In early April, APA surveyed its members about the impact of the current
economic crisis on their patients and practices. A total of 805 members
Although only 18 percent of respondents reported that the economic crisis
was having a substantial impact on the mental health of their patients, 70
percent said that because of the crisis their patients were having to choose
between psychiatric care and other basic needs.
Fifty-nine percent of respondents also said that they were taking steps to
help such financially strapped patients get needed care (see chart). One
method was reducing fees. Another was structuring flexible payment schedules.
Still a third was referring them to alternative, less expensive sources of
care. Interviews that Psychiatric News conducted with members
illustrate some of the steps that they are taking in this
"A lot of my job now is trying to help patients pay for
things," said Leigh White, M.D., who works in a student psychiatry
service at Michigan State University. "I try to stretch their visits to
help them reduce costs."
"I have had consultations that I have had to refer out because people
have been concerned about how much money [a psychiatrist visit] is going to
cost," reported Hunter McQuistion, M.D., director of outpatient and
community psychiatry at St. Luke's and Roosevelt Hospitals in New York
"I encourage patients not to quit treatment, not to take a hiatus, so
that they won't backslide or relapse," said Rosalind Griffin, M.D., a
psychiatrist in private practice in Farmington Hills, Mich. "I tell them
that I am willing to let them pay as they are able to.... [I also try to
convince them that] talking about their inability to pay, their guilt, and
their shame about being in debt is more therapeutic than staying away from
therapy in order to not increase their debt.... They need their ego strength
to get through this really critical period."
"I had one patient with bipolar disorder who was on an atypical
antipsychotic," Daniel Dahl, M.D., an associate professor of psychiatry
at the University of Alabama, said. "He had trouble affording his
medication and stopped taking it. So we put him in the hospital, where he
could afford it."