Following the Money in the Social Aspects of Psychiatry


Here’s how money ties back to most social determinants of health.




“Follow the money” has become a popular phrase after it was supposedly whispered to reporter Bob Woodward in his investigation of President Nixon’s Watergate scandal. Whether mythical or not, it has become one way to understand complex circumstances.

After posting my last column on Friday on social psychiatric issues not to be complacent about, I wondered what else—if anything—could tie these issues together. After some discussion with colleagues, a possible answer became apparent. Money! Or lack thereof.

After all, we are a strongly capitalistic society and solving public social issues often takes money. Let’s see if that could be at the root of these concerns.

-Racism remains. In its origin, the racism of Black slavery was financially driven for the benefit of the southern economy and became structurally institutionalized over time. Check!

-International conflicts. Perhaps Russia’s invasion of Ukraine had some financial motivation as Ukraine is thought to be the “breadbasket” of the world. Check!

-Anti-Semitism escalation. One of the conspiracy myths is that Jews control too much of the world’s economy. Check!

-The deaths of despair and children. The lack of well-paying jobs for white males without a college education, as well as the profit from the guns involved in the mass shootings of children and others, has financial implications. Check!

-Our climate crisis. The profiteering of fossil fuel corporations has driven the opposition to switching quickly to alternative energy sources. Check!

-Burnout in physicians and society. For-profit managed care in medicine that controls what physicians can do is the major cause of physician burnout and, likewise, other businesses in the United States. Check!

-Internet communication. Much has been said about the major tech companies ignoring the risks and harms of social media in favor of advertising profits. Check!

-Homelessness in America. Financial ruin, untreated mental illness, and lack of affordable housing is a major cause of homelessness. Check!

-Trans backlash. Possible “advantages” of trans female athletes in lucrative sports competition is a factor in eliminating their participation. Check!

-Abortion control. Having to go to states where abortion is available certainly has financial implications for the poor, a challenge that could escalate if mifepristone, used in about half of the abortions, is no longer available. Check!

Although some of these follow the money trails may seem simplistic and exaggerated, they do seem to be connected in being social determinants of mental health. However, as the gap between the rich and poor increases, the funding of public social causes does not correspondingly increase.

Then, if we think about the general financial aspects of the social in psychiatry, finding the money is difficult. There is clear reimbursement for the biological in prescribing medication, with financial support by pharma. There is also clear reimbursement for the clinical process of psychotherapy. But what supports the social? Nothing obvious. When I was President of the American Association for Social Psychiatry around the turn of the new millennia, I had to use my academic benefits to supplement the meagre dues of the small organization. Social psychiatric organizations are often bereft of outside funding.

How can this be readjusted and reframed? Right now, the funding, whether time or money, is from the goodness of the hearts of socially oriented psychiatrists. There is no question, though, that the United States, the richest country in the world, could potentially fund these social causes if the collective will insisted upon it. In clinical psychiatry, the social must be reframed as the relational essence of the clinical encounter or, in other words, the basis of most any successful treatment.

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times™.

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