Health Systems and Policy Research

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In the Midst of a Mental Healthcare Crisis: How Psychiatrists Can Better Advocate for their Clients

Bouloudnine R, Lee BX, Rowe M

Background: Psychiatry is at a crossroads in the U.S. This crisis can be characterized, in part, by: (a) the tension between social and biological psychiatry; and (b) the Recovery Movement. Given the present dominance of biological psychiatry in mental healthcare, psychiatrists receive little training on social conditions and social determinants of health. Meanwhile, with a strong push from discontented patients, advocates, and some policymakers, recovery-oriented care seems to minimize the importance of psychiatry and psychiatrists. In this context, what is psychiatry, and what is a psychiatrist in the U.S. to do? Methods: Twelve in-depth qualitative interviews were conducted with community psychiatrists at a public mental health center. Established qualitative research methods, by which approximately 8 or more interviews typically allow for “saturation,” were utilized. The main interview question, “What is a psychiatrist?” was followed by questions involving the themes noted above. Results: For those interviewed, psychiatry seemed deeply embedded in medicine. While the biological model had been able to improve some parts of psychiatric practice and its users’ quality of life, many psychiatrists clearly identified the limits of this model and expressed frustration with its tendency to marginalize their role as one of medication management. Conclusion: Regarding the crisis that clients and the health system are undergoing, it seems necessary to go beyond a simple definition of a psychiatrist as someone with skills for treating mental illness. The questions that arose in our research include: How and with which skills can psychiatrists improve symptoms, the life context that contributes to patients’ symptoms, and the mental health delivery system that often fails to meet people’s needs? Or going further, how can psychiatrist’s best advocate for their clients so as to reduce disorder, disability, discrimination, and disadvantage?