The Business of Mental Health

There are two sides of the health care industry - the service side and the business side. Service, in this sense, refers to the actual delivery of medical attention. More specifically, it refers to a patient's dealings with not only the health care providers but also the administrative staff (particularly when booking appointments and checking in). The second side of the health care industry is the business side. Providers and patients probably prefer not to think of health care as a business, but it is; in order to provide adequate service to their patients, the clinic, doctor's office, or hospital needs to earn money through insurance claims and self-pay statements. While health care is (supposed to be) a non-profit industry, there still needs to be a certain amount in financial returns so that the facility can continue to provide its services to its patients. 

Mental health care can be an especially difficult service to refer to as a "business." Patients are already dealing with mental illness of varying degrees; when you introduce the potential bills related to their mental health services, this can become both an added stressor as well as a potential barrier to care. Still, mental health providers, like all health care professionals, need to generate an income in order to continue counseling patients. Thus the question of how to introduce the topic of billing can be difficult for providers. To what extent do you tell patients, that you will be charging them what some may consider an unjustified amount of money for a service?

This topic can be a little easier when a patient is coming in for an outpatient mental health appointment. The patient (or the patient's parent) made the appointment knowing that there will be a charge (including co-pays, deductibles, etc.) Where things get slightly more complicated is when a patient is seen on a hospital's medical floor for a psychiatric consultation. In this case, the patient was admitted for a medical reason, but was seen by a mental health provider during his or her stay. In this case, how much responsibility is on the mental health provider to warn the patient or his/her parents, that the service is both separate from the medical services and billable? Does the psychiatrist or psychologist provide this information knowing the patient or parent may then refuse what may be a necessary consultation? On the front end, the patient would not receive a service that could potentially improve his/her quality of life. Additionally, the provider's or providers' number of consultations annually could decrease dramatically.  Without this caveat, however, patients or parents may become angry if they receive a bill related to a service for which they were not specifically admitted even if there were benefits to the service. Even when a patient is admitted to an inpatient psychiatric unit, the costs associated with the admission may not be fully understood leading to similar issues. All of the issues described may be part of the problem that many have with health care in general - the costs can astronomical leading to extreme financial hardship. 

While mental health care is indeed a service, is the failure of administrators and providers to underscore the 'business' side of an industry already stigmatized in American society doing a further disservice to the patients they serve?