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Shirking Shrinks

Discusses the efforts of mental health professionals to help each other in depression and other problems. Psychiatrists support groups; Treatment program for psychiatrist; Considerations given to psychiatrist with mental illness.

Do mental health professionals help each other when they're struggling withdepression' marital problems, alcoholism, and the like? The good news is that psychiatrists have developed sUpport systems for their distressed colleagues. The bad news is that psychologists, who outnumber psychiatrists about three to one, have not gotten the message. As psychologist Gary Schoener, Ph.D., puts it, "The concept of helping our own is not there in psychology. We don't even offer each other `professional courtesy'--physicians often don't charge each other for services, but we would never adopt such a practice."

What are psychiatrists doing right? All 50 states have treatment programs for psychiatrists and other physicians, and these programs work with state licensing boards to ensure that impaired practitioners are rehabilitated, not simply punished. The American Psychiatric Association has also taken steps to help their own. "We do workshops and presentations on illness and impairment," says Harvard psychiatrist Malkah Notman, M.D., who chairs the association's Committee on Physician Health, Illness, and Impairment. `"We have videos, articles, papers. We link Up members who have problems with local organizations [that can help them]."

Although the official ethical guidelines for psychiatrists do not actually require them to look out for each other, they do point in the right direction: "Special consideration should be given to those psychiatrists who, because of mental illness, jeopardize the welfare of their patients and their own reputations and practices. It is ethical, even encouraged, for another psychiatrist to intercede in such situations."

One of those who intercedes is John Fromson, M.D., director of Physician Health Services in Massachusetts. His organization's rigorous program is designed to help drug-addicted psychiatrists get back on track. "There's drug testing twice a week. Attendance is reqUired at Alcoholics Anonymous or similar programs three times a week. Regular meeting are required with our staff. The psychiatrist must also be in therapy, and his or her professional work is closely monitored. If participants do not comply, we may report them to the Board of Registration and Medicine, a very serioUs matter."

The resources available to impaired psychologists are pitiful in comparison. The problem starts right at the top, with the American Psychological Association. When I asked APA about services for impaired psychologists--calling, by the way, as a member of the organization--I was first told there weren't any. Eventually, I reached the executive director of APA's clinical arm, who said that, yes, a committee concerned with impairment exists, But that "it's never issued any reports."

In fact, in 1988 this small, underfunded committee issued an impressive 250 page manual called Assisting Impaired Psychologists, which was revised in 1994. However, other than members of the committee, I've had trouble finding even one psychologist aware of the report's existence. The former and current committee members I spoke to all expressed enormous frustration over the organization's lack of interest in impaired psychologists. Even the committee's name suggests denial and disinterest: At one time it was the committee on "distressed psychologists"; then it became the committee on "firm paired psychologists,; now it's the "Advisory Committee on Colleague Assistance."

Perhaps 13 state organizations offer limited services to impaired psychologists. Tennessee's program is one of the best, and California, which harbors the greatest number of psychotherapists--Lord knows we need them--has a promising new referral program. Alas, the program only serves the California Psychological Association's 5,000 paying members--about a third of the state's clinical psychologists.

According to psychologist Karen Saakvitne, Ph.D., APA's efforts are "a disgrace." "It's phenomenal," she said, "what we won't look at." Peter Nathan, an original member of APA's distressing committee, adds, "APA fiddles while Rome burns."