Can psychiatrists ethically remain bystanders?
PSYCHIATRIC VIEWS ON THE DAILY NEWS
A week ago, as I discussed in the column, “To Strike or Not to Strike at Kaiser Permanente in California,” the mental health care workers at Kaiser Permanente facilities across Northern California went on strike. The strike continues. Psychiatrists are not participating.
The conflict is along the lines of managed mental health care concerns ever since its inception in the late 1980s2: business cost savings prioritized over patient care and clinical well-being. Recently, with the increase of mental health problems from the pandemic, the patient needs have escalated further. To replace the strikers, Kaiser has apparently loosened their hiring criteria and administrators have pitched in for patient care. Wouldn’t it interesting and important to have an outcomes research study comparing the time before the strike and during the strike?
That the strike is particularly about mental health care adds a striking relevance for psychiatry. As one colleague who was also a lifelong patient at Kaiser shared:
“Was born at Kaiser SF and have been Kaiser patient my whole life and think the system of care is about as good as it gets . . . EXCEPT FOR MENTAL HEALTH.”
Once again, mental health may be adversely affected within overall health care.
At the same time, more and more mental health clinicians are refusing to even accept patients’ private insurance. Previously, many clinicians stopped accepting patients with the public insurance of Medicaid and Medicare because of inadequate reimbursement. However, out-of-pocket paying is practically impossible for many.1
These recent developments may be the canaries in the coal mines of psychiatry. What might bring in more fresh air to prevent increased psychiatric morbidity and mortality? The Inflation Reduction Act passed a week ago? Psychiatrists joining their colleagues of other disciplines in protest? Calls for a national singles payor system?
Another colleague told me:
“In this case, better to trust those on the ground to work it out rather than favoring anybody.”
But can the rest of us ethically be mental health care bystanders? The ethical guidelines of the American Psychiatric Association lists “colleagues” as among our secondary priorities. We are supposed to be our professional brothers and sisters’ keepers.
1. Schencker L. Why is it so hard to find therapists who take insurance in Illinois? Chicago Tribune. August 21, 2022. Accessed August 26, 2022. https://www.chicagotribune.com/business/ct-biz-therapists-health-insurance-coverage-illinois-20220821-brvnriarsbfxhcwqofpjpfhem4-story.html
2. Moffic HS. The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Jossey-Bass; 1997.