Speakers urge colleagues to get involved in public health psychiatry
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NEW ORLEANS — Mental health services are only a small part of public health psychiatry, according to presenters here at the American Psychiatry Association annual meeting.
“Public health psychiatry is what we do collectively as a society to assure conditions for people to be mentally healthy,” said Kenneth Stewart Thompson, MD.
He spoke as part of a panel delivering a report from the APA’s Social Determinants of Mental Health Task Force.
Panelist Sanya Virani, MD, MPH, explained that social determinants of mental health are societal problems that impede achieving optimal mental health.
“This is not clinical care,” Thompson said. “I don’t think you can address a collective problem one patient at a time.”
He said this aspect of psychiatry involves populations and the health conditions they are experiencing, health promotion, operating at a “place” level, considering how policies impact people and addressing large amounts of people through the development of programs, with mental health services being just one part.
He shared examples of public health psychiatry: removing lead from the environment, screening and early intervention for psychosis and other psychiatric challenges, place-based initiatives to promote emotional literacy and coping skills, housing set-asides and the Child Tax Credit.
That tax credit, Thompson said, “was probably the most important mental health intervention we ever did, and we lost it. We moved 50% of children in the U.S. out of poverty, and they’re back again. It’s shameful.”
The task force put together a list of recommendations for the APA, he said.
“There is no time like now to do something different in American psychiatry,” Thompson said. “We are a society in crisis. We can’t just do more of what we’ve already been doing. We are among the most privileged people who have ever lived, sitting on top of a society that is generating on a daily basis the casualties that are making us wealthy. If we are not going to do something about it, we are complicit.”
Fellow task force member Gary Belkin, MD, PhD, MPH, former deputy health commissioner of New York City, said, “We need to embrace the social. There are 28 antidepressants on the market right now. Our clinical model has failed to deliver on the morbidity in our population.
“We think social determinants are about the adverse-facing, disadvantaged people,” he continued. “But it’s a call to advantaged people. In New York City, day care centers and houses of worship got this right away.”
Belkin said psychiatrists need to get outside their offices a day or two a week, making it the new normal to get involved at day care centers and senior centers.
“We propose to establish a center in the APA that will recruit national experts on this and start a long game to join the rest of the world and show them how much we can offer,” he said. “A work plan needs to be included in the bylaws that grows out our allies and friends, organizations advocating for housing and equity and well-being.”
Virani noted that the task force will issue a white paper detailing its findings and recommendations.