What Should You Know about “Split” Mental Health Treatment?

Have you ever faced the challenge of identifying a suitable mental health care provider and felt confused? Initially you may have no idea whether you need the support of one person or a team that can offer psychotherapy, medication, or a variety of other types of support.

Quality mental health care is provided by professionals with a range of qualifications. To make the best decision for your situation you should understand what different professionals offer and ask the right questions so that your care is as effective and seamless as possible, especially if you receive support across multiple disciplines. Recognize that insurance coverage and convenience are factors in accessing care. There are reasons why services are sometimes “split” between psychotherapists and medical doctors. Quality of care is not always determined by delivery from the most credentialed professional at all times. In some instances split care may be the best solution.

Here are some tips on managing split treatment to help you make good choices and get the most out of it when care is provided this way:

Understand what “split” treatment entails

Split treatment pertains to having at least two individuals responsible for your mental health care. One manages medication treatment while the other provides you with psychotherapy. Psychiatrists (MDs) manage medication treatments while licensed clinicians can perform psychotherapy. These clinicians have a range of credentials and backgrounds, including LMHC, LCSW, LMFT, PsyD, PhD, MD.

Determine factors that might affect access to care

Split treatment is driven by pragmatic and market considerations. There is a large supply of non-medical credentialed psychotherapists, so it is simply easier to find a professional who can provide psychotherapy. By contrast, medical-credentialed mental health providers (MDs) are much fewer in number and thus in high demand to provide support and prescriptions for their regular practice and ongoing referrals by doctors in different specialties treating other conditions.

Another reason split care arises is due to the structure of managed care and the different reimbursement for the two different types of services. Not everyone will have access to a psychiatrist who can provide medical treatment and offer the level of psychotherapy a patient requires. Managed care as well as Medicare and Medicaid separate medication treatment from psychotherapy. Each medically designated treatment gets reimbursed at a different rate than psychotherapy. Psychiatrists tend to be the most expensive, therefore, if you are on a tight budget you may want to choose the psychiatrist to manage medications while having another licensed clinician administer psychotherapy.

Avoid common myths when making your choices

Don’t choose your specialist for the wrong reasons. Don’t rule out a psychiatrist because you believe that psychotherapy needs to be part of your treatment. There is a commonly held, yet incorrect, belief that psychiatrists don’t know how to do psychotherapy because they are trained in medicine. Psychotherapy is part of psychiatric training, and some psychiatrists will do additional training in one or more forms of psychotherapy.

What matters most is how skilled at psychotherapy or counseling your practitioner is if that is going to be an important part of your treatment. Furthermore, many psychotherapists may have very good training and knowledge about medications. Therefore, you should ask your psychotherapist about their knowledge about medications, and when they think it would be appropriate to consider, particularly if split care with a psychiatrist is needed.

Create a team

One of the most important factors that you need to consider is whether you get along with and gel with your care providers. Then take it to the next level, and make sure the providers work well together if you need split care. Ask questions to help you understand whether the two professionals can work in collaboration. If they work well together, you can receive benefits because they can see two different perspectives (medical and psychological) around the issues you are facing.

In addition, as a psychiatrist who does psychotherapy as well, I can sometimes be in the role of an additional primary care provider alongside their internal medicine doctor or family medicine doctor. If a patient has other medical conditions in addition to their mental health condition, I can sometimes catch acute medical problems that need further addressing by their internal medicine doctor.

Avoid creating competition between a psychiatrist and a psychotherapist. It is quite common for a patient or client to tell some parts of an experienced situation in a slightly different way to both providers and come out with different perspectives or feedback. It can then feel natural to deem one provider as the "right" one, and the other as the "wrong" one. It won’t help your situation if they are at odds with one another. When you encourage them to become collaborators for your care you are likely to reap the most benefit. Therefore, it would be good to allow the two providers to share their perspectives with one another if they are helping you with the same situation.

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Split care may or may not be the right option for you, but it is not necessarily a problem. Understand what different practitioners offer and if you decide to work with multiple providers, ensure open channels of communication between all providers in your care.

To find a therapist, visit the Psychology Today Therapy Directory.