Posted by Dr. Vollmer on December 15, 2014
Does “Community Psychiatry” mean low-income pill mills or can Psychiatrists have a larger impact on community mental health, without going through the avenue of public policy change? In other words, can a graduating psychiatrist, one with ten years of training, four of which are specialized in psychiatry, find an employment opportunity in which they are not asked to be a medication dispensing machine? Can they find a job where they are responsible for program development or psychoeducation, where they educate large numbers of people about positive mental health, or how to live a happier life?
My impression is that to be employed as a psychiatrist means you are forced into a narrow role of prescription writing, without the benefit of deep relationships with patients, or the psychological benefit of implementing system change. What if graduating medical students do not understand this horizon? What if they think they are going into a world in which mental health can be promoted by psychiatrists, not just by teaching about medication, but by promoting healthy living and healthy lifestyles, for the body and the mind? What if they come to learn that psychoeducation is mostly done by professionals who do not have medical licenses, and with the shortage of providers, the medical license is seen to be optimally used only for medication management. All other activities, such as groups, wellness activities, vocational coaching, are done by those with Master’s level degrees. I can imagine the disappointment new graduates might feel as they discover that “Community Psychiatry” does not mean helping the community, but rather it means medicating the community. which may help some, but not in a more global way which is more fulfilling, and a greater justification for years and years of training.
Psychiatry, as I frequently say, needs to re-gain its foothold into the “whole person” and not just the “medication piece.” It is possible that medical students are not exposed to this limitation until late in their training. I think we need to tell them, so the field can re-boot. Community Psychiatry should mean the psychiatrist is helping the community function in a way that decreases the mental health burden on the individual and his family. This can only happen though if psychiatrists are paid to run and design programs, not just write prescriptions. This is my rant. I am not letting it go.