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"Mental illness affects one in five Canadians. It is a factor in 90 per cent of suicides. And its cost to the economy in health-care dollars spent, and in lost

by scarmig 11y ago

"Mental illness affects one in five Canadians. It is a factor in 90 per cent of suicides. And its cost to the economy in health-care dollars spent, and in lost productivity, amounts to nearly $50-billion a year. Yet, no province currently pays for therapy provided by a private psychologist or social worker... Research has found that psychotherapy is as effective as medication – and in some cases works better... In 2013, a team of European researchers collated the results of 67 studies comparing drugs to therapy; after adjusting for dropouts, there was no significant difference between the most often-used drugs – selective serotonin reuptake inhibitors (SSRIs) – and psychotherapy." Naive question: Is the current consensus that SSRIs and other medications are generally effective? If therapy manages to match the efficacy of something that's not at all effective, that isn't a strong reason to fund it, even if the other thing also happens to be funded. I suspect the answers are "sometimes" and "it depends." But, yes, therapy should be funded for conditions that evidence shows will likely respond better to therapy than to pills or placebo. ETA: Found this article, which describes the issues and takes a pro-SSRI over therapy or placebo perspective: http://slatestarcodex.com/2014/07/07/ssris-much-more-than-you-wanted-to-know/ http://slatestarcodex.com/2014/07/07/ssris-much-more-than-yo...

mattmanser 11y ago
50-65% improve with SSRIs compared to 30% with placebos http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/antidepressants.aspx http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/an... There was a discussion on here recently which had some evidence of the "therapy is even better than SSRIs", but therapy is a lot more expensive as a treatment I think. Like in the UK it's £45 per session. Here in the UK I know you can get 6 weeks therapy on the NHS, but as the article laments, it just stops even if you're not cured which seems bizarre and there's a waiting list which doesn't help in the case of severe anxiety when you need help now. On the other hand, you can get fairly inexpensive self-help books which you can use to teach yourself a lot of the CBT techniques: http://www.amazon.co.uk/Overcoming-Anxiety-Self-Help-Behavioral-Techniques/dp/1849010714 http://www.amazon.co.uk/Overcoming-Anxiety-Self-Help-Behavio... Which isn't even mentioned in the article.
- furyg3 11y ago
  A family member has suffered for a long time with a mental disorder that included major depression and even a serious suicide attempt. For a large part of her life therapy was drug-focused. It was very difficult to achieve consistency, both for the patient and for the care-givers (medicine changes, hope of better optimizing medications, changing insurance coverage, etc). Only since she has also been receiving talk therapy (including CBT) in addition to some drugs has she seen serious improvement and a better ability to rely on herself and make good decisions when it gets difficult. Talk therapy is expensive, but the cost of medications can also be extremely high, and the cost to the family and society when things goes wrong can also be huge. In many cases medicine works wonders... but there are a lot of disorders (e.g. personality disorders like borderline) where medicine has far less of an impact (none or only treat some very specific symptoms). I'm really optimistic about our developing knowledge about brain chemistry and developing newer and better treatments, but it is very naive to think that they can solve problems with drugs that are fundamentally interpersonal issues. It's very difficult to resist the sexiness of replacing hours with a therapist with a pill, especially in a profit based health system.
nerfhammer 11y ago
A counterpoint is that in contrast to these studies most/many private therapists offer at least some forms of treatment that are not at all evidence-based
rrss1122 11y ago
The answers are "sometimes" and "it depends." I'm of the opinion that research dollars should go towards more cost-effective treatments. Therapy appointments are in general pretty expensive, both in actual cost and in time spent. However, one treatment method I found out about recently seems to tackle both these drawbacks of traditional therapy. That treatment method is called cognitive bias modification. It's based on the premise that anxiety disorders and related mental illnesses are maintained by cognitive biases in the sufferer, attention and interpretation biases specifically, and by changing these biases people who suffer from mental illness can see relief. One way to accomplish changing these biases is by presenting people with stimuli they would normally encounter in their environment and training them to identify positive stimuli, in effect modifying their attention bias towards positive stimuli. If you do a search for cognitive bias modification in your device's app store, you can already find apps that claim to help. The efficacy of these apps is not scientifically established, but it does point to the promise that CBM therapy can be both cost-effective and easily accessible. It might not even be necessary to subsidize people's access to this kind of therapy, but instead to simply subsidize the production of apps that assist with this kind of therapy. Here is a paper explaining the current state of the field (as of Dec 2011): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092585/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092585/

by scarmig 11y ago

mattmanser 11y ago

50-65% improve with SSRIs compared to 30% with placebos http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/antidepressants.aspx http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/an... There was a discussion on here recently which had some evidence of the "therapy is even better than SSRIs", but therapy is a lot more expensive as a treatment I think. Like in the UK it's £45 per session. Here in the UK I know you can get 6 weeks therapy on the NHS, but as the article laments, it just stops even if you're not cured which seems bizarre and there's a waiting list which doesn't help in the case of severe anxiety when you need help now. On the other hand, you can get fairly inexpensive self-help books which you can use to teach yourself a lot of the CBT techniques: http://www.amazon.co.uk/Overcoming-Anxiety-Self-Help-Behavioral-Techniques/dp/1849010714 http://www.amazon.co.uk/Overcoming-Anxiety-Self-Help-Behavio... Which isn't even mentioned in the article.

furyg3 11y ago
A family member has suffered for a long time with a mental disorder that included major depression and even a serious suicide attempt. For a large part of her life therapy was drug-focused. It was very difficult to achieve consistency, both for the patient and for the care-givers (medicine changes, hope of better optimizing medications, changing insurance coverage, etc). Only since she has also been receiving talk therapy (including CBT) in addition to some drugs has she seen serious improvement and a better ability to rely on herself and make good decisions when it gets difficult. Talk therapy is expensive, but the cost of medications can also be extremely high, and the cost to the family and society when things goes wrong can also be huge. In many cases medicine works wonders... but there are a lot of disorders (e.g. personality disorders like borderline) where medicine has far less of an impact (none or only treat some very specific symptoms). I'm really optimistic about our developing knowledge about brain chemistry and developing newer and better treatments, but it is very naive to think that they can solve problems with drugs that are fundamentally interpersonal issues. It's very difficult to resist the sexiness of replacing hours with a therapist with a pill, especially in a profit based health system.

nerfhammer 11y ago

A counterpoint is that in contrast to these studies most/many private therapists offer at least some forms of treatment that are not at all evidence-based

rrss1122 11y ago

The answers are "sometimes" and "it depends." I'm of the opinion that research dollars should go towards more cost-effective treatments. Therapy appointments are in general pretty expensive, both in actual cost and in time spent. However, one treatment method I found out about recently seems to tackle both these drawbacks of traditional therapy. That treatment method is called cognitive bias modification. It's based on the premise that anxiety disorders and related mental illnesses are maintained by cognitive biases in the sufferer, attention and interpretation biases specifically, and by changing these biases people who suffer from mental illness can see relief. One way to accomplish changing these biases is by presenting people with stimuli they would normally encounter in their environment and training them to identify positive stimuli, in effect modifying their attention bias towards positive stimuli. If you do a search for cognitive bias modification in your device's app store, you can already find apps that claim to help. The efficacy of these apps is not scientifically established, but it does point to the promise that CBM therapy can be both cost-effective and easily accessible. It might not even be necessary to subsidize people's access to this kind of therapy, but instead to simply subsidize the production of apps that assist with this kind of therapy. Here is a paper explaining the current state of the field (as of Dec 2011): http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092585/ http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092585/