Implementing Publicly Funded Psychotherapy Services: What Can Ontario Learn from England?

Little research on the value of Health of the Nation Outcome Scales (HoNOS) has occurred in out-patient settings, particularly psychotherapy services. To determine whether HoNOS provides an adequate assessment for psychotherapy services which is sensitive to change. HoNOS ratings from 1688 patients from eight out-patient psychotherapy services were collected. Of these, 362 also had ratings post-treatment. Mean scores, pre-to post-treatment differences, and reliable and clinically significant change criteria were calculated for HoNOS items and for total scores. The mean total HoNOS rating was 8.93, which is comparable to psychiatric out-patients. Only three items showed sufficient variability to use in assessing pre- to post-treatment change. Significant limitations were found in rating items that commonly present to psychotherapists. The lack of variability in most items limits HoNOS's usefulness in this population.

The Changing Face of U.S. Mental Health Care

Objective Although telehealth psychotherapies have been studied for over 20 years, mental health services remained largely delivered in person until the COVID-19 pandemic forced clinics to reconsider the utility of telehealth psychotherapy. This study aims to compare patient engagement in in-person versus telehealth services in outpatient psychotherapy for mood and anxiety disorders. Method: A cohort investigation was conducted, using a propensity score matched sample, extracted from an electronic health record (EHR) to compare engagement in psychotherapy for 762 patients who used in-person services before the pandemic to a cohort of 762 patients who used telehealth psychotherapy after the onset of COVID-19. The authors compared cohorts on initial engagement in psychotherapy services following an initial intake, number of psychotherapy sessions attended, and the rate of missed sessions. Results: There was a 26% increase in the total number of individual psychotherapy sessions attended when the clinics transitioned to telehealth services (p < .001). In addition, patients who received telehealth psychotherapy were five times more likely to not cancel or miss any scheduled sessions (p < .001). Conclusion: These results indicate that telehealth services may result in improved treatment engagement for outpatient centers focused on brief evidence-based psychotherapies for mood and anxiety disorders.

The Changing Face of U.S. Mental Health Care

There is no way in which the growing mental health needs of our nation can be fulfilled by the existing numbers of clinical psychologists and psychotherapists using outdated and by now expensive 1on1, f2f, and tb approaches (Kazdin & Blase, 2010a, 2010b). It is inevitable in any human organization that there will be distance between the top movers, shakers, and followers. This evolutionary process in clinical psychology and psychotherapy is taking place in front of our very eyes every day through the internet. Even though the notion of hierarchy is not yet present in current clinical psychology and psychotherapy thinking, practices, and service delivery, the diminishing f2f, 1on1 approach (including participants or families) is still the major paradigm that makes it difficult to progress toward a hierarchical paradigm in the delivery of public clinical psychology and psychotherapy services.

Cost and insurance coverage remain important barriers to mental health care, including psychotherapy and mental health counseling services ("psychotherapy"). While data are scant, psychotherapy services are often delivered in private practice settings, where providers frequently do not take insurance and instead rely on direct pay. In this cross-sectional analysis, we use a large national online directory of 175 083 psychotherapy providers to describe characteristics of private practice psychotherapy providers who accept and do not accept insurance, and assess self-reported private pay rates. Overall, about one-third of private practice psychotherapists did not accept insurance, with insurance acceptance varying substantially across states. We also found significant session rate differentials, with Medicaid rates being on average 40% lower than reported cash pay rates, which averaged $143.26 a session. Taken together, low insurance acceptance across a broad swath of mental health provider types means that access to care is disproportionately reliant on patients' ability to afford out-of-pocket payments-even when covered by insurance. While our findings are descriptive and may not be representative of all US psychotherapists, they add to scant existing knowledge about the cash pay market for an important mental health service that has experienced increased use and demand over time.

Autistic youth have a high co-occurrence of mental health challenges and a resultant high need for mental health treatment. However, they experience mental health service disparities compared to non-autistic youth. Social determinants of health (SDH) may contribute to mental health service disparities among autistic youth, yet this has not been previously examined. Therefore, the present study utilized a validated composite of children's SDH to examine whether autistic youth with better SDH were more likely to use psychotherapy services compared to those with poor SDH using state-level records of insurance billing claims data (2019 All-Payer Claims Database). 700 autistic youth with a co-occurring mental health condition were included in analyses. One or more claim records for psychotherapy CPT codes were used as indicators of psychotherapy service use. SDH was assessed using the Childhood Opportunity Index, a continuous composite measure of neighborhood SDH. The predictive effect of SDH on psychotherapy use were examined, while examining covariates of insurance type and age. Approximately 70% of the sample did not use any psychotherapy services. Inconsistent with findings from non-autistic samples, autistic youth's SDH did not predict their likelihood of using psychotherapy services; rather, those with low and high opportunity alike did not access psychotherapy. Age increased the likelihood, and using Medicaid decreased the likelihood of psychotherapy service use. These results may highlight the compounded barriers to psychotherapy that autistic youth may experience, including the paucity of mental health providers who accept Medicaid and accept autistic youth clients.

Psychotherapy services face increasing demand but are vulnerable to critical scrutiny by service purchasers seeking evidence of cost-effectiveness. Psychotherapy research, although it can benefit practitioners, cannot adequately address these concerns because of poor external validity and it is argued that complementary strategies are needed. A number of service-based evaluative methods are reviewed and the distinctions clarified between service evaluation, operational research, professional audit, service audit, quality assurance and total quality management. Maxwell's (1984) six category framework is used to examine a number of issues in psychotherapy services including the assessment process, treatment-of-choice decisions, predicting negative effects of treatment, dose-response in psychotherapy, brief interventions, therapist competence, clinical significance, cost effectiveness and measures of psychotherapy service inputs, process and outcomes. This review advocates reflective practice within a self-evaluating psychotherapy service and a systemic approach which can take account of the perspectives of patients, purchasers, service managers, referrers and practitioners.

BackgroundThis study investigated the prevalence and factors associated with counselling and psychotherapy service use among Chinese sexual minority populations.MethodsA nationwide cross-sectional study was performed using snowball sampling method, which led to the inclusion of 18,193 participants. Participants’ sociodemographic background, clinical, and psychological data were gathered. Multivariate logistic regression analysis was performed to explore any associated factors.ResultsThere were 2007 participants who had used counselling and psychotherapy service out of the total population. Among those who had used psychotherapy services, 80.2% participants perceived discrimination, 1.1% reported that they had been refused treatment by a counsellor and/or psychotherapist, 1.6% had experienced verbal harassment, and 8.4% reported that their counsellor and/or psychotherapist lacked knowledge and experience in treating sexual minorities. In addition, regression analyses indicated that those who were divorced/widowed, had religious beliefs, and those who had experienced discrimination, verbal harassment, and rejection for treatment by health professionals all had an increased likelihood of utilising counselling and psychotherapy service.ConclusionsService providers and policy makers in China should improve the quality and availability of counselling and psychotherapy services to address the mental health needs of sexual minority populations.

Few data are available on the characteristics of inpatient treatment and subsequent outpatient treatment for depression in Germany. In this study, we aimed to characterize the inpatient and outpatient treatment phases, to determine the rates of readmission and mortality, and to identify risk factors. We carried out a descriptive statistical analysis of routine administrative data from a large health-insurance carrier (BARMER). All insurees aged 18 to 65 who were treated in 2015 as inpatients on a psychiatry and psychotherapy service or on a psychosomatic medicine and psychotherapy service with a main diagnosis of depression were included in the analysis. Risk factors for readmission and death were determined with the aid of mixed logistic regression. Of the 22 893 patients whose data were analyzed, 78% had been hospitalized on a psychiatry and psychotherapy service and 22% on a psychosomatic medicine and psychotherapy service. The median length of hospital stay was 42 days. Follow-up care in the outpatient setting failed to conform with the recommendations of the pertinent guidelines in 92% of the patients with a main diagnosis of severe depression during hospitalization, and in 50% of those with moderate depression. 21% of the patients were readmitted within a year. The mortality at one year was 961 per 100 000 individuals (adjusted for the age and sex structure of the German population), or 3.4 times the mortality of the population at large. In the regression model, more treatment units during hospitalization and subsequent treatment with psychotherapy were associated with a lower probability of readmission, while longer hospitalization with subsequent pharmacotherapy or psychotherapy was associated with lower mortality. The recommendations of the national (German) S3 guidelines for the further care of patients who have been hospitalized for depression are inadequately implemented at present in the sectored structures of in- and outpatient care in the German health care system. This patient group has marked excess mortality.

Counselling and psychotherapy services have taken off with uneven speed across China since the 1980s after several years of stagnation. Researchers have attributed socioeconomic development (or the lack thereof) and regional differences as main barriers to the development in this field. However, little is known today about the status of counselling and psychotherapy services across China. To investigate and compare the current situation of practitioners and service delivery of counselling and psychotherapy in more developed and developing regions across China. Convenience sampling methods from counselling and psychological services organizations in 29 Chinese provinces, municipalities or autonomous regions were used to recruit 1,543 participants to take part in the investigation by completing a 93-item self-designed questionnaire. Organizations in developing and more developed regions in China varied in their current practices and employment situation of their practitioners, and in the quality of service delivery. However, counselling and psychotherapy offered at universities in both types of regions are of similar quality. In China, the level of socioeconomic development significantly influences the development of professional counselling and psychotherapy services. Important progress is evident in the field; however, the lack of systematic training and the scarcity of professional practitioners remain a challenge.

This description of counseling and psychotherapy services at Amherst College begins with our heritage from the “mental hygiene” movement of the nineteenth century, the founding of the first university mental health services and the later development of a counseling center tradition. By tracing the evolution at Amherst, from a brief counseling and assessment office to a psychotherapy service, I hope to illustrate and discuss the factors which support a psychotherapy service, as opposed to other models such as a counseling and assessment service or a triage and referral service. Important questions include staffing, time limits, administrative involvement, the institutional context, acknowledging the proper limits of our authority, the need to be aware of how our values may influence our judgments, and resisting the pressures to reduce or streamline our services. I argue for the value of providing a therapeutic space for college students.

Neuropsychologists treating patients with brain injury face many challenges in helping them recover and adapt to their injuries. Individual and group psychotherapy in a milieu-oriented treatment setting are important tools to facilitate this process. This article first focuses on "why" psychotherapy services are important after brain injury. Following that, specific prerequisites, criteria, and techniques of psychotherapy (How, When, and Where sections) are explored. Case study examples are incorporated to illustrate important concepts.

Although standard of care prior to hematopoietic stem cell transplantation (HSCT) includes a psychosocial evaluation, little is known about the rate and predictors of psychotherapy utilization among patients presenting for pre-HSCT evaluations. This study aimed to examine the proportion of patients undergoing pre-HSCT evaluations who subsequently utilize psychotherapy services and to explore predictive factors, including distress, anxiety, depression, and quality of life (QoL). Participants were a cross-sectional sample of 351 HSCT candidates at an NCI-designated comprehensive cancer center. Questionnaires assessing distress, anxiety, depression, and QoL were administered using validated instruments. A subset of patients, representing 14% of the sample, utilized psychotherapy services. Relative to patients who did not utilize psychological services, patients who followed-up with psychotherapy reported significantly more depressive and anxious symptoms (P<.001) and endorsed worse QoL on the Functional Assessment of Cancer Therapy-General. (P=.04). Of note, a subset of patients who utilized psychotherapy services reported low levels of distress (67%), depression (13%), or anxiety (13%); on the other hand, a subset of patients reported moderate-to-high levels of distress (25%), depression (71%), or anxiety (60%) but did not utilize services. Results indicate that only a small subset of patients presenting for pre-HSCT psychosocial evaluation subsequently utilized psychotherapy services. Most patients who reported psychosocial concerns and who could potentially benefit from intervention did not use psychotherapy services. Further research is necessary to help clarify barriers to psychotherapy service utilization among HSCT patients and to help improve uptake among high-need patients.

Parents involved with child protective services (CPS) often face various challenges, including sociostructural marginalization, mental illness and difficulties in family relationships. Although their need for mental health services is generally acknowledged, the extant child welfare literature lacks studies on how CPS‐involved parents may benefit from such services. In an attempt to address this gap, the current study seeks to explore clinicians' and parents' perspectives regarding the role of psychotherapy services (e.g. individual or conjoint counselling/therapy) for child welfare cases. Semi‐structured interviews were conducted with clinicians working with CPS‐involved families and parents accused of child maltreatment. Thematic analysis of the interview data generated three themes: (1) psychotherapy as a place for safety and empathy, (2) psychotherapy as a place for challenge and (3) psychotherapy as a place for problem resolution. The findings suggest that psychotherapy services may benefit CPS‐involved parents not only by offering much‐needed emotional support and resources within sessions but also by facilitating parents' collaboration with CPS through their partnership with caseworkers outside of sessions. For child welfare practice, it is recommended that psychotherapy services be included from the outset of parents' CPS involvement to promote their psychological and relational well‐being as well as their successful completion of CPS requirements.