As we look forward to 2010, we asked our CLINICAL PSYCHIATRY NEWS Editorial Advisory Board members for their top predictions for psychiatry. They discussed issues ranging from advances toward treating trauma to a focus on helping patients tackle obesity. Here, in no particular order, are five of our editorial advisers' predictions for the New Year.
Trauma and Abuse
"The country has been at war for 9 years, and that fact has been wearing on the military and their families," said Dr. Thelissa A. Harris, who teaches psychotherapy to residents at the Institute of Living/Hartford Hospital in Connecticut.
"Efforts toward predeployment emotional boosting, past deployment briefing, and treatment of emotional trauma have been implemented, but there is evidence that more effort is needed," she said. "Research for improved assessment and treatment, as well as continued efforts in the best practices as we know them today will be put forward in 2010 as our soldiers and their families manage the emotional and physical toll of war."
Dr. Paul J. Fink also sees an emphasis on treating trauma as paramount in 2010 "One of my areas of expertise is child abuse, trauma, and the work of Dr. Vincent J. Fe-litti and the Adverse Childhood Experiences study," he said. "I believe that in the next 10 years, it will be imperative that we become familiar with the role of child abuse and trauma on development in general and on the development of disease--physical and mental--in later life. This is an important trend that is currently being ignored in the body politic and psychiatry."
Looking beyond the symptom of the disease and actually treating the disease is imperative, said Dr. Fink, professor of psychiatry at Temple University in Philadelphia, a former president of the American Psychiatric Association (APA), and author of the "Fink, Still at Large" column for CLINICAL PSYCHIATRY NEWS.
"We know that 3 million or more of women are beaten by their men. If a child is in the house when that occurs, he or she will be traumatized. That trauma is multiplied each time a child hears its mother screaming. "Therefore, it will be an important part of the future of psychiatry to help people understand the root causes of trauma and the enormous role of child development in the development of disease."
Psychiatry and the Military
In the wake of reports about rising suicide rates among men and women serving in the U.S. military--and the tragic Fort Hood, Tex., shootings allegedly by a psychiatrist--Dr. Lee H. Beecher thinks that 2010 will bring continued probes into the root causes and questions about what can be done to keep such a tragedy from happening again.
"What policies and procedures do the military have to screen and prepare psychiatrists for military service?" asked Dr. Beecher, adjunct professor of psychiatry at the University of Minnesota. "What is the proper role and scope of practice for a military psychiatrist as seen by the military and the public?"
Dr. Beecher also would like answers to the following questions: "What should the military do about psychiatrists who might identify themselves culturally with a country or group that is designated as an 'enemy' of the United States?
"How do the military services identify and intervene with physicians who are impaired by mental or substance abuse disorders? What happens to these officers?"
Managed Care and Reform
Dr. Beecher is concerned about the constraints placed on psychiatrists by managed care companies as they try to provide the best possible care for their patients.
"Is the private practice of psychiatry dying or thriving in the age of managed care and corporate medicine? I suspect both are true," said Dr. Beecher, a past president of the Minnesota Physician-Patient Alliance (www.physician-patient.org).
"How many psychiatrists identify themselves as being primarily in private practice; do they do psychotherapy; do they accept Medicare; how do they advertise their practices; and do they have (problematic) provider agreements with insurance companies? …