Independent Private Practice
Comprehensive Direct Psychiatric Care provided in the independent private practices setting enables doctor and patient to work toward the fullest possible remission of symptoms as soon as possible, and to maintain this improvement indefinitely with the minimum effective treatment dose over the years. We do this work based on my ongoing review of the psychiatric literature, continuing medical education, best practices and consensus guidelines such as the Practice Parameters issued by the American Psychiatric Association, Facts for Families from the American Academy of Child and Adolescent Psychiatry, and other professional organizations… all correlated to your own information and experience base, insights, preferences and judgments about treatment responses.
Unfortunately, relatively few people have the freedom to choose the level of psychiatric service they actually may need or prefer, after sifting the internet, talking with trusted friends and family and then checking their insurance policies where they often find network limitations which penalize them by reimbursing less if they seek care from an independent private practitioner who is not “in network”.
Many insurance companies, preferred provider organizations (PPO's), employee assistance programs (EAP's), large employers and institutions contract with third party managed care organizations (MCO's). Along with Behavioral Healthcare systems, these approaches have attempted unsuccessfully since 1991 to curb the overall growth in healthcare costs by requiring proof of "medical necessity" for every doctor-patient encounter, or offering “integrated” care with psychiatrists advising other medical specialists and mental health professionals, rather than working intensively with patients having the greatest needs—as in Comprehensive Direct Psychiatric Care.
MCO's and their reviewers do not share in the responsibility for treatment outcomes, but nevertheless may prevent or discourage psychiatrists and patients from taking the necessary time to learn to manage and live with a psychiatric disorder. MCO's usually limit psychiatrists to a "medication management" role, while another clinician does the "talk therapy."
Sometimes a divided approach—now known as “integrated” Behavioral Healthcare because of its focus on primary care medical settings— works well. However in my experience patients confronting the most challenging, complex, relapsing and remitting neuropsychiatric disorders may benefit most when the psychiatrist provides both psychotherapeutic and psychopharmacologic treatment.