 |
 |
|
|
The article "California County Puts Social Workers in Charge of MH System" in the September 4 issue echoes a trend seen at the state level. The California Council on Mental Health Evaluation Planning has among its 36 members only one slot for a psychiatric physician from the private sector. The rest of the council consists of "consumers," social workers, psychologists, and mostly nonphysician representatives from various mental health-related state and county agencies. The emphasis is on obtaining information on how patients (clients) are doing in various psychosocial domains: income, living situation, interactions with the law, social activities, job activity, opinion about services, and so on.
There is little systematic effort to evaluate the adequacy of treatment given. How one will be able to evaluate treatment outcome without this information is difficult to discern. Also, even though there is ample knowledge that various physical problems can cause or at least contribute to behavioral dysfunction, there is, as yet, no systematic effort for gathering this information to help determine the adequacy of treatment.
The psychosocial approach being undertaken reflects the absence of appropriate medical input and thereby puts into question the usefulness of the evaluation being undertaken and the wisdom of the expenditure of tax dollars in this vast statewide effort. It appears the approach being used "decorporectomizes" patients by virtually eliminating the bio in what should be a biopsychosocial evaluation.
At the local county level hundreds of thousands of dollars have been provided recently to help adolescents and their families deal with substance abuse problems. Money is earmarked to pay private sector psychologists, social workers, counselors, and others, but none is earmarked for psychiatric physicians. With all the advances that have been made in psychiatry to understand and deal with substance abuse, it seems shortsighted (inept? inefficient?) to offer a lower level of care than our state of medical knowledge can provide. This is neither cost-effective utilization of tax dollars nor good quality care. Predictably outcome will be poorer than it need be.
This trend toward not incorporating the strengths of the medical approach in treatment planning and evaluation, which comes about through lack of adequate medical representation on planning, evaluation, and bureaucratic administrative bodies, must be countered for the sake of the well-being of those being offered various health services, particularly in the public sector. Here is another important role for our public education, public relations, and government affairs efforts.
Maurice Rappaport, M.D.
Area 6 Trustee