‘What’s ailing psychiatry?’ Patient care is top concern
I thank my colleagues who responded to my survey about challenges facing psychiatry (“Your vote, please: What’s ailing psychiatry?” From the Editor, Current Psychiatry, June 2008).
Survey results indicate that psychiatrists care more about their patients than their pocketbooks. The 3 top-rated challenges address the “broken” public mental health system, lack of parity for mental illness, and the shortage of beds to hospitalize psychiatric patients. Close behind are inadequate philanthropy for psychiatric causes—such as education, research, and clinical programs—and dismal lack of adequate primary care for the seriously mentally ill. Unreimbursed time spent on paperwork, persistent stigma, and shrinking funds for research were tied, and low compensation for psychiatrists ranked after those ( Table ).
Among the lowest-ranked challenges, the high rate of off-label psychotropic use was considered least important, which makes sense given how many psychiatric disorders have no FDA-approved drugs. Similarly, the lack of evidence-based psychotherapy research may reflect the fact that a large portion of today’s psychiatric work is assessment, differential diagnosis, and medical management rather than psychotherapy. Other mental health professionals are doing the bulk of psychotherapeutic interventions.
Let me end by expressing my surprise that not one reader wrote about psychologists’ push for prescribing privileges as a threat to psychiatry—which I deliberately did not include on my list—even though it is a hot-button issue. This suggests to me that so many issues impact psychiatric practice that psychologists are under the radar. However, I expect this issue will reemerge in the future.
Henry A. Nasrallah, MD