Tight Budgets in Public Mental Health Clinics Impact Care

While many community mental health clinics have been increasing their use of evidence-based psychosocial practices (EBPs), these clinics have also been relying more heavily on independent contractors to treat patients, largely for budgetary reasons. However, these independent contractors may not be utilizing EBPs as much as salaried therapists, according to research published in Psychiatric Services.

“The independent contractor therapists we surveyed turned out to have less positive attitudes towards evidence-based talk therapies for youth, such as cognitive-behavioral therapy, and less knowledge about them, compared with salaried employee therapists,” Rinad S. Beidas, PhD, an assistant professor of Psychology in the department of Psychiatry at Penn Medicine, said in a statement.

EBPs, broadly defined as talk therapies that are informed by rigorous research, clinician expertise, and patient preferences, include practices such as cognitive-behavioral therapy (CBT), which emphasizes problem-solving and teaches specific skills to youths in order to help them correct distorted thinking and change behavior.

In recent decades, all healthcare disciplines have been working to provide better, more standardized care by identifying EBPs and pushing for their use. In the city of Philadelphia, the Department of Behavioral Health, led by Commissioner Arthur C. Evans Jr, PhD, created a program in 2007 to foster and support EBPs in public mental health clinics.

Dr Beidas and her colleagues began studying EBP implementation in Philadelphia three years ago. “One of the things that my team initially noticed, which we did not expect, was that there were a lot of independent contractor therapists at these agencies,” Dr Beidas said.

Some of the agencies had begun to use independent contractors exclusively, appearing to reflect a national trend of moving away from salaried therapists and instead to contractors in staffing mental health clinics. Contractors are cheaper to maintain because they are paid only when they see patients, and they don’t require the overhead costs of salaried employees, such as insurance benefits.

This led Dr Beidas and colleagues to wonder whether these contractors would be as involved in implementing EBPs compared with salaried therapists. “When we looked in the literature, we found nothing on this,” she said.