A Vision Statement
by 2007-2008 MPS President
Jeffrey Hardwig, MD
VISION STATEMENT TO MINNESOTA PSYCHIATRIC SOCIETY
Our organization is the sum of the creative potential of its individual members combined to better serve our patients. Our competency at providing the best care available combined with our steadfast commitment to patients is our only unassailable claim to authority.
ACCESS: The mind is drawn to a story. We as psychiatrists hear the stories of our patients every day and we are connected to them through our empathy and our commitment to help. More than any specialty, we understand our patient’s lives.
Those of you with a little gray hair have had your careers coincide with the decline in patient access to care. For me personally, it has been a daily frustration to realize that our profession has so much more to offer the individuals that we care for in the form of proven psychotherapies and biological treatments and yet these treatments have become increasingly less available as we have seen an erosion of, or failure to build, the infrastructure of mental health treatment. Services such as Child Psychiatry just don’t exist in much of the North.
STIGMA: When I was in Medical School in the early 80’s, I called my mother to tell her that I had decided on a specialty. I wanted to be a psychiatrist. There was a long pause on the other end of the line and finally she asked, “Have you ever thought about surgery?” Her motherly pride in me was briefly tested by my choice.
Roger Kathol’s new book, “Healing Body and Mind” points out that the justification to segregate and under-fund mental health treatment was based on myths born of stigma that mental health treatments don’t work and it is a waste of money to pay for illnesses that are “over diagnosed, incurable and too sensitive to talk about.”
Now I know the enemy. It is stigma, still. The people that believed these myths have been highly influential in shaping the current state of affairs. Our non-system is the result of a deliberate, ill-conceived plan to spend as little as possible on mental health treatment. One other key myth is that there would be no consequence to this for the rest of medicine.
This realization has given me focus for my thoughts and energy, and I’m grateful to Dr. Kathol for writing this book. So many times I would complain to my nurse that prior authorization procedures were not only counterproductive but harmful to our patients. It would anger me but I used humor to cope. I would joke, “Who do I throttle.” I didn’t really know where to direct my complaints and had the sense that my frustration was what was wanted. I was expected to give up. The enemy is an old one, the same one, IGNORANCE.
People don’t understand the mentally ill, the treatment of mental illness and importantly, they don’t understand us. Whose job is it to tell them?
MINE and YOURS.
However, there is reason to be hopeful, that with mental health parity the worst is behind us. How we approach our problems will define the future of our profession. That is why the current interest in the Mental Health System makes me so hopeful.
It is so screwed up, there are so many problems to solve that there is literally something for everyone to do. If we draw a line in the sand here and push back from this point, we can all be part of a rebuilding. It is up to today’s psychiatrists to build a profession that we would join all over again and that will attract bright medical students to become psychiatrists of the future.
INTEGRATED CARE: It makes no sense to simply put money into a disintegrated, carved out system. Instead, an integrated model of care with psychiatrists and other mental health resources in primary care settings where most patients are currently being seen is needed. In an integrated system, care is provided under one budget and with a shared record that overcomes the lack of communication currently present.
COMMUNICATION:
Mental Health treatment is provided in multiple disconnected systems. These systems do not communicate well with one another, and as such, especially in rural areas, this hinders continuity of care. Links need to be made between these systems and psychiatrists are in the best position to take a leadership role in establishing effective communication.
To illustrate the point, in International Falls, if an individual requires emergency hospitalization, coordination is required among six separate agencies, the Community Hospital, Social Services, the Family Practice Clinic, the Mental Health Clinic, the Admitting Hospital (typically 100 miles away) and sometimes Law Enforcement.
In another example, in-home services for children’s mental health is provided by an agency that operates out of Grand Rapids, Minnesota, over 100 miles away. Case Management comes from the County. Sometimes a therapist from the Mental Health Center is involved, and if a psychiatric hospitalization is required, they would go to yet another city, typically Hibbing, to be treated in another system altogether. I would like to point out in Northern Minnesota where I practice this happens without the benefit of a child psychiatrist at any point along the way. The process of establishing effective communication is slow but there are beginnings.
In my years as a MPS Councilor and in my President Elect year I participated in a number of meetings with other treatment providers in this northern region for the purpose of improving communication. All parties involved agreed that communication is important, but the subject had to be brought up and worked out by us. It wasn’t going to work itself out. I believe that this has enhanced continuity of care between inpatient and outpatient treatment.
MEMBERSHIP IN PROFESSIONAL ORGANIZATIONS:
When I was in medical school, the late M. J. Martin tried to get us to join organized medicine with the words, “hang together or hang separately.” It was a good pun, but I was not afraid. If I knew then how things would turn out, I would have been afraid and would have become active in our professional organization sooner.
I have NO special gifts, sadly for me, but that is beside the point. Like you, I care about my patients, I care about my profession and I want to help. I think that is true of any one of you who has had the courage and perseverance to stick to this work in the face of the hardships of the past decades. When we unite, then we can be a force to be reckoned with and the task is so much easier.
From early in our lives, we are taught to do chores to contribute to the welfare of our families, and the fact is that children who do chores grow up to be good citizens, willing to volunteer their time for the benefit of the larger community. That mature volunteer spirit is important in our organization. Each person has an idea that may blossom into a plan. Each person can connect with others. Each person can educate the public or a representative, or improve our image and move us closer to our goals.
Our organization is the sum of the creative potential of its individual members combined to better serve our patients. Our competency at providing the best care available combined with our steadfast commitment to patients is our only unassailable claim to authority. That authority places responsibility squarely on every psychiatrist’s shoulder to be a leader in our profession
MEMBERS–IN–TRAINING:
Members–in–Training at the Area 4 meeting have told us they want more mentorship and guidance from professional organizations. At one point it may have been enough to simply learn our craft, but with the challenges we face, it is part of every physician’s job description to be actively involved in supporting their patients through professional membership and activity. We support a “core curriculum” on professionalism taught in residency and backed by mentorship.
WE CAN TAKE BACK PSYCHIATRY, but if we expect to take back our profession, the effort is possible only when we don’t have to see patients every ten minutes in order to survive economically. Also, if we want to continue to be the doctors who know our patients best, we need to take the time to get to know them. Discriminatory billing against psychiatrists who do psychotherapy should end. If insurance companies want to spend less on medications, then reimburse us for the time needed to apply psychotherapeutic means of treatment.
RURAL ISSUES:
I don’t know when you will have another rural psychiatrist as president and so during my year, part of my focus will be on rural issues. The access problems faced in rural areas are not unique but they are magnified.
I have been meeting with rural psychiatrists, and they are, for the most part, unanimous in their call for more child psychiatrists and chemical dependency services.
Personally, I think life in rural areas is the best-kept secret in the United States. I live there because I am emotionally connected to the people and the natural beauty of lakes and islands. However, it’s hard for me to imagine ever having enough psychiatrists in rural areas to meet the need there. Subsequently, I support telepsychiatry as a means to make specialists available to our patients without requiring long drives for patients, and telecommunication can provide teaching to our family physicians, psychiatrists and therapists.
Telepsychiatry, integration, and leadership in the various subsystems of mental health services within the state are only possible if there are actual individuals to put in those positions. That is why it is so important that we see this point as our lowest ebb and fight back from here to create a system that serves our patients well and attracts new psychiatrists.
Since we got where we are in part due to legislative action, the solution will in part be legislative. We will continue to support our MPS Political Action Committee and be full partners with the rest of medicine by supporting the MMA. We are asking to be equal partners in medicine so it is only reasonable and expected that psychiatrists pay their MMA dues and be active in the MMA.
The following steps can be taken by everyone:
- Communication among the mental health elements is a do-able immediate first step. It is a standard of good care and necessary for continuity.
- Connect the disparate elements to create an actual mental health system with psychiatrists in influential positions.
- Educate the public, our non-psychiatric colleagues and the purchasers of insurance about the benefits of psychiatric care and the unintended costs of carved out mental health care.
- In time, integrate behavioral health and physical health treatment.
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