Why We Need to Rethink Private Practice Psychological Health Care

For more than a century, outpatient mental health care has relied on an outdated model that assumes a separate provider working alone to meet all the needs of those seeking help. This solo approach goes back to Sigmund Freud's initial practice, and although nearly every other field of medicine is developing, behavioral health care is essentially the same. It is no surprise that the model is insufficient.

The need for mental health care has never been higher – while technologies like AI can improve collaboration and efficiency, it has not yet been able to replicate the effectiveness of expert clinicians working as teams. Today, the best solution to meet this need is an integrated system that connects care and drives better outcomes.

It is well known that outpatient care is dispersed, making it nearly impossible for individual providers to provide genuine coordinated support. To better serve patients, we need to reimagine a system in which therapists, psychiatrists, primary care providers and other experts work together to support the entire person. When the care team shares insights and is consistent with the treatment, patients get the right support at the right time. This comprehensive outcome-driven care improves access, increases accountability, and lays the foundation for truly rewarding better healthier value-based models, not just more services.

So why do we still stick to such a system that makes so many people wait, struggle and slip in the cracks? The future of mental health care cannot be placed on the shoulders of a solo provider. We need a collaborative model where multiple providers work together to help people really get better.

Behavioral health as a “team exercise”

Lack of communication can lead to real negative consequences when patients are forgotten, linking and coordination with therapist, psychiatrist, and primary care provider. Typically, one provider focuses on the medication, while the other deals with emotional or behavioral support. If unconsolidated, these efforts can be unintentionally confronted with each other. The patient feels like a stumbling and mental aspect of the body and mind, which may mean less efficient treatments.

For example, the therapist may be working with patients using exposure therapy, with the goal of helping the patient experience anxiety and perform anxiety through limitations, rather than avoiding this. At the same time, prescribers do not know about this treatment and can adjust the patient's medication to suppress anxiety. Without real-time coordination, the therapist is working to resolve the symptoms being taken.

Research shows that communication between providers and comprehensive coordinated treatment is a key driver of patient satisfaction. These factors are crucial to the integrated care model. One of the most effective ways the therapists and prescribers can work together is to develop a shared treatment plan that adapts over time. Many prefer to start with treatment, but for some, treatment alone is not enough. When the therapists and prescribers start with treatment and then introduce medication when needed, it builds trust, keeps the patient engaged, and often leads to better results.

Disadvantages of traditional private practice models

Since private practice therapy is often isolated, access to peer consultation and real-time clinical collaboration is limited. This can create a gap in care, especially when the therapist needs a leave or a crisis. Many therapists do not have access to the opportunity of experts such as psychiatrists, primary care providers, or clinicians with other expertise. For example, people with expertise in anxiety or depression may not have experience in medication use or trauma and therefore have difficulty meeting the full needs of comorbidities or client needs. Without a diverse clinical network, patients may receive incomplete care.

In more complex situations, such as when a patient initially needs CBT for ADHD and then requires trauma-centric treatment, a single provider may not have two specialties. Without coordination among providers, the most pressing issues may not be addressed first, leading to care and slower advancements.

Other medical professions do not operate in this way. The most innovative primary care model over the past two decades has been built on team-oriented multi-specialty collaboration. Mental health care should be no different.

The burden on the patient

Patients often assume responsibility for managing their own care due to poor communication between providers. This coordination is often not possible when someone deals with a mental health challenge. Recently, I stepped in to help my loved ones get the care she needs in another state. Despite being a clinician with years of experience and a wide network of professionals, it still took me hours of research, coordination and advocacy to find therapists with the right expertise and background, identify prescribers, confirm that they are all within the network, check quality of the reviews, and connect points between providers.

If it's hard for me, then someone who lives and breathes this job, imagine the feeling of someone without this background, especially those who are already struggling with depression. This is a system that puts huge pressure on the individual’s most vulnerable person. The impact is not only on the patient. Families are often worried, unsure how to help or what to do next. No one should take care of himself, especially in times of crisis.

Supervision and quality assurance

The team-based model adds a critical layer of supervision to help prevent misdiagnosis and ensure patients are treated with the right care at the right time. Even the most experienced clinicians may miss subtle clues, especially in complex situations. Through a strong clinical supervision and a dedicated quality assurance team, behavioral health providers can track results in a more consistent and structured way, monitor trends and review individual performance. This helps mark missed opportunities, guide targeted training, and support continuous improvements throughout the nursing team, resulting in more accurate diagnosis and more effective interventions.

The power of mental health collaboration

A clinician on my team recently provided book advice and local support group information for a newly divorced father. Within minutes, they obtained a tailored list of resources from trusted colleagues, a study that private practice therapists may have spent hours on. This real-time collaboration not only saves time, but also ensures that patients receive comprehensive and thoughtful support.

A truly collaborative behavioral health team includes:

• Direct patient care provided by the therapist
• Prescriptions who support drug management
• Nursing coordination and navigation, linking patients to resources and nursing transitions (up or down in nursing)
• Emergency intervention crisis services
• Partnerships with primary care providers to ensure full-person health care

Integrating behavioral and physical health care leads to better mental health outcomes and should be a priority in health care models. We can't always expect solo clinicians to do all this.

The future of mental health care is collaborative

Our current mental health care methods are outdated, and for those who need it the most, our mental health care methods are outdated. We should make it easier for people to be better than it is harder.

No provider should expect to do everything, nor should the patient alone have to browse the fragmented system. Team-based models make care more accessible, more effective, and supportive of the patients and providers who care about them.

The best results when connected to mental health. When providers can share responsibilities, communicate openly, and coordinate care, people are more likely to get the support they need at the right time and in the right way.

Photo: Lovethewind, Getty Images

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