We believe that psychiatry is in the early phases of a major paradigm shift involving its model for delivery of care. Although many excellent psychiatric practices currently exist, there are two extreme models of outpatient practice that have major drawbacks. In the first of these models, the psychiatrist relies almost exclusively on psychotherapy, particularly psychodynamic therapy, and treats a small number of patients several hours a week for several years. What is wrong with this? Only a small number of patients are treated, and the evidence for the effectiveness of some of these approaches is limited. What is clear is that there are many very ill patients, and this model of care primarily caters to a few, wealthy people. This doesn't do society justice.
In the other extreme model of psychiatric practice, psychiatrists see patients for brief medication visits and do not develop an understanding of what is going on in their patients' lives. Both the psychiatrists and the patients develop a mindset of "better living through chemistry"; i.e., they come to believe that psychotropic medications are the answer to all of the patient's problems. Although some patients may benefit, many end up taking too much medication and having less-than-ideal relationships with their psychiatrists.
The solution to these extremes (and to the overwhelming need for psychiatric care in the United States) involves an evolving paradigm shift to a model where psychiatrists work as leaders of coordinated mental health teams that include psychologists, social workers, nurse practitioners, and counselors. In such a model, care is delivered by various members of the team, and knowledge about each patient is shared among members of the team using technology and team meetings. Care is efficient, but psychiatrists have the opportunity to develop a good understanding about the influence of each patient's illness on his/her life. Some patient visits with the psychiatrist may be brief, others much longer. Most importantly, all members of the mental health team can be utilized in a manner that best serves the patient and allows psychiatric care to reach a greater number of persons needing treatment.
This post was co-written by Eugene Rubin MD, PhD and Charles Zorumski MD.