Do Psychopharmacologists Speak to Psychotherapists? A Survey of Practicing Clinicians

Background: Split-treatment, the provision of psychotherapy and psychotropic medication by two different professionals, has become prevalent in U.S. mental health care delivery, as more Americans receive prescriptions and American psychiatrists provide less psychotherapy. Historically, communication between professionals treating the same patient has been an accepted principle of optimal care, but there has been only one formal assessment (Avena & Kalman, 2010a, b) of whether or not such communication actually takes place in the private sector. This article supplements the aforementioned survey of psychotherapists with a survey of psychiatrists. Subjects and Methods: An eight-item survey was mailed to 150 full-time private practice psychiatrists in Manhattan and New Jersey. Questionnaires were completed anonymously and returned by mail. Data was gathered about years of practice experience, how many patients were seen in the prior month, and how many patients were also in psychotherapy with another professional. Frequency of communication with psychotherapists on behalf of these patients and for patients in treatment for six months or longer was also assessed. Lastly, information was compiled on which professional more frequently initiated the communication when it did occur. Results: Sixty-one psychiatrists, averaging 26.7 years in practice, returned surveys. For all respondents, the total number of medication-only patients seen in the last full month was 1903, of which 785 (41.25%) were in psychotherapy with another mental health professional. Respondents reported a total of 875 split-care patients in treatment for six months or longer, with no communication with the psychotherapist being reported on behalf of 24% of these individuals. Respondents indicated that they had initiated 68.4% of the most recent contacts with the other professional, and just 10 of 55 (18.2%) responding

psychiatrists reported quarterly communication with their split-care patients' psychotherapists for all shared patients. Conclusions: We found that split-care treatment is common but that adequate communication between professionals engaged in such treatment frequently does not take place. Corroborating the findings of the earlier survey, many questions remain about the need for guidelines regarding the conduct of split-treatment and about how best to determine the importance of communication between professionals engaged in this therapeutic arrangement.