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Cuts have left clinics struggling

RE “MENTAL health clinics cited” (Page A1, June 20):

As a former clinic manager, I am not surprised that the Arbour Health System clinic in Lawrence is in trouble for having unlicensed therapists treating patients. The pressures that led to that kind of dysfunction also affect other clinics.

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In the late 1990s, grant money for treating the mentally ill dried up. As clinics struggled to survive on insurance reimbursement alone, we saw a marked change in the quality of service. Therapists were required to see more clients per week, to try to make up the money through insurance reimbursements. At the same time, state services that helped very sick people survive in the community were cut. The clinical work for therapists went from demanding to grueling, and then to impossible. Insurance companies unilaterally cut their payments every year.

Experienced therapists fled. Young clinicians right out of school were seeing severely mentally ill people, who might be just out of the hospital, still suicidal, still psychotic, still homicidal, addicted to drugs, and with no medication appointment for a month. If therapists didn’t see enough clients, their pay was cut, so they might come in on Saturdays to see more people. The few clinicians who remained after they got licensed were the ones who supervised the next wave of people right out of school.

As long as we try to fund mental health agencies solely by insurance reimbursement, particularly by Medicaid or Medicare reimbursement, and as long as insurance companies are allowed to repeatedly cut their payments, we can expect to see the quality of care at agencies decline.

Lynda L. Warwick

Pepperell

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