When I first began reading "Why Provide Music Therapy in the Community for Adults
With Mental Health Problems?", my initial impression was more of a skeptical one. The author,
Helen Odell-Miller, provides a brief overview of the British healthcare system early in the paper, emphasizing the market-led economy governed by the balance between purchasers and providers. Providers furnish services, which are available to be sold to purchasers. Services from providers
must be justified as not only effective but also cost-effective. Otherwise, purchasers will have no
rationale to warrant acquiring these services. It is therefore reasonable to expect providers to attempt
to provide adequate information and explanation to convince purchasers to procure these services.
Based upon this system of "purchasers vs. providers", it appeared that the purpose of the article was
to put a quite favorable "spin" on music therapy so that its salability and marketability would be
enhanced.
This resonated with me in a negative and deprecating manner with a ring of possible
deception. If this treatment modality is truly effective, then why would one need to actively
promote and patronize the purchasers? Is this article sycophantic? As stated above, this was
my initial impression. Fortunately, mature persons, when provided with additional information ,
are allowed to change their minds when warranted.
The paradigm of mental health treatment has shifted from inpatient institutionalization
to outpatient therapy and preventive care. This is related to the prohibitive cost of inpatient
treatment. Theoretically, music therapy, which can involve multiple patients simultaneously,
would be far more economical than either inpatient therapy or outpatient one-on-one treatment.
However, economical treatment and effective treatment are two separate issues. In order to
be cost-effective, treatment must be economical and effective concomitantly.
After alluding to the type of healthcare system with which music therapy must contend,
the author sets out to establish its effectiveness. With my already existent skepticism, I was
hoping for a convincing argument that music therapy truly has merit. I must admit that
I was not disappointed. Even thought I was expecting some hypothetical declaration,
I was pleasantly surprised to find that actual cases with real outcomes were presented. I would
compare this to the adage "This is where the rubber meets the road." One can talk about
theoretical outcomes but actual patient results are what really count. The author systematically
presented multiple actual cases outlining length of treatment; the reason for referral; and aims,
benefits and outcomes as reported by a multidisciplinary team. Some outcomes were better
than others (even full rehabilitation being reported) but all were reported as positive. Although
I initially had misgivings and skepticism; positive outcomes cannot be overlooked or minimized.
To further address my initial doubts about providers touting their services, I briefly researched current practices here in the U. S. regarding medical marketing and found that it is commonplace for providers to report positive outcomes in an effort to enhance sales and usage. Therefore, my initial skepticism of music therapy has been neutralized by the author effectively presenting actual case reports with positive outcomes and also by my learning that it is customary to present these positive outcomes as a mechanism to enhance marketability and salability.
I found this article to raise many important points about the use of music therapy in community settings in America, even though it was written about music therapy practices in England. I was also glad to see benefits and treatment outcomes of music therapy in the community adult mental health population. Benefits of long term care are mentioned in the article that result from an engagement in music therapy for periods of two to four years, once or twice a week include: a decrease in breakdown as well as a decrease in readmission to the hospital. I have often heard it mentioned in the international community that American mental health treatment is too focused on quick fixes. Many short term units will focus on treatments such as cognitive-behavioral therapy, dialectical-behavioral therapy, and psychopharmacology. Though I believe that treatments such as these focused on stabilization and maintenance are appropriate, and necessary, in the long term I believe it does not address the full spectrum of long-term mental health. I believe the use of music therapy in community mental health setting is also important for long term psychiatric health considering some of the many challenges faced my music therapists in acute psychiatric settings.
Many inpatient stays due to insurance coverage and managed care in the US can be limited to seven to ten days. Because of the rate of turnover in acute care many patients are only able to see a music therapist once within this setting. Carylbeth Thomas said "Since acute care essentially demands assessment and treatment of the client simultaneously, there is often little time for individual interviews, testing or ability to review existing information prior to actual treatment. The music therapist must rely mostly on observation and intervention concurrently in order to work effectively and successfully in acute care settings. In these kinds of settings, each session needs to be considered in its own right as a one time experience. The music therapist is often expected to assess several new individuals during this process." (Crowe and Cowell 2007)
Work with this population, along with simultaneous assessment and treatment also requires a music therapist to build what they can of a therapeutic relationship in a single session. Seeing a music therapist for a single session also would not offer the therapeutic benefit of the stable containing space that Odell-Miller talked about in reference to a community setting.
The acute care music therapist is also challenged to work towards goals that are attainable in the time alloted. Carylbeth Thomas went on to discuss some possible music therapy goals in the acute care setting. "More generalized goals such as behavioral containment, emotional support, structure of experiences, involvement with others, and validation of the individual are always to be considered with all clients." (Crowe and Colwell 2007)
To conclude I will say that I believe there is much potential and therapeutic change to be found in community based adult mental health music therapy in America to which the arguments are similar to the arguments of Odell- Miller in her article. It can address long term benefits such as a long term containing therapeutic space, and could go beyond short term treatment goals stabilization and reduce rates in the long-term of relapse and re-hospitalization. It could address transference and countertransference relationships in a way that a short term psychiatric unit does not address. Given the challenges of music therapy with acute care patients, I believe community based treatment with the adult mental health population not only has the opportunity to address a completely different assortment of goals, it also adds a new level of potential to the outcome of a music therapy based intervention.
Reference
Crowe and Colwell (2007). Music Therapy for Children, Adolescents, and Adults with Mental Disorders (p.128-129). American Music Therapy Association.