Sure thing, and I'm glad you're thinking about creative solutions since we need all the good ideas we can get. I think especially re: prescribing, there's an idea in the air that it's mostly just an algorithm or decision tree, or something that someone can be easily trained to do well, eg. "they're depressed so give them an antidepressan…
Sure thing, and I'm glad you're thinking about creative solutions since we need all the good ideas we can get. I think especially re: prescribing, there's an idea in the air that it's mostly just an algorithm or decision tree, or something that someone can be easily trained to do well, eg. "they're depressed so give them an antidepressant, how hard can it be?!" (not saying you're saying this, but the idea can be implicit in these discussions sometimes). The whole "prescribing is an art" thing is partially true, since a lot of the knowledge comes from first-hand experience (maybe similar to how I could read all the law books I want but that probably wouldn't make me a good litigator, since I'd actually need a lot of on the ground experience).
Another thought is that we need to figure out what we really want. Do we have a problem with doctor/prescriber shortages? Or do we have a problem with overprescribing psychiatric medications to half the country? Or somehow both? My sense is that increasing prescribers will almost certainly lead to proportionally greater prescriptions for milder cases ("SSRIs for everyone!") but won't necessarily help those with severe illness who need higher octane meds with a prescriber who really knows what they're doing.
This line of thought leads me back to the idea that one way to deal with this problem is for us to stop viewing most mild cases of psychological distress as "psychiatric" problems that require medical treatment and instead more as "problems in living", while reserving the psychiatric labels and medications for more severe cases. Not sure how we'd accomplish this other than some slow cultural change, major changes to pharma regulations, or me finding a magic wand.
Yeah I want to write an article along the lines of "let's split mental health in half", because there really are two distinct issues, the problems in living people and the seriously mentally ill. Part of my thinking is that w/ more people in the field overall the most skilled people could pay greater attention to the cases where they're needed most, but mental health practitioners are people too and I get why many wouldn't want to go into the areas where help is needed most, or to treat people w/ the worst illnesses when more moderate or even worried well clients are available and in the case of private practice/clinicians, pay more. There's ultimately both a supply and demand problem and tackling both simultaneously likely the right way to go.
Sure thing, and I'm glad you're thinking about creative solutions since we need all the good ideas we can get. I think especially re: prescribing, there's an idea in the air that it's mostly just an algorithm or decision tree, or something that someone can be easily trained to do well, eg. "they're depressed so give them an antidepressant, how hard can it be?!" (not saying you're saying this, but the idea can be implicit in these discussions sometimes). The whole "prescribing is an art" thing is partially true, since a lot of the knowledge comes from first-hand experience (maybe similar to how I could read all the law books I want but that probably wouldn't make me a good litigator, since I'd actually need a lot of on the ground experience).
Another thought is that we need to figure out what we really want. Do we have a problem with doctor/prescriber shortages? Or do we have a problem with overprescribing psychiatric medications to half the country? Or somehow both? My sense is that increasing prescribers will almost certainly lead to proportionally greater prescriptions for milder cases ("SSRIs for everyone!") but won't necessarily help those with severe illness who need higher octane meds with a prescriber who really knows what they're doing.
This line of thought leads me back to the idea that one way to deal with this problem is for us to stop viewing most mild cases of psychological distress as "psychiatric" problems that require medical treatment and instead more as "problems in living", while reserving the psychiatric labels and medications for more severe cases. Not sure how we'd accomplish this other than some slow cultural change, major changes to pharma regulations, or me finding a magic wand.
Yeah I want to write an article along the lines of "let's split mental health in half", because there really are two distinct issues, the problems in living people and the seriously mentally ill. Part of my thinking is that w/ more people in the field overall the most skilled people could pay greater attention to the cases where they're needed most, but mental health practitioners are people too and I get why many wouldn't want to go into the areas where help is needed most, or to treat people w/ the worst illnesses when more moderate or even worried well clients are available and in the case of private practice/clinicians, pay more. There's ultimately both a supply and demand problem and tackling both simultaneously likely the right way to go.
lol yeah it sounds like we’re both thinking of writing basically the same article (although whether our proposed fixes are the same I’m not sure)