Insight Matters
Spring, 2002

Psychiatry at the Crossroads
by Brien Dyer, M.D., President

I enjoyed meeting and learning with many of you at the Annual Meeting of the Ohio Psychiatric Association (OPA) in Dayton, Ohio, April 27-28, 2002. As I assume duties as your president, I have three issues to share with you, as I did at the annual meeting.

First, why be involved in organized medicine such as the OPA?

Psychiatrists and other physicians used to think 25 years ago: "I'm a doctor, things will always be the same; I can give my patients the best state-of-the-art care, and be reimbursed fairly. Besides, I don't want to get my hands "dirty" dealing with political things. They are a waste of time, it is not necessary, and it certainly is not fun." I used to think the same way. I even quit the American Psychiatric Association for a few years out of protest of a policy I did not like. That was a mistake, in retrospect. I should have worked within the system. You don't abandon your family because someone does something you don't like. You talk about it and resolve it. Well, then came the caravan of steamrollers that flattened our cherished thinking.

So-called "managed care" organizations now tell us, effectively, with the threat of non-reimbursement, how to practice, how and what to prescribe, as well as limit access of our patients to care. If we do object, we might find ourselves "depaneled" - translated: "shut up and color, because we are in charge of patient care, doctor, and you are not."

Both private and government payors have decided that mental illnesses are not as important as other illnesses, since they are paid for at a lower rate. As for parity for alcohol and other drug addiction diagnoses, "forget about it!"

State hospitals are being closed at an alarming rate, and the money "saved" by deinstitutionalization has not all streamed to the outpatient side, resulting in increased homelessness and incarceration of the mentally ill. The unmet needs of children are especially appalling.

And now, the piece de resistance, the New Mexico state legislature and governor decided on March 6, 2002, after years of intense personal and financial lobbying and, in my opinion, misinformation by the American Psychological Association, that psychologists, non-medical mental health specialists, can order laboratory tests and prescribe medications. The only requirements are, essentially, a ten-week course (450 hours), passing a "national test," and "supervision" by a family practioner.

I love psychologists; they were some of my best psychotherapy teachers in residency, and I'm married to one, but we both believe that this dumbing down of medical mental health care is bad for patients, who will surely suffer for it in New Mexico. Let's not let this ridiculousness spread beyond that state. We must now "dirty our hands" and become continually involved in the political fray for our survival, as psychologists are doing, but especially for our patients' safety.

Second, what about the joy and the privilege of the practice of psychiatry?

When we can separate ourselves from the burden of paperwork, and other administrative requirements, the privilege and responsibility of helping mentally ill and drug addicted people get well are truly awesome

We psychiatrists and our mental health colleagues in other disciplines, can make an immeasurable difference in the lives of our fellow citizens.

We can clearly do this on a 1:1 basis by having a quality and ethical practice.

We can, and must of necessity, also "treat" our patients on a "macro" basis by advocating for greater, if not universal, access to health care.

We see on the faces of our patients, and can advocate to end hate, discrimination, poverty, domestic and other violence, child abuse, and social injustice that lead to hopelessness, compound mental illnesses and drug addiction, and fill our prisons. And, all these people have children, and so on, and so on, and so on the cycle goes.

But, to see our patients get well, and be relieved of terrible psychological pain and the stranglehold of addition, well, it just doesn't get any better than that. It is well worth the effort, as you know.

Third, a challenge. Psychiatry is at a crossroads.

We must view patient care as requiring more than a biopsychosocial approach. Psychiatrists are trained in the biological and psychological aspects of patient care. But we must now realize that patient care now requires "biopsychosocialpoliticaleconomic" intervention, even for patients just to be able to afford the cost of the live-saving medications we can prescribe.

Ultimately, I believe our country must decide whether health care is a right or a privilege.

Please, please be involved in organized medicine, if not in direct volunteer services as elected officers and committee members, at least in your important financial support and membership.

We must band together with our local, county, state and national psychiatric and other medical associations, and the Ohio Psychiatrists' Political Action Committee, to ensure that our patients get access to appropriate care, and that only adequately medically-trained professionals practice medicine.

When all is said and done, how can you and I not get discouraged, and make a difference to our patients on a daily basis? Helen Keller said, "The world is not moved forward by the mighty shoves of its heroes, but by the aggregate of the tiny pushes of each honest worker." Let us be honest workers.

In the words of Robert J. Ronis, M.D., Immediate Past President of the OPA, "
Together, let's make OPA the organization we want it to be - the heart, mind and voice of Ohio psychiatry."

I look forward to working with and serving you as your president during the next year.

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