Epilogue

Our contributors have provided us with a wealth of vital information about the extent of mental illness in our country, the vast waste from the neglect of psychiatric patients and the savings that could be realized by the ready availability of medically necessary psychotherapy without arbitrary restrictions. We have seen data about the cost effectiveness of extended psychotherapy for patients with borderline personality disorder, posttraumatic stress disorder, the medically ill, depressed patients, and child patients. Actuarial studies in this country and in Germany attest to the cost savings realized when patients have access to appropriate length and intensity of dynamic psychotherapy. Indeed, in some diagnostic groups, extended intensive psychotherapy is vital to recovery.

The obstacles to the support of dynamic psychotherapy include a fast-paced, “sound bite” culture that is blind to the slow and subtle processes of long-term psychotherapy. The difficulty in funding and pursuing controlled clinical trials for long-term treatments has led to a relative paucity of convincing research results. Perhaps the most formidable obstacle has been profit-driven insurance practices that have ravaged appropriate medical services of every type and have found psychiatric patients an especially vulnerable population from whom it is easy to withhold care in the interest of short-term profits. These patients are neglected, however, at the peril of society at large, which picks up the tab in increased disability payments, decreased productivity, and increased medical and surgical costs, to say nothing of increased suicides and immeasurable, unnecessary human suffering.

On the other hand, experience of the last few years demonstrates that legislative bodies and the public at large are open and responsive to the good data that are available. It is up to advocates of psychotherapy to bring our best arguments to the attention of policymakers and to the American people.