Can Investing in Psychological Services Reduce Medical Costs in the Long Run?

Robert McGrath and Gillian Donovan call Nicholas Cummings and William O'Donohue's Understanding the Behavioral Healthcare Crisis: The Promise of Integrated Care and Diagnostic Reform "timely, informative, and important." However, they question the authors' unqualified endorsement of the medical cost offset argument for psychological services, noting,

Although there is good evidence for the possibility of a medical cost offset resulting from the provision of psychosocial services (Chiles, Lambert, & Hatch, 2002), there are also notable failures to demonstrate this offset (e.g., Bickman, 1996; Polen, Freeborn, Lynch, Mullooly, & Dickinson, 2006). In the absence of extensive information about the circumstances under which the offset is demonstrable, using this argument as the primary justification for involvement in healthcare has the potential to backfire.

In toto, does the extant evidence support claims that psychological services actually save money in the long run by reducing medical costs?

Read the Review

Behavioral Health Care in the Brave New Health Care World
By Robert E. McGrath and Gillian Donovan
      PsycCRITIQUES, 2012 Vol 57(7)

Comments

[Nick Cummings]

In all of my continuous research in medical cost offset I cautioned that traditional psychotherapy services do not yield positive results because long-term psychotherapy or usual approaches that are aborted to fit into managed care's limits do not result in the effect. In the former psychotherapy costs replace medical costs, and in the latter emotional issues that have been translated into physical symptoms are not addressed. This precaution has essentially been ignored. Medical cost offset occurs with short-term interventions by trained psychotherapists working in the primary care setting

[Robert McGrath]

I agree with Dr. Cummings' comment completely. My concern is that mental health professionals will take positions in primary care without appropriate background to avoid providing services in a way that wipes out the medical cost offset. In particular, most therapists know only the 45-minute therapy model. We need to be better prepared for the provision of stepped care, titrating the level of service based on assessment of the patient. An excellent introduction to the topic is O'Donohue & Draper's (2011) "Stepped Care and e-Health," but there is also a substantial research literature on this topic. Unfortunately, most mental health professionals are unaware of this literature.