education.
Finding the best therapist is not an easy task. Many mental health advocates say that patients should look for only state-licensed practitioners. The oversight of the state board, they say, ensures the clinician meets eligibility standards, and exposes them to investigation and possible disciplinary action if they are targets of complaints.
Alternative mental health treatments generally fall outside licensing and insurance systems, for better or worse. John Kepner, executive director of the International Association of Yoga Therapists, describes his area as an “emerging field” that promotes physical and emotional well-being, and says many suffering from stress-related ailments have been aided by yoga therapists. He said his group is working on establishing professional standards.
Though state licensing may have its benefits, he said, he’s ambivalent about the spiritual principles of yoga getting entangled in the bureaucracy of government regulations.
“Yoga and licensing are uneasy bedfellows,” he said.
Another issue to consider is the privacy of confidential information shared during therapy sessions. While state-licensed mental health practitioners covered under insurance are required to comply with federal laws limiting the disclosure of private information to others, alternative practitioners may be excluded or fall in the “gray space” of these laws, said Mark Schreiber, a Boston attorney who specializes in, among other things, medical privacy laws.
Mental health advocates say people need to consider many questions when looking for a therapist — and whether it’s a psychologist with a doctoral degree or a mental health counselor with a master’s may not be the most pressing issue.
Given tight budgets for most people, Larry DeAngelo, a staffer for the National Alliance on Mental Illness in Massachusetts, advises that most people first see what their insurance will cover, what clinicians fall under the insurer’s plan, and if specific clinicians have room for new patients. Availability remains tight, he said, and the debate over what type of therapist someone wants to see can almost be a luxury.
“It’s like when people are desperately starving, and you ask — do you want a chocolate bar or ice cream?” DeAngelo said.
Though insurers have come under fire for low reimbursement rates for behavioral health clinicians — as compared with those providing medical services for physical problems — many insist they are committed to giving members broad coverage from a wide variety of professionals.
For instance, Michael Sherman, chief medical officer for Harvard Pilgrim Health Care, said his company, as a general rule, pays for treatment administered by state-licensed mental health clinicians with advanced degrees who can practice without supervision. By that standard, over the past decade, Harvard Pilgrim began reimbursing licensed independent social workers, mental health counselors, and marriage and family therapists.
According to many mental health specialists, anyone seeking therapy services should first see a primary care doctor (or a pediatrician in the case of a child) to rule out any physical ailment to explain the emotional distress. For instance, some hormonal or neurological problems can explain depression or mood issues. Once a physical problem is ruled out, then a doctor can often help advise the patient about what type of therapist is best suited for their specific issue — such as a psychiatrist who can prescribe medications if bipolar illness is a possibility, a social worker if school troubles loom large, or a marriage and family therapist if divorce is on the horizon.
Eisman, of the Massachusetts Psychological Association, said there is also the intangible of chemistry between a patient and clinician — no matter if they have a MD, PhD, or LICSW after their name. She said any good clinician has had his or her share of therapeutic relationships that just didn’t work, and often can facilitate a better referral if necessary.
“Therapy works best when you can talk honestly,” she said.
Patricia Wen : Boston Globe : February 4, 2013
A Dedham mother remembers when her teenage daughter became overwhelmed with anxiety and was using illicit drugs. When her daughter’s doctor suggested she see “a therapist,” the mother began investigating, and soon found a dizzying array of options — psychiatrists, psychologists, psychiatric nurse practitioners, and social workers, among others.
Some specialized in prescribing mood-altering medications, while others focused on psychotherapy that delves into the child’s past. Some focused on changing destructive behaviors, while others probed family and school stresses. Beyond that, there were also pastoral counselors, yoga therapists, and life coaches.
“I used to think all therapists were the same,” said the mother, who asked to remain anonymous to protect her child’s identity.
“See a therapist” has become standard advice to many going through periods of anguish. Whether they’re victims or bystanders coping with traumatic events such as school shootings and natural disasters, or individuals going through a divorce or losing a job, some 13 percent of Americans use mental health services each year. These clinicians are in short supply nationwide, though Greater Boston — and the Northeast in general — has more than in most parts of the country. Among the available providers comes a confusing blizzard of options — and terminology.
“Terms like therapist, counselor, or psychotherapist are not regulated,” said Elana Eisman, executive director of the Massachusetts Psychological Association, which represents some 1,700 psychologists in the state. “Anyone can use those terms.”
In Massachusetts, however, not just anyone can promote themselves as a psychiatrist, psychologist, mental health counselor, or marriage and family therapist — professions that are licensed and regulated by the state with established educational and training standards. And though most health insurers will cover treatment provided by most state-licensed mental health professionals, some are excluded, such as certain types of licensed social workers with less training and education.
Finding the best therapist is not an easy task. Many mental health advocates say that patients should look for only state-licensed practitioners. The oversight of the state board, they say, ensures the clinician meets eligibility standards, and exposes them to investigation and possible disciplinary action if they are targets of complaints.
Alternative mental health treatments generally fall outside licensing and insurance systems, for better or worse. John Kepner, executive director of the International Association of Yoga Therapists, describes his area as an “emerging field” that promotes physical and emotional well-being, and says many suffering from stress-related ailments have been aided by yoga therapists. He said his group is working on establishing professional standards.
Though state licensing may have its benefits, he said, he’s ambivalent about the spiritual principles of yoga getting entangled in the bureaucracy of government regulations.
“Yoga and licensing are uneasy bedfellows,” he said.
Another issue to consider is the privacy of confidential information shared during therapy sessions. While state-licensed mental health practitioners covered under insurance are required to comply with federal laws limiting the disclosure of private information to others, alternative practitioners may be excluded or fall in the “gray space” of these laws, said Mark Schreiber, a Boston attorney who specializes in, among other things, medical privacy laws.
Mental health advocates say people need to consider many questions when looking for a therapist — and whether it’s a psychologist with a doctoral degree or a mental health counselor with a master’s may not be the most pressing issue.
Given tight budgets for most people, Larry DeAngelo, a staffer for the National Alliance on Mental Illness in Massachusetts, advises that most people first see what their insurance will cover, what clinicians fall under the insurer’s plan, and if specific clinicians have room for new patients. Availability remains tight, he said, and the debate over what type of therapist someone wants to see can almost be a luxury.
“It’s like when people are desperately starving, and you ask — do you want a chocolate bar or ice cream?” DeAngelo said.
Though insurers have come under fire for low reimbursement rates for behavioral health clinicians — as compared with those providing medical services for physical problems — many insist they are committed to giving members broad coverage from a wide variety of professionals.
For instance, Michael Sherman, chief medical officer for Harvard Pilgrim Health Care, said his company, as a general rule, pays for treatment administered by state-licensed mental health clinicians with advanced degrees who can practice without supervision. By that standard, over the past decade, Harvard Pilgrim began reimbursing licensed independent social workers, mental health counselors, and marriage and family therapists.
According to many mental health specialists, anyone seeking therapy services should first see a primary care doctor (or a pediatrician in the case of a child) to rule out any physical ailment to explain the emotional distress. For instance, some hormonal or neurological problems can explain depression or mood issues. Once a physical problem is ruled out, then a doctor can often help advise the patient about what type of therapist is best suited for their specific issue — such as a psychiatrist who can prescribe medications if bipolar illness is a possibility, a social worker if school troubles loom large, or a marriage and family therapist if divorce is on the horizon.
Eisman, of the Massachusetts Psychological Association, said there is also the intangible of chemistry between a patient and clinician — no matter if they have a MD, PhD, or LICSW after their name. She said any good clinician has had his or her share of therapeutic relationships that just didn’t work, and often can facilitate a better referral if necessary.
“Therapy works best when you can talk honestly,” she said.
DEPRESSION SCREENING TEST
A Regular Checkup Is Good for the Mind as Well as the Body
By Ann Carrns : NY Times : November 13, 2012
Everyone is familiar with the concept of a periodic medical checkup — some sort of scheduled doctor’s visit to check your blood pressure, weight and other physical benchmarks.
The notion of a regular mental health checkup is less established, perhaps because of the historical stigma about mental illness. But taking periodic stock of your emotional well-being can help identify warning signs of common ailments like depression or anxiety. Such illnesses are highly treatable, especially when they are identified in their early stages, before they get so severe that they precipitate some sort of personal — and perhaps financial — crisis.
“Absolutely, people should have a mental health checkup,” said Jeffrey Borenstein, editor in chief of Psychiatric News, published by the American Psychiatric Association. “It’s just as important as having a physical checkup.”
About a quarter of American adults suffer from some type of mental health problem each year, according to the National Institute of Mental Health, and 6 percent suffer severe ailments, like schizophrenia or major depression. When left untreated, mental health illnesses are more likely to lead to hospitalization — something that could mean time lost from work.
Ideally, doctors should ask patients about their moods as part of a regular wellness visit, Dr. Borenstein said — there doesn’t necessarily need to be a special visit to gauge mental health. But if the doctor doesn’t bring it up, patients can educate themselves and start the conversation with their physicians.
Jeffrey Cain, president of the American Academy of Family Physicians, said family doctors were trained to spot symptoms of mental illness, like depression, and he encouraged patients to bring in questions or concerns for discussion. But people don’t necessarily go to their family doctor and say they are depressed, he said. Rather, they say they’re tired, or that they lack energy, that they’re having trouble concentrating or that their body aches — all of which can be symptoms of depression or anxiety.
There are some well-known screening tools that patients can use as a starting point to assess themselves, to help prompt a conversation with their doctor. Dr. Borenstein mentioned a common tool used by doctors to assess patients for depression: a “P.H.Q.,” for “patient health questionnaire” He cautioned that the idea here was not to self-diagnose using such forms — there are several versions, varying by number of questions — but rather to self-assess, and then discuss your concerns with a professional.
The P.H.Q.-9, which asks nine questions, was developed by researchers at Columbia University and Indiana University, with help from a grant from Pfizer Inc. The form is available on several Web sites, including (phqscreeners.com/pdfs/02_PHQ-9/English.pdf).
It asks about the patient’s outlook and health habits over the previous two weeks. The first question, for instance, asks patients whether they have had “little interest or pleasure” in doing things and asks them to check a box ranging from “not at all,” which scores a zero, to “nearly every day,” which scores a 3. A professional computes a total score, which gives more weight to frequent symptoms; the higher the score, the greater the likelihood of significant depression.
Another set of screening tools for depression and other mental health disorders were developed by Screening for Mental Health, a Boston-area nonprofit that creates assessment tools for use by health plans, colleges, the military and the general public. Founded by Douglas Jacobs, an associate clinical professor of psychiatry at Harvard Medical School, the organization grew out of the first National Depression Screening Day, which is held annually each October during Mental Illness Awareness Week.
Mental illnesses have specific signs and symptoms, much as a disease like diabetes does, Dr. Jacobs said, and those symptoms can be identified and treated. Take depression, again, as an example. It’s normal to be sad for a while after a personal loss or a traumatic event. But when the effects linger and begin to affect your self-esteem, or interfere with your ability to do your job or handle other responsibilities, he said, you may want to consider if you are suffering from a more serious depression that should be treated professionally — with behavioral therapy, medication or both.
At the site helpyourselfhelpothers.org, which is sponsored by Screening for Mental Health, you can find locations near you that offer mental health services. Or, you can use a free online screening tool that can help you gauge if you might be at risk for various illnesses including depression, anxiety, bipolar disorder, eating disorders and post-traumatic stress disorder.
You can choose a specific screening or answer questions to help narrow your choice. For instance, the tool asks you to complete the sentence “I have been...” with phrases like “feeling sad or empty,” or “drinking more than planned.”
The depression screening tool asks questions about how you have been feeling during the last two weeks, like whether you have been “blaming yourself for things” some of the time, all of the time, or most of the time.
The questionnaire concludes with a finding based on your answers. For instance, it might tell you that “Your screening results are consistent with symptoms of an eating disorder,” along with a recommendation to seek a professional evaluation. Gina N. Duncan, an assistant professor of psychiatry at the Medical College of Georgia at Georgia Health Sciences University in Augusta, who has blogged about the notion of a personal mental health checkup, said sleep disruptions were often a sign of stress. If you’re sleeping much more or less than usual, or having difficulty falling asleep, that can be a warning signal..
Many large employers include mental health coverage as part of their health benefits packages, and recent federal rules on benefits “parity” mean such benefits at large plans should not have higher have co-payments and deductibles or stricter limits on treatment than benefits for other medical or surgical needs. Also, most large companies currently offer employee assistance plans, which provide counseling and referrals — both over the phone and in person — to workers and members of their families who are suffering from personal crises.
Helen B. Darling, president of the National Business Group on Health, a consortium of large employers, said employee assistance plans were an important way to screen for mental health problems. Help through them is generally provided free of charge outside of the main health insurance plan, so using the service does not generate an insurance claim.
Over all, however, 15 percent of employers in the United States do not offer mental health coverage to employees, according to the Society for Human Resource Management. Such benefits may become more widely available in 2014, when many provisions of the Affordable Care Act take effect. Mental health benefits will be part of the “essential package” that must be offered by many insurance plans, including the new state-sponsored insurance exchanges.
By Ann Carrns : NY Times : November 13, 2012
Everyone is familiar with the concept of a periodic medical checkup — some sort of scheduled doctor’s visit to check your blood pressure, weight and other physical benchmarks.
The notion of a regular mental health checkup is less established, perhaps because of the historical stigma about mental illness. But taking periodic stock of your emotional well-being can help identify warning signs of common ailments like depression or anxiety. Such illnesses are highly treatable, especially when they are identified in their early stages, before they get so severe that they precipitate some sort of personal — and perhaps financial — crisis.
“Absolutely, people should have a mental health checkup,” said Jeffrey Borenstein, editor in chief of Psychiatric News, published by the American Psychiatric Association. “It’s just as important as having a physical checkup.”
About a quarter of American adults suffer from some type of mental health problem each year, according to the National Institute of Mental Health, and 6 percent suffer severe ailments, like schizophrenia or major depression. When left untreated, mental health illnesses are more likely to lead to hospitalization — something that could mean time lost from work.
Ideally, doctors should ask patients about their moods as part of a regular wellness visit, Dr. Borenstein said — there doesn’t necessarily need to be a special visit to gauge mental health. But if the doctor doesn’t bring it up, patients can educate themselves and start the conversation with their physicians.
Jeffrey Cain, president of the American Academy of Family Physicians, said family doctors were trained to spot symptoms of mental illness, like depression, and he encouraged patients to bring in questions or concerns for discussion. But people don’t necessarily go to their family doctor and say they are depressed, he said. Rather, they say they’re tired, or that they lack energy, that they’re having trouble concentrating or that their body aches — all of which can be symptoms of depression or anxiety.
There are some well-known screening tools that patients can use as a starting point to assess themselves, to help prompt a conversation with their doctor. Dr. Borenstein mentioned a common tool used by doctors to assess patients for depression: a “P.H.Q.,” for “patient health questionnaire” He cautioned that the idea here was not to self-diagnose using such forms — there are several versions, varying by number of questions — but rather to self-assess, and then discuss your concerns with a professional.
The P.H.Q.-9, which asks nine questions, was developed by researchers at Columbia University and Indiana University, with help from a grant from Pfizer Inc. The form is available on several Web sites, including (phqscreeners.com/pdfs/02_PHQ-9/English.pdf).
It asks about the patient’s outlook and health habits over the previous two weeks. The first question, for instance, asks patients whether they have had “little interest or pleasure” in doing things and asks them to check a box ranging from “not at all,” which scores a zero, to “nearly every day,” which scores a 3. A professional computes a total score, which gives more weight to frequent symptoms; the higher the score, the greater the likelihood of significant depression.
Another set of screening tools for depression and other mental health disorders were developed by Screening for Mental Health, a Boston-area nonprofit that creates assessment tools for use by health plans, colleges, the military and the general public. Founded by Douglas Jacobs, an associate clinical professor of psychiatry at Harvard Medical School, the organization grew out of the first National Depression Screening Day, which is held annually each October during Mental Illness Awareness Week.
Mental illnesses have specific signs and symptoms, much as a disease like diabetes does, Dr. Jacobs said, and those symptoms can be identified and treated. Take depression, again, as an example. It’s normal to be sad for a while after a personal loss or a traumatic event. But when the effects linger and begin to affect your self-esteem, or interfere with your ability to do your job or handle other responsibilities, he said, you may want to consider if you are suffering from a more serious depression that should be treated professionally — with behavioral therapy, medication or both.
At the site helpyourselfhelpothers.org, which is sponsored by Screening for Mental Health, you can find locations near you that offer mental health services. Or, you can use a free online screening tool that can help you gauge if you might be at risk for various illnesses including depression, anxiety, bipolar disorder, eating disorders and post-traumatic stress disorder.
You can choose a specific screening or answer questions to help narrow your choice. For instance, the tool asks you to complete the sentence “I have been...” with phrases like “feeling sad or empty,” or “drinking more than planned.”
The depression screening tool asks questions about how you have been feeling during the last two weeks, like whether you have been “blaming yourself for things” some of the time, all of the time, or most of the time.
The questionnaire concludes with a finding based on your answers. For instance, it might tell you that “Your screening results are consistent with symptoms of an eating disorder,” along with a recommendation to seek a professional evaluation. Gina N. Duncan, an assistant professor of psychiatry at the Medical College of Georgia at Georgia Health Sciences University in Augusta, who has blogged about the notion of a personal mental health checkup, said sleep disruptions were often a sign of stress. If you’re sleeping much more or less than usual, or having difficulty falling asleep, that can be a warning signal..
Many large employers include mental health coverage as part of their health benefits packages, and recent federal rules on benefits “parity” mean such benefits at large plans should not have higher have co-payments and deductibles or stricter limits on treatment than benefits for other medical or surgical needs. Also, most large companies currently offer employee assistance plans, which provide counseling and referrals — both over the phone and in person — to workers and members of their families who are suffering from personal crises.
Helen B. Darling, president of the National Business Group on Health, a consortium of large employers, said employee assistance plans were an important way to screen for mental health problems. Help through them is generally provided free of charge outside of the main health insurance plan, so using the service does not generate an insurance claim.
Over all, however, 15 percent of employers in the United States do not offer mental health coverage to employees, according to the Society for Human Resource Management. Such benefits may become more widely available in 2014, when many provisions of the Affordable Care Act take effect. Mental health benefits will be part of the “essential package” that must be offered by many insurance plans, including the new state-sponsored insurance exchanges.
