Magazine article Clinical Psychiatry News

Commentary: Outreach Not Your Ordinary Mental Health Clinic

Magazine article Clinical Psychiatry News

Commentary: Outreach Not Your Ordinary Mental Health Clinic

Article excerpt

We are in the midst of enormous changes in health care delivery. Implementation of the 2010 Patient Protection and Affordable Care Act will make health care accessible to more people than ever before, and ushers in a cultural shift from a prohibitively expensive interventional health care model to one based on prediction and prevention.

Instead of waiting to get sick and seeking expensive urgent care, we are moving toward identifying vulnerable patient populations early and encouraging them to become active participants in maintaining their health.

Whether you like it or not, the Affordable Care Act (or some modification of it) is here to stay, because we simply can't afford the 20% of our gross domestic product that health care costs us, and it's not making us any healthier.

Psychiatry is not well positioned to respond to this cultural shift, because as a specialty, we are moving in the opposite direction, creating more illnesses and prescribing more drugs. Patients only come to see us now as a last resort because they know we will label them with a disease and prescribe drugs.

Twenty-five percent of all Americans are now diagnosed with a mental illness, and with the recent publication of the DSM-5 and its record-breaking number of mental illnesses, soon 50% of the population might have a diagnosable mental illness.

We are perpetuating the myth that if you are feeling anything other than wonderful in every moment, you might be suffering from a mental illness. We are "psychopathologizing" the ordinary ups and downs of the human experience and promoting pills for whatever ails the patient.

I believe we would reduce the incidence of mental illness in this country by 90% if we prohibited direct-to-consumer advertising by pharmaceutical companies. (According to the World Health Organization, pharmaceutical companies spent billions on this form of advertising last year alone. The WHO says that New Zealand is the only other industrialized country in the world that allows this form of drug advertising.)

The message to the patient: Are you anxious, shy, sad? Can't stay focused or can't stay awake? If so, you could have a disease for which there is a drug (nowadays often more than one). Such messages are good for business, because we're reimbursed better if we see four patients an hour for 15-minute medication checks than we are for an hour-long psychotherapy session.

We are spending less time listening and establishing an intimate rapport, even though this is what most of us like best about what we do and understand as an important aspect of our healing power. Can we do both? Is it possible to make a soulful, human connection in a short time, and could this reduce an epidemic of overprescribing? I believe we can if we expand the ways in which we engage people--and in doing so, move into the new prevention paradigm.

In addition to my degreed credentials, I also am a clown and proudly serve as chief of community mental health at Gesundheit! Institute in Hillsboro, W.Va. The clown/fool/jester/trickster is an archetypal human characteristic that has served the purpose of lightening mood, diffusing anxiety, helping patients look at the familiar from a new perspective. The character can serve as a sacred healer. …

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