The Numbers Count: Mental Disorders in America
Currently, Iowa ranks 47 th in the nation for the number of psychiatrists per person. In July, University of Iowa Hospitals and Clinics, the county mental health department, and a local community health center began a partnership to train more psychiatrists in community settings.
Michael Flaum, MD, director of the Iowa Consortium for Mental Health and a psychiatrist at UI Hospitals and Clinics, says the role of a psychiatrist in health care is to diagnose, assess and guide the treatment of mental illnesses.
"In my experience there is no such thing as a 'typical patient.' But we can make some generalizations based on prevalence rates of various disorders. Psychiatric disorders are extremely common - it is estimated that about one in four people in the US have a diagnosable mental disorder. Clearly, not all of those seek treatment.
"Mood disorders (major depression and bipolar disorder) are very common (- 10 percent of population). Anxiety disorders (including panic disorder, obsessive compulsive, post-traumatic stress and others), are even more common, but probably less of these people seek treatment. Schizophrenia is perhaps the most debilitating of all mental disorders, and affects about one to two percent of the population."
How long a patient is under psychiatric care varies by diagnosis says Flaum. "Some illnesses, like schizophrenia and bipolar disorder tend to come on in early adulthood and often persist throughout the lifespan. Others, such as obsessive compulsive disorder may be transient."
More people are seeking psychiatric care in Iowa and there fewer psychiatrist in the state but, says Flaum, of the two, more people seeking care, is more of a factor. "This is one of the consequences of the "stigma-busting" that has been going on for the last 20 years or so - taking us out of the bad old days when mental illnesses were hidden and seen as shameful."
Flaum says the shortage of psychiatrists in Iowa is very serious. "There are only three states in the country that have fewer psychiatrists per population. At the U of I, there is an office that is set up to track ongoing need and supply of physicians; each year they track how many providers there are in a given area (like psychiatry or pediatrics) and how many open positions there are - that is how many hospitals or practices are actively looking to fill needed vacancies. From this, they calculate something they call a critical demand ratio.
"For family practitioners, that number is - six percent, for pediatricians it is - seven percent, for surgeons and OB-GYN's it is as high as 12 percent. But then when we look at psychiatrist, it is a staggering 29 percent. There are currently 63 unfilled positions - with only a supply of just of 200," he says.
It's important to note, Flaum says, that this shortage is a national trend, not just a local one; and it happens to be particularly bad in Iowa. "Why the national shortage? I'm speculating here, but my concern is that what a psychiatrist working in a community setting actually does on a day to day basis is becoming a much less appealing and satisfying job than it once was; partly because of the way health care is financed. Psychiatrists, like many other specialists, are forced to see many patients in a day- typically - four per hour; and because of the shortage, it is not uncommon to see those only a few times per year. Practically, this results in a very narrow focus - How are the meds? What are the side effects? What are the benefits? Then a new prescription is written for the latest drug.
"I hope this partnership between the University, the county, and the local community health center will be the beginning of a broader effort to really take a fresh look at the role of a psychiatrist in typical community settings and bring the psychiatrist back to a more central role of working collaboratively with other disciplines including social work, nursing, vocational counselors, and working with families and peers; to figure out what works for individuals and families.
"That is what will bring in the best and the brightest back to this field"
Iowa turned the shortage of family practice physicians around in a relatively short time. "In the 1960s it was recognized that there was a shortage, and it was getting worse. A well orchestrated effort was undertaken with legislative support and funding and they turned the situation around in a matter of a decade or so. There is no longer a shortage.
"We can do the same - but first it takes recognition of the problem and a consensus among stakeholders that something needs to be done which is why I'm happy to have had the opportunity to discuss this with you today," he says. |
