“The medical society’s lock on psychiatric care in this country is starting to break up,” says Barbara Alexander, “and they’re really hysterical about it.”
Clinical social workers are among the major providers of mental-health-care services, along with psychiatrists, psychiatric nurses, and psychologists. Right now, insurance companies that provide reimbursement for outpatient mental-health care are required by law to pay for services only by MDs and PhD psychologists; but many do pay voluntarily for the work of clinical social workers. A bill to make such reimbursement mandatory, Senate Bill 577, recently passed the Illinois senate but was voted down by the house on June 23–by two votes.
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The Illinois Psychiatric Society won’t give out information on fees charged by its members; but according to several sources, $100 for an hour of a psychiatrist’s time is the average, with a high of $125 in the Chicago area. Clinical social workers, according to a spokesperson for the Illinois Society for Clinical Social Work, average $40 to $70 an hour. Psychiatrists can prescribe medications, hospitalize, and do physical checkups; clinical social workers cannot. But according to Elliott, “There is no difference in terms of the talking treatment. . . . It used to be that a psychoanalyst was concerned only with the mind, and the social worker with the milieu–but that difference does not exist anymore, unless you’re dealing with a strict Freudian psychiatrist, and those are probably found only on the east coast now. Psychiatrists now are taking a more interpersonal approach–closer to what a clinical social worker does. The basis of all of it is psychoanalysis.”
Elliott says she doesn’t really have an average patient; they’re all adults who work for a living, but they may be gay, straight, single, or married. She points out that CSWs do most of the less glamorous counseling, such as therapy for alcoholism and other drug-abuse problems. Furthermore, many psychiatrists (who are considerably rarer than CSWs) prefer the more lucrative work to be found in hospitals, where they can see more patients, usually with more severe problems, for shorter sessions and more money. There are often more CSWs available, and they may be more willing to provide garden-variety therapy.
So if costs are lower, why do business groups like the Illinois Chamber of Commerce oppose this bill? “Because they want to kill anything that’s mandated anything,” responds Goldstein. “We have been unable to get their attention and say, ‘Why do you think the biggest companies in the country are using social workers? Because they’re cheaper, dummy!’
“Second, it is not the case that a clinical social worker or any other mental-health practitioner will necessarily save money. Just by virtue of adding a new provider you will increase the cost–people will see a psychiatrist and a clinical social worker.” Why? “I wouldn’t have a clue, but the studies I’ve seen tell me that would happen. And people see clinical social workers more frequently than psychiatrists.
“I guess I’m saying that if it ain’t broke, don’t fix it. And from our perspective at least, it ain’t broke.”
