The speciality needs not just a rebrand and a makeover, but a return to what we are best at.
Over two decades of working in this profession I have come to realise that despite our skills and expertise as medical specialists who deal with psychiatric illness, most people don’t really know what psychiatrists do unless they have had interactions with us.
Over time, one of our roles has been to advocate for our relevance, showcase our unique talents and demonstrate how they help those we are tasked to treat like no other mental health professionals that we work alongside. I always believed that we were indispensable, irreplaceable and valuable.
In recent times, I have come to reconsider my stance. Perhaps I have been beaten down, or perhaps I am seeing this side of the argument from the other perspective: that of the policy makers, governments and the mental health system as a whole.
Or perhaps it’s that over the past two decades, my role and that of my colleagues has changed.
Our workplace setting certainly has: we no longer work in environments designed to treat chronic psychiatric conditions. We now sit at the crisis precipice, there to utilise mental health paperwork and authorise emergency treatments to contain acute psychiatry presentations.
Even our therapeutic settings have largely evolved; since the pandemic, many have abandoned the consulting room for a telehealth approach to treatment. Our referrals are diagnostically laden – we are ruling in and out conditions such as ADHD to a society largely intolerant of diagnostic uncertainty and lack of a quick fix.
The recent industrial action taken by NSW psychiatrists and the swift response of a government to replace those taking action with a locum and temporary workforce, and a directive for other mental health professionals to pick up the slack for an unknown period of time, demonstrates one fundamental point. It doesn’t matter how much we talk about how relevant we are, our brand suggests otherwise.
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So maybe in these times of irrelevance and disrespect for who we are and what we do, we need to regroup, to claw back to where we used to be and to define what is our core business. We need to book that off-site meeting, emblazon the walls with butcher paper, bring out the felt pens and facilitators and get some change happening.
There has never been a better time to redefine our brand.
But besides our public image, it’s the substance of our work that is due for a change.
Nobody believes our current mental health system is fit for purpose. Everybody knows that the best way to care for people with severe and complex mental illness is to do so for the long haul, not just for brief moments of crisis.
We know that many of the mental illnesses we treat are chronic or episodic. Having a stable and consistent clinician or team is crucial to developing real rapport, trust and hope for improvement. Recovery is possible, but less possible in the system we currently have, which at times sets people up for failure.
With the benefit of years in the game, I am fortunate to remember times where patients were treated in hospitals on occasion, but also in residential and rehabilitation programs that were realistic about timeframes and the mix of different approaches needed to improve a person’s quality of life.
I remember Spectrum in the outer suburbs of Melbourne, where people with longstanding and life-threatening responses to severe childhood adversity received wraparound care from a multidisciplinary team including art therapists as well as psychologists and psychiatrists.
Patients had social workers assisting with crucial aspects of their life such as housing and finances. Crises were managed in the team with less need to “flick” people to a crowded emergency department.
I remember psychosocial rehabilitation services, again designed to help and ultimately care for people with schizophrenia, rather than solely relying on changing medications and 72-hour involuntary admissions to hospital, mostly spent in the emergency department.
It was holistic care, again never perfect, but addressing the need for rehabilitation, enhancing domestic skills and providing assistance with securing accommodation before they left the program.
In the past, where we have done our best work is away from acute hospital settings. Programs that allowed longer stays, such as in rehabilitation or residential settings allowed us to deliver what was needed for better outcomes, being mindful of the requirement for investment in resources and specialist care.
If we went back to basics and moved away from busy emergency departments and chaotic acute psychiatry wards, reinstated longer stay services and reclaimed our “brand” of being the experts of care, we could offer real alternatives, rather than trying to operate in rigid systems that are not fit for purpose.
We could work alongside our psychology, social work and nursing colleagues to offer true care rather than piecemeal stop gaps in times of crisis.
Psychiatrists are best placed to run these settings, alongside their social work, psychology and nursing colleagues.
Our brand should resonate with these skills we have been trained in, although rarely use nowadays. We are better than one-size-fits-all telehealth that is diagnosis-driven, and we can do more than manage a psychiatric crisis in an emergency department before we are forced to “tick and flick” people who are vulnerable and desperately unwell by hospital bed managers.
The predicament currently affecting NSW psychiatry is a microcosm of what is occurring all over Australia and in many other countries.
Let’s use this moment in time to regroup and rebrand. We can use this time to go back to core business, care for those who desperately need our help, and find the satisfaction and reward in doing what we do well. That doesn’t mean designing new silos or services that are not sufficiently staffed to operate, but going back to what we know used to work.
Dr Helen Schultz is a consultant psychiatrist, a coach and mentor to RANZCP psychiatry trainees. This piece was originally published at medium.com.
