3 Solutions to the Psychiatry Shortage

Last week’s blog detailed some of the dynamics contributing to the diminished availability of psychiatric care for our clients. We are all well aware that this shortage is real and that it is anticipated to grow.

So what is the solution…especially for new solo providers or for small practices.

1. Refer and collaborate

Having an ongoing and positive relationship with a psychiatrist that you can refer to is a successful strategy for handling the medication management needs of your clients.

Perhaps a new practicing psychiatrist will be willing to accept your referrals and maintain treatment updates so that the two of you are coordinating care in the best interests of your shared client. To start that type of relationship, I suggest having an acute awareness of what the psychiatrist you want to connect with values.

Is there a particular kind of client they want to see? What information would they want in a referral packet for new clients?

Are there required releases in place so that your two offices can communicate freely? How would they like to facilitate collaboration?

The referral process can go two ways…a psychiatrist that you are successfully collaborating with is likely to refer you clients that he/she feels need ongoing therapy to help them achieve their comprehensive mental health goals. This is a win win for everyone.

2. Take it to the web

Being willing to use online options for providing psychiatry services significantly opens up the conversation. This tech savvy solution can work wonderfully and has huge implications for clients and clinicians.

I love hearing the stories of clients living in rural areas accessing psychiatry services through tele-health in life changing ways.

Here is an article on how North Carolina is exploring Tele-psychiatry options.

This solution is not as simple as a Skype call. Concerns about privacy, quality and meaningful connections with clients are real. There are SO many factors to consider for successful implementation.

For more on this, I have turned to one of my favorite sources for behavioral health innovation and best practices, www.openminds.com.

Click here for a webinar from Open Minds that details best practices for Creating, Designing and Implementing a Successful Tele-behavioral Health program. With an open mind and a commitment to best practices…it is possible!

3. Think outside the box

One clear and effective solution is to look beyond psychiatrist for the provision of psychotropic medications. There are several other health professionals that are more than qualified to help and many that already are….

Pediatricians - Not every child with ADHD absolutely needs to be seen by a psychiatrist for ongoing medication management. Although I highly suggest having the initial evaluation completed by a psychiatrist to ensure that we’re on the right track, it may not be necessary for follow-up care to continue at that level. For children, many general practitioners or pediatricians are more than capable of monitoring progress on low dose stimulant medications.

OB/GYNs Likewise, mildly depressed woman are able to have their medications managed by OB/Gyns or general practitioners in certain cases. Women that are already actively in therapy for mild mood disorders and are progressing without incident would likely be good candidates.

Psychiatric Nurse Practitioners - Each state varies with regard to how much prescribing authority they provide Psychiatric Nurse Practitioners. Click here for a site that will give information on the prescribing authority for PNPs in your state. Some mental health teams will have a psychiatrist provide the initial diagnosis and nurses provide the ongoing medication management and follow up care.

But these three health care providers are already facing their own demand concerns. There is a nursing shortage that is fast growing as well. So this leads me to another idea…

Ask yourself… “As a psychologist, would you want to have prescribing authority?”

RxP Movement (Psychologists with Prescriptive Authority) In 2013,Illinois became the third state to have approved RxP legislation allowing psychologist to gain prescribing authority. There are five other states already considering this option. The thought is that with a combination of capacity building and legislative momentum, this solution could bring psychologists into the conversation as a strong alternative for psychiatric care. Click to read more information on the RxP Movement. There has been significant lobbying against it over the years, but I must admit… it does offer a potentially less medicalized solution to a continually growing issue. What do you think? Leave your thoughts, comments, suggestions in the comment section below.

The truth is…no solution will be perfect.

While I am certain that there are several reasons that can be listed for why tele psychiatry is not the best solution…it does provide an option.

Likewise, we can detail reasons why other health professionals are not the best way to provide medication management.

But, I can’t help but consider the alternative. Hundreds and thousands of clients unable to receive needed psychotropic medications. ​

Together, we solve the problem.

I often joke that they don’t invite social workers to the party…they invite us to the problem.

Collectively, behavioral health professionals have what it takes to solve this issue. I don’t pretend to personally have all the answers…but I believe we can engage in a healthy dialogue to help us find our path forward. We can approach these issues with a fresh perspective and emerge with creative solutions.

I would love to hear your voice in this conversation.

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