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The Future of Psychiatry?
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Dr. Chris Sedergreen.

A highly respected psychiatrist has recently sent a letter to her patients announcing her decision not to return to clinical practice. I've known her professionally for over 15 years and can attest that her departure will leave a gap in her patient's lives that will be almost impossible to fill.

The psychiatrist is looking to find ways to fill the enormous gaps in psychiatry delivery, that arise from woefully inadequate funding and general mismanagement of resources by non-physician managers. Her decision came after much soul searching and genuine concern for the well-being of the patients she would no longer be able to care for. As she said “I have searched for a colleague who would be willing to take over my practice, but it will likely come as no surprise that this person was impossible to find.”

This ought to be a wake-up call to the profession and to all medical professional associations across the country, as well as to the Colleges of Physicians and Surgeons who go out of their way to create obstacles to medical practice.

Like all the so-called 'cognitive' branches of medicine psychiatry is woefully inadequately funded. This is as true for psychiatrists as for GPs who try to fill the gap caused by the severe shortage of psychiatrists. Indeed GPs are now openly expressing reluctance to accept patients with psychiatric issues.

Before I retired I referred a suicidal patient on an emergency basis to a local department of psychiatry: she was sent home and killed herself within a week. Lest this comment is seen as a criticism of that department, let me hasten to add that I had no idea of the pressures they were working under: there are never enough resources that are in any case managed by non-physicians, who typically build mini-empires around themselves.

The managements and the politicians are 100% to blame. Much of it started in the early 1980s with the absurd decision to close down psychiatric institutions and cast all the inmates onto the streets, to be preyed upon by drug pushers (instead of bringing the institutions up to humane standards).

There is a tendency in certain segments of the medical profession to discount mental health issues. Sometimes the dismissive term "the worried well" is used to describe such patients; as if they are not really unwell at all. Yet there is a vast abundance of data that demonstrates the cost to society in dollar terms, in terms of lost productivity, not to mention of lost lives with real potential, of failing to provide adequate care. It would actually be to society's benefit to provide adequate treatment to patients with mental illness.

If the mental health budget were tripled overnight, it would barely be adequate; but that doesn't mean that we shouldn't at least triple the number of practicing psychiatrists (as well as show them respect for the valuable work that they perform).

What is really needed is a fundamental re-appraisal of how we, as physicians and as a society, should manage mental health disorders. I’m not talking about tinkering at the edges of the system; but about a newly designed system that takes proper care of patients with mental illness and above all prevents them from being exploited by persons who have anything but their best interests at heart.  It will undoubtedly require a lot more money, but it will likely also save a great deal of money if the strategy is properly considered. For example, much of the money now being poured into addictions management will be able to be diverted into more effective uses.

 

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