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As a first year psych resident, I work on medical and psychiatric services almost equally.
The contrast between availability of evidence based treatments on medical vs psychiatric services is shocking, and incredibly frustrating .
A clinical vignette...
The contrast between availability of evidence based treatments on medical vs psychiatric services is shocking, and incredibly frustrating .
A clinical vignette...
In medical emerg: I see a patient with a fracture. Unsure if it could be an open fracture, so ortho comes to see. They do a reduction and casting, arrange for outpatient follow up.
I am able to work in a team, set up appropriate care, and follow up
I am able to work in a team, set up appropriate care, and follow up
In psych emerg: I see someone in a situational crisis. I’m able to do an assessment and believe the biggest contributing factor is borderline personality disorder. This person would benefit the most from therapy, DBT or trauma most likely, and follow up
But wait
But wait
There is nowhere to get DBT or trauma therapy. There is no waiting list for outpatient psychiatrists or case managers I can add them to. I’m unsure if admission is likely to help, because there’s no consistency in interventions provided on inpt psych units
This person says to me “why did I even come here? You didn’t help me”
And I agree. I know how, but I can’t.
And I agree. I know how, but I can’t.
The point is not to sink into a bleak outlook on psychiatric care (resist it, we must)
The point is to imagine what it could be like
Imagine if a routine part of the psychiatric assessment was figuring what TYPE of therapy would benefit that patient the most?
The point is to imagine what it could be like
Imagine if a routine part of the psychiatric assessment was figuring what TYPE of therapy would benefit that patient the most?
Imagine if we could say, “you would benefit from an inpatient stay to access a brief course of therapy for suicidality”
Or
“You need more support then you have at home right now. We have an outreach team who will follow up with you tomorrow”
Or
“You need more support then you have at home right now. We have an outreach team who will follow up with you tomorrow”
Imagine if I could refer to evidence based rehab facilities for people who want to stop using substances. If I could provide consistent safe supply for people who don’t want to stop using substances, but also don’t want to accidentally overdose and die.
Imagine if I could easily get someone into stable and safe housing. The psych emerg would be half empty overnight.
