Diagnosing a mental disease or disorder, something like schizophrenia or clinical depression or bipolar disorder, requires the expertise and training of a physician. A medical doctor. Someone who understands the complex interrelationships between -- and how to treat -- mental and physical illnesses.
That's why the Texas Medical Association is involved in a case before the Texas Supreme Court to stop marriage and family therapists from diagnosing mental disease or disorder. Somewhere in the course of providing their much-needed, valid, and legal service to, as Texas law states, "evaluate" and "remediate ... dysfunction in the context of marriage or family systems," these marriage and family therapists decided they need to be able to diagnose mental illness.
Yes, we have a serious access-to-care problem for mental health services in Texas. And the mentally ill in Texas need every resource they can get, from doctors, therapists and others. But the outcome of this case won't solve that problem.
This case is about payment. Money. And any decision the Supreme Court reaches won't put more money into our mental health system.
Texas' marriage and family therapists, the people taking the case to the court, state as much in several of their legal filings. The lower court decision they are appealing, they write, is "a dire threat to the viability of marriage and family therapy practice." In another brief they say the lower court decision "may threaten the practice of marriage and family therapy in Texas and the livelihoods of many" therapists.
Why? The money. Health insurance companies don't want to pay for these therapists' services without a diagnosis on the claim form. The Texas Medical Association worked with the therapists to try to fix this problem during the 2015 legislative session. When that didn't work, they went back to fighting in court.
The best explanation of this problem comes from a letter to the editor of The Dallas Morning News written by my colleague Dr. Ed Nace, a Dallas psychiatrist: "The mental health crisis in Texas is not related to marriage and family therapists not being able to make medical diagnoses. The crisis results largely from the underfunding of mental health and addiction treatment; managed care insurance companies denying needed treatment; the lack of progress in federally demanded parity for psychiatric illnesses as insurance companies drag their feet to thwart paying fairly; and the lack of psychiatric inpatient beds in our community hospitals (as psychiatric units bring in less insurance money than surgical units). For example, the new 870-bed Parkland Hospital only has 14 in-patient beds for psychiatric care.
"Marriage and family therapists have a lot to offer patients, but making medical diagnoses is not what they are trained to do. The Texas Medical Association and the courts got it right. More diagnosticians isn't the answer to the crisis we witness daily."
Texas does have a severe shortage of mental health professionals. We don't have enough psychiatrists, psychologists, psychiatric nurses, clinical social workers or marriage and family therapists. The problem is payment. Professionals who render a needed service should be paid for their work on behalf of their clients and patients.
Don R. Read, MD, is president of the Texas Medical Association. president@texmed.org