News-Record.com

The Health Beat Blog says it bluntly: Medical practitioners are often slow to adopt well-researched, proven mental health interventions -- because they're rarely profitable.

... you'd think that health care practitioners would make it a priority to provide effective mental health treatment. But a 2005 study from the National Institutes of Mental Health (NIMH) and Harvard found that only one-third of mental health therapies received by patients meet minimal standards for adequacy as established in national guidelines. That means that when we know what works -- and even draw up guidelines to define best practices -- relatively few providers follow the rules. Why is it so hard to translate knowledge into practice?

Three academics -- Robert Drake, M.D. and Jonathan Skinner, Ph.D from Dartmouth Medical School, along with Goldman -- wrote an issue brief for the conference that looked at his very question. Their conclusion? It's all about the money.

According to the authors, most effective mental health treatment regimes are not purely medication-based but also involve psychosocial intervention -- that is, a program of cognitive and behavioral measures such as patient education, psychotherapy, and peer support. ...

Given [cognitive behavioral therapy]'s focus on self-esteem, perspective, and encouragement, it might come off as somewhat touchy-feely to the outside observer -- but in fact it's proven to be quite effective. ...

Why can't psychosocial treatments seem to catch a break? "Unlike new medications, where the marketing of new practices is supported and encouraged by patents," notes Drake et al. in their issue brief, "psychosocial treatments are not patented and therefore lack the economic incentives to promote them widely. Because it is difficult to market, doctors are less exposed to best practice strategies and consumers are often unaware of other strategies for treatment."

Speaking about this issue in person during a panel at the conference, Drake didn't mince words, noting that "no one makes a profit off psychosocial interventions, so they are used less often." Moreover, a treatment like CBT is not quick and easy: it's sequential, collaborative, and personalized. In short, it's messy, labor intensive -- and thus hard to sell.

Is there a way these "best practices" can be applied more widely when market forces appear to be arrayed in opposition? Or is this a problem the market cannot fix? I'm not much of an economist, so anyone who has some insights, please speak up.