Evidence continues to mount that both individual and family psychotherapy save money by cutting health expenditures, reducing employee absenteeism and boosting productivity. In the February American journal of Psychiatry, psychiatrists Glen Gabbard of the Menninger Clinic, Susan Lazar of George Washington University, John Hernberger of'Georgetown University and David Spiegel of Stanford University report that, after reviewing IS studies of different therapy modalities with a variety of diagnoses involving more than 1,200 people, 16 of the studies revealed overall health-cost savings. Some of the most significant cost savings were achieved with family therapy, involving patients suffering from major affective disorders, such as schizophrenia and bi-polar and borderline personality disorders.
In one of the studies reviewed by Gabbard's team, crisis-oriented interventions with the families of 28 schizophrenic patients resulted in less than half the number of inpatient days as treatment with individual and milieu therapy. Gabbard's team also found that individual therapy with borderline personality patients demonstrated significant health-cost savings. In a study of 30 patients, after one year of twice-weekly psychodynarnic therapy, inpatient months per year were cut by half, months per yea;- away from work dropped from 4.5 to 1.4 and medical visits dropped to one-seventh of pretherapy rates.
With milder forms of affective disorders, such as nonpsychotic depression, however, psychotherapy did not seem to lead to significantly lower health care costs. Gabbard speculates that the economic impact of therapy is not as evident in such cases because hospitalization. which seldom accompanies these conditions, does not factor into the costs. But a study by Kirk Karlow, director of the Center for Applied Research and Evaluation at the University of Houston-Clear Lake, of 208 middle-aged members of an employee assistance program yielded a different result. The study looks at all medical costs, even those not specifically related to the patients' psychological diagnoses, and concludes that psychotherapy for people with milder diagnoses leads to significant savings on seemingly unrelated medical costs, in diagnostic categories ranging from infectious diseases to sprains. Reporting in June's Community Mental Health Journal, Harlow found that in the year before they began therapy, subjects' medical costs were significantly higher than those of people in the control group, who never went into therapy. The mental health treatment group's medical costs declined gradually for two years following therapy, at which point they began to rise again, eventually reaching pretreatment levels. Harlow concludes that the study underscores the need for better-coordinated case management between doctors and therapists, so that psychotherapy can be started earlier and reinforced later.
Help on Bad Hair Days
A pilot study by Georgia Robins Sadler, associate director for community outreach at the University of California at San Diego Cancer Center, points to an intriguing new avenue for public health outreach. Concerned about die high mortality rate from breast cancer among African American women (50 percent higher than among white women), Sadler and her associates trained eight beauty-salon cosmetologists working in low-income, African American communities to talk about the relationship of breast cancer to self-examinations, mammograms, weight loss and smoking. Rather than relying primarily on written material, Sadler tapped into the black cultural tradition of oral storytelling, asking storytellers to train the cosmetologists to share information without seeming didactic.
"We examined structural models of stories and decided to go with the bad news/good news model," says Sadler. "Have you heard the bad news that our black sisters have one of the highest rates of breast cancer? Did you know the good news, that there are treatments that can save almost all these lives? …