Can we find a new and expanded kind of community psychiatry?
PSYCHIATRIC VIEWS ON THE DAILY NEWS
A recent column concerned the need for more resources to help autism in girls when indicated and legally possible. The same need is occurring across the board in mental health, as another New York Times article on April 11th conveyed: “As Mental Health Crisis Grows, More Doors Open to Care.”1
On the negative hand, the rise in undo psychological symptoms has been going on for years, and escalated even more during the pandemic. Of particular concern is the continual rise in suicidality in teenage girls. On the positive hand, stigma has lessened. So, as the “crisis” in the article title suggests, this is both a dangerous time and an opportunity for new solutions.
In essence, the solution this article describes is the growth of private industry in developing actual structures to provide resources and services. Those can be supplemented by the cost savings of telepsychiatry for those with less severe disorders and perhaps the emergence of artificial intelligence for enhancing treatment planning.
One of the developers, PMB, has plans to develop a 5-building behavioral health village. However, once again, some opposition has arisen in the guise of “not in my backyard.”
My own particular experience during the pandemic is that along with the increase in psychiatric problems in youth, including suicidality, there is a dearth of residential facilities, and those that exist are often not affordable. Hospitalizations that are too short necessitates more step-down programs and residential is the first step down.
Where might this development be heading? It is a different for-profit private equity response to a need. However, the private for-profit managed care industry has previously elicited much criticism for putting profits over patient care, as I covered in the 1990s.2 However, that private development emerged because the public community mental health movement developed under President Kennedy in the 1960s was decimated under President Reagan in the early 1980s, and basically had only served the poor in the communities, as important as that was.
Would it be possible that a new private and public partnership venture could produce integrated buildings and programs spanning addictive and mental disorders, the youth and the elders, the poor and the rich, and everything else in-between? If that happens, that would be a new and expanded kind of community psychiatry where we are all in it together in an integrated instead of fragmented way.
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.
1. Gose J. As mental health crisis grows, more doors open to care. The New York Times. April 11, 2023. Accessed April 28, 2023. https://www.nytimes.com/2023/04/11/business/mental-health-addiction-care.html
2. Moffic HS. The Ethical Way: Challenges & Solutions for Managed Behavioral Healthcare. Jossey-Bass; 1997.