By Robert Lamberts, M.D.
When I get discouraged about the state of the healthcare system, I but need to look in one place to see that things could be worse: the mental health system. While there remains hope that there will somehow be reform and things will get better in the arena in which I work, it is very difficult for me to see anything getting better for the Psychiatrists.
One of my staff recently had a family member have a fairly major “breakdown.” I was caring for this person, mainly due to the fact that there are not close to being enough psychiatrists available to help. I have found that as a primary care doctor, I have had to become an “amateur psychiatrist” (as I call it) and diagnose and treat people whenever possible. Some of this is due to the stigma of people going to psychiatrists, but most of it is simply due to their unavailability. This was the case with this family member, and I did my best to address the needs medically, and even offered the best counselling I could.
Yet things went from bad to worse, and she ended up needing hospitalization, as she started having paranoid ideation and was very worrisome to the family that she might harm herself or her husband. I thought she simply had to go to the teaching hospital ER and they would either admit (voluntary) or commit (involuntary) her to the psych ward. I found out that the only place where an involuntary admission can occur is the state psych hospital. This was not the case when I started practice, but due to the total lack of fianancial viability of a locked psych unit, all of the others have closed down.
Of all of the places I have worked, the scariest one for me personally was at a state psychiatric hospital. This was not only scary due to the significant pathology in the patients (the worst of the worst), but the total lack of hope in that setting. There were not the financial resources available to really help those who needed to be helped, so they all were basically held there at the state hospital. It was the most helpless set of people I have ever seen.
I am sure my picture was somewhat jaded by my dislike of the clinical rotation, but it still paints a pessimistic picture of the reality of psychiatric care. These are the most needy patients, and the ones least likely to seek out care for themselves. If there is an area of healthcare that needs to be nationalized, it is psychiatric care. These people often cannot help themselves, and lack the resources to do so even if they could. I have no idea what a national psychiatric healthcare system would look like (I fear to think of it, honestly), but I don’t see many ways that things could get worse than the current system.
To all you psychiatrists out there, you have my deepest respect.