Experts Suggest Ways to Deal with Challenges Surrounding Care of Psychiatric Patients

“Telemedicine, which is already having great success in neurology and intensive care unit medicine, is a great fit for this space,” Dr. Grace says. “Widespread access to a tele-psychiatrist would bring significant tangible benefits to patients, hospitals, hospital staff, and the population at large, who ultimately pay for healthcare in the nation.”

Dr. Horst says he believes everyone who treats psychiatric patients should have education in psychiatric medicine education. One way to achieve this would be to mandate continuing medical education coursework in mental health disorders.

The Reality of a Utopia

Traditionally, our healthcare system has been designed to react to illness, meaning that physicians treat illnesses when individuals become sick.

“But as science and technology now better understand the etiology of most illnesses, we are more equipped to design more preventative interventions rather than wait for individuals to become sick,” Dr. Bianco says. “Prevention interventions require an initial investment that the healthcare system is not necessarily willing to invest in at this time and a shift in the way it charges for services. If the healthcare system is unwilling to go that route, and we know we can prevent many illnesses by shifting the focus of treatment, consequently, human suffering is augmented and quality of life jeopardized.”

More recently, the general population and providers have acknowledged that healing takes place more effectively when it is applied in more integrated approaches (i.e., the utilization of the bio-psycho-social-spiritual model), Dr. Bianco adds. This greater appreciation is demonstrated by different research studies applied to different populations (both the general public and different providers). Despite this, the system (i.e., training) does not support a full integration of interventions.

“The system continues to operate under the traditional medical model that is fragmented and hyper-specialized,” Dr. Bianco says. “Science has demonstrated that the mind and the body work in more complex ways, requiring a more holistic approach to treatment. Although all segments among providers now understand and accept that, the system they dwell in does not support the daily challenges of treatment.

“Treatment continues to be fragmented as it is the medical model. At this point, at a minimum, a hospital should have a psychiatric department composed of individuals who are adequately trained (e.g., health psychology, behavioral medicine) to absorb a portion of individuals who primarily present with mental health issues.” TH

Karen Appold is a freelance medical writer in Pennsylvania.

References

1. Torrey EF, Kennard AD, Eslinger D, Lamb R, Pavle J. More mentally ill persons are in jails and prisons than hospitals: a survey of the states. Treatment Advocacy Center website. Available at: http://www.treatmentadvocacycenter.org/storage/documents/final_jails_v_hospitals_study.pdf. May 2010. Accessed August 18, 2015.
2. Results from the 2013 national survey on drug use and health: mental health detailed tables. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, U.S. Department of Health & Human Services website. Available at: http://www.samhsa.gov/data/sites/default/files/2013MHDetTabs/NSDUH-MHDetTabs2013.pdf. Accessed August 19, 2015.
3. Any mental illness among adults. National Institute of Mental Health website. Available at: http://www.nimh.nih.gov/health/statistics/prevalence/any-mental-illness-ami-among-adults.shtml. Accessed August 19, 2015.
4. Internal medicine certification examination blueprint. American Board of Internal Medicine website. Available at: https://www.abim.org/pdf/blueprint/im_cert.pdf. January 2015. Accessed August 19, 2015.

Table 1. The Key Principles and Characteristics of an Effective Hospital Medicine Group (HMG)1

Source: Substance Abuse and Mental Health Services Administration, U.S. Department of Health & Human Services

Do ‘Psychiatric Hospitalists’ Exist?

Psychiatric hospitalists who work in inpatient psychiatric units leave their units to do general consulting on the floor. Fellowships are available for these types of psychiatrists, called “consultation liaison psychiatrists,” reports James N. Horst, DO, a hospitalist at IPC Healthcare, Inc., in North Hollywood, Calif.

In fact, Duke University Health System has a group of dual-boarded medicine-psychiatry hospitalists as well as psychiatrists who are hospitalists.

“There has been more of a move toward this trend,” says Sarah Rivelli, MD, medical director of psychiatry clinical services at Duke University Hospital and Duke University Medical Center in Durham, N.C. “At Duke, this has been a successful model, both from a faculty perspective and health system perspective. We’ve expanded our psychiatry hospitalist program to our two community hospitals as well.”