Academic journal article Australian Health Review

The Rosen–Cunningham Debate: Another, Alternative View

Academic journal article Australian Health Review

The Rosen–Cunningham Debate: Another, Alternative View

Article excerpt

The Pierre Janet Centre, PO Box 273, Vic. 3162, Australia. Email: pierrejanetcentre@gmail.com

Received 18 May 2016, accepted 5 June 2016, published online 7 July 2016

I would like to add decades ofmy personal psychiatric experience

to those of Rosen et al.1 and their critic, Cunningham.2 In my view, neither community-based treatment (including the 'onestop community shop') nor in-patient treatment, backed up by hospital-based emergency triage, as presently conceived, can ever provide the quality of psychiatric service that one would expect in any other medical speciality. Arguments for or against community psychiatry vis-à-vis hospital psychiatry, while fundamental, fail to address an even more fundamental issue. This is less where patients are treated, or even how, but by whom.

In neurosurgery, only a neurosurgeon is permitted to conduct surgical treatment. In psychiatry, the medical specialist is increasingly regarded as a consultant to a panoply of non-medical therapists, themselves subservient to a mental health team. Neurosurgeons, of course, work in teams, but only the medical team wields the scalpel. In psychiatry, the physician is virtually the last one to treat. Even were one to secure funding and staffing for a suitably balanced community-come-hospital-based treatment service, that service could only ever be as good as its professional medical staff. It may be argued that psychiatrists, in their consultancy role, should be able to maintain standards. In practice, cases routinely pass under the radar. …

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