Psychotherapy Finances

Here’s a topic long discussed, and verified from time to time: the falling income of mental health professionals.

The American Psychological Association reported in its April issue of The Monitor on Psychology that salaries have decreased in related jobs across the board. From practitioners in clinical practice to professors and researchers, incomes have continued to dwindle over the last nine years.

For a chart published by the Monitor for selected positions from 2991 to 2009, click here.

Psychologists in applied settings (consulting to business, for example) continued to earn the highest salaries, although even these dropped from about $95,000 to under $90,000.

Lowest on the scale were assistant professors, followed by clinical psychologists or, “direct health service providers.” In the latter category, average income dropped from more than $60,000 per year to the high 50s.

Associate professors, though, were the hardest hit.

The APA surveys salaries once every two years.

Generally, as Psychotherapy Finances surveys have shown, private practice income has steadily declined. The only way to recover some of the loss is to offer a broader spectrum of services, such as consulting or coaching.

Details are emerging on the implications for mental health treatment in the Patient Protection and Affordable Care Act (health care reform) signed by President Obama March 23. The $938 billion package is designed to expand access to mental health care, according to analysts.

Mental health parity bills required insurers to offer comparable mental health benefits – if they were offered at all. But under health care reform, new health insurance exchanges are mandated to offer mental health coverage. That also includes substance abuse treatment coverage.

In addition, the new law significantly expands Medicaid, which remains the country’s biggest mental health benefits payer.

The Legal Action Center, an advocacy organization, published a more detailed analysis concluding: “The final bill requires all group and individual plans to comply with Wellstone/Domenici, which requires that SUD/MH benefits be provided in the same way as all other covered medical and surgical benefits.”

Additional details are available on the LAC’s Website.

The American Psychiatric Association, which has been supportive of the initiative throughout the process, said the final law that emerged is “a major step forward” in mental health insurance coverage, but conceded that “it’s not perfect.”

Oregon Governor Ted Kulongoski has vetoed a bill that would have authorized prescription privileges for trained psychologists.

Senate Bill 1046 was passed by both the state House and Senate and was sent to the governor’s desk in February. Kulongoski kept people in the mental health community guessing since then, although he signaled a possible intent to veto two weeks ago.

Had it been approved, Oregon would have become the third state in the nation to allow certain psychologists to prescribe drugs, joining New Mexico and Louisiana.

“I am concerned that Senate Bill 1046 as written creates serious policy and regulatory conflicts,” Kulongoski wrote in a veto statement to the secretary of state.

“Furthermore, I believe that a policy change of this significance requires more safeguards, further study and greater public input than was provided during the February special session.

“I believe that the best first step toward achieving the goals of Senate Bill 1046 is for the legislature to authorize in the 2011 Legislative Session a pilot program that would generate data on which to inform and guide solutions that give greater access to broader mental and physical health care,” the governor added.

The Oregon bill represented psychologists’ best hope since the Hawaii Legislature passed a prescription bill in 2007. That bill was vetoed by Governor Linda Lingle.

Social networks like Facebook, Twitter and Myspace are increasingly popular on the Internet. Using them wisely can help build your practice, as we’ve noted in numerous past issues of Psychotherapy Finances. But how much personal information should you reveal about yourself online — and is it OK to retrieve information about a client?

These are questions that have yet to be addressed by professional associations, state laws, and the courts. Any therapist who wades into the issues in his or her private practice is basically blazing new trails.

The topic was explored in-depth in a recent Washington Post article that raises some relevant issues, and examines the pros and cons.

Policies are evolving and there appears to be no hard and fast rules. Although the American Psychological Association hasn’t addressed the matter, the American Psychiatric Association maintains that using the Web to gather information about a patient is fine if it’s done in the interest of helping that person, and not out of curiosity.

Stephen Behnke, ethics director for the American Psychological Association, told The Post: “We are just beginning to understand what ethical issues the Internet is raising. To write rules that allow our field to grow and develop and yet prevent [patient] harm at the same time: That’s the challenge.”

Meanwhile, therapists are handling the issue in ways that they see fit, in essence developing their own policies that protect their clients, but still allow the therapist to function in this new, online world.

Colorado psychologist Stephanie Smith, for example, has a Twitter account and posts links to items that clients and potential clients may fine helpful. However, she felt she had to draw the line when clients and former clients began sending her “friend” requests on Facebook. Now, she tells clients upfront about her policy of not involving them in her Facebook postings (there are several levels of privacy you can employ on a Facebook page.)

On the other hand, Smith does occasionally post something about her children, or even celebrity news, on her Twitter page. “It’s my style, but I know some people would not be comfortable” with it, she says.

This is becoming a hot topic, not only for therapists but clients as well. There were dozens of comments on The Post story, which you can read by clicking on the link at the bottom of the article. Emotions run high on all sides.

It looks like the latest bid to establish prescription privileges for psychologists may go down in flames. At best, a delay may be in the works.

The Oregon Legislature approved SB 1046 on February 26, raising hopes among supporters in the mental health community that the state would soon become the third in the nation to allow psychologists to prescribe.

But this week Governor Ted Kulongoski issued a “notice of possible intent to veto” the bill. Although it doesn’t necessarily mean a veto is imminent, it apparently buys time for the governor to continue weighing a very contentious issue.

The notice, posted on the governor’s Website on Monday, says it allows him “to take such action five days after the date of this notice, or later, if he chooses to do so.

“This notice is not exhaustive and may be followed by subsequent notices of intent to veto. The law provides the Governor until the end of day April 1 to issue notices of intent for possible vetoes. Final action on all bills from the February legislative session must be taken by end of day April 8.”

The notice also seemed to soft-pedal the legislation. News announcements in February indicated that a law along the lines of New Mexico’s or Louisiana’s was in the works.

But the description on the Website describes a law that would have to come back for further legislative scrutiny:

“Senate Bill 1046 establishes a Task Force on Prescribing Psychologists to develop criteria for consideration by a future legislature that will allow certain licensed psychologists to prescribe medication. The bill also creates a Committee on Prescribing Psychologists, within the Oregon Medical Board, to develop a formulary of approved drugs that could then be prescribed by the licensed psychologist who also meets the professional requirements established by the legislature.”

You can check for a definitive ruling on SB 1046 using this link.