Fundamental Changes Are Needed in Mental Health Care

We need to get way outside the box to solve the mental health crisis.

8/1/2021 7:01:00 AM

The mental health system is beset by delays, inefficiencies, and shortages, resulting in untreated psychic pain. We need a paradigm shift in thinking about the system, argues zombieautopsies

We need to get way outside the box to solve the mental health crisis.

from Massachusetts show that adult patients waited in emergency rooms or boarded on non-psychiatric medical floors for an average of 53 hours. Children and teens waited a whopping 59 hours on average.These kinds of problems have been around for a very long time. As a psychiatrist, I’ve watched this situation remain stubbornly and ludicrously dysfunctional for the entirety of my

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. I keep asking myselfwhy? It’s not as if we’re not aware. If we know things are so bad, then why haven't we seen truly meaningful improvement?I thought for a while thatbiasagainst psychiatric illness was the culprit. If we just could get more people to accept and believe in the existence of psychiatric suffering, then things would automatically get better. However, while it’s true that pervasive stigma persists, we have enjoyed a steady, impressive, and laudable lessening of this stigma. Clearly, these improvements have not been accompanied by a commensurate change in access to quality mental health care. Things are better, but only slightly, and in some parts of the country, things are a whole lot worse. This is especially the case in socio-economically challenged urban and rural settings, but not exclusively.

Even wealthy universitieshave struggled to improve their mental health services.We also know that if we did invest more in the prevention of psychiatric illnesses – that is, if we enacted community programs to stem the development of psychiatric problems in the first place – then we would stand to save literally millions and millions of dollars and countless lives. If people have better access to food, shelter, security, and community, then people will suffer less psychological problems. This might seem obvious, but it’s nice to know that we have headtopics.com

all sorts of datain support of these endeavors.To be sure, the infrastructure for mental health care is sorely in need of an overhaul, but increasingly I wonder whether the lack of change forces us to ask tough questions about mental health care itself. Is it possible that the ways we practice, and the ways we train others to practice, are simply not viable in light of the current need? To put it another way, I’m confident that when I care for patients the way that I was trained, I can deliver quality treatment. But I am not nearly as confident that this style of practice can meet the needs of the nation. This leads to a whole new set of sometimes uncomfortable questions:

1. Is the ongoing lack of access to quality mental health care asystems issue, we can’t get patients connected with clinicians, or anumbers issue,the number of clinicians fall far short of existing epidemiological demands despite any improvements we could make to the system.

2. If we suffer from both a systemsanda numbers issue (as I suspect we do), then which of these issues is worth addressing most aggressively?From a systems standpoint, let's consider the classic 50-minutepsychotherapysession. Why is that number so immutable? It is certainly the case that sometimes people need 50 minutes. But sometimes they need more, and other times they need less. How could we change things to better match the allotted time to the need? After all, varying the amount of time would potentially make more time available. The same could be said for the 20-minute

managementvisit. Sometimes we need way more than 20 minutes, and other times we need less than 10. Read more: Psychology Today »

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zombieautopsies Great topic/question, bad anslysis. If you want to think outside the box for a solution, you have to get out of the medical model.

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Olympian Alexi Pappas On Reframing Mental Health As An InjuryOlympic Runner Alexi Pappas was surrounded by mental health growing up. But, that did not mean she had the vocabulary to describe it. It was not until she had her own experience with depression and her doctor explained that the brain, like a bone, could get injured, that she began to understand.

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