200914
Access to Comprehensive Psychiatric Assessment
and Integrated Treatment
POSITION STATEMENT
Approved by the Board of Trustees, May 2009
Approved by the Assembly, Septemer 2009
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"Policy documents are approved by the APA Assembly and Board of Trustees… These are …position statements that define APA official policy on specific subjects…" -- APA Operations Manual. |
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ISSUE: Patients who seek help for psychological and emotional disorders require and deserve a psychiatric assessment in order to have their conditions accurately diagnosed and their treatment needs delineated in a comprehensive, biopsychosocial manner. However, some Managed Care Organizations (MCOs) will initially refer these individuals to non-physician mental health clinicians for psychotherapy, without the benefit of a psychiatric assessment which is necessary to assure that treatment is appropriate. Often, these patients continue to suffer needlessly for extended periods without improvement before a psychiatric consultation is made available. Additionally, MCOs often will only authorize psychiatrists to prescribe medication in the context of a “split treatment” with a non-medical clinician, without regard for whether the treatment preferentially warrants a single psychiatric clinician undertaking all aspects of care.
POSITION STATEMENT:
For patients referred for the treatment of mental illness:
- Restricting access to assessment by a psychiatrist and integrated treatment is not cost-effective.
- Delegating treatment to various specialties is a medical, not a procedural administrative or business decision.
- There are some situations in which split treatment has advantages, many situations in which it is inadvisable, and no situation for which it should be mandated by a health plan.
APA supports screening and referral protocols by which:
- Any patient who is referred for mental healthcare should be properly screened and be seen by a psychiatrist early enough for meaningful clinical input towards the patient’s comprehensive psychiatric assessment and to ensure attention and coordination of medical care for associated medical needs.
- Treatment planning should be based on a comprehensive assessment using the biopsychosocial perspective.
- Patients in need of treatment should not be barred from receiving combined psychotherapy and medication management from psychiatrists who are available and willing to offer it.
Prepared by the APA Committee on Managed Care: Paul H. Wick, M.D. Chair, Robert C. Bransfield, M.D., Co-chair, Gregory G. Harris M.D., George D. Santos M.D., Jonathan L. Weker M.D., Barry K. Herman M.D., Alan A. Axelson M.D., Anthony L. Pelonero M.D., Nicolas Abid M.D., and Joel Johnson M.D.
See the related resource document here.