That’s because other professionals are willing to do it more cheaply. Under managed care psychiatrists now work in direct competition with psychologists, social workers and psychiatric nurses who also offer face-to-face therapy, sometimes at half the price. Nonmedical mental-health clinicians outnumber psychiatrists 3 to 1. That exasperates psychiatrists, who spend 13 years in med school. ““All you have to do is hang out a shingle and you’re a counselor,’’ says Dr. Roy Menninger, chairman of the Menninger Foundation in Topeka, Kans.
A few psychiatrists are resisting change. But in the past several years many have begun treating only the most serious mental illness, using more high-tech science and medication and less ““expressive therapy.’’ That isn’t the solution to all their professional woes: primary-care physicians dole out up to 65 percent of popular antidepressants like Prozac. Many shrinks support universal coverage, which would bring in millions of new patients for all mental-health professionals. But the classic talking cure may become a rarity, something for the well-heeled few.
