For those who may not know, the biochemical model of psychiatric conditions is far from worked out - if it has any validity at all. The medications used for anxiety and depression - the most common problems in industrialized countries - often(typically/possibly even best case) are no more effective than non-medication treatments alone. For younger patients, the idea of medication only management is not endorsed by any professional society at this point. This is a big hole in a purely neurochemical theory of “mental illness” as I see it.

There is precious little literature providing information on comparative effectiveness of treatments (med v. non-med or med v. med) for “mental illness.” When comparative studies are found, very often the differences measured are intended to “stack the deck” in favor of a newer agent over an older one, or the measurements are on parameters which may not have clinical importance.

For serious conditions such as schizophrenia, clozapine - an older agent with very serious potential side effects - is ikely to be the most effective treatment available to address the parameters of the disorder most often consider pathologic. Comparing newer agents to perphenazine (another older agent with potentially fewer life-threatening complications than cloazapine) revealed that the older drug was at least as good, and likely produced fewer untoward side effects than the newer agents. Last I checked, Litium - with its faults - was still the gold standard medication treatment for bipolar disorders.

In other words, the idea that newer is better is not established. Newer is however, more expensive.

More isn’t necessarily better either.

Psychiatrists would not be delinquent if they chose to employ well-established, effective and safe treatments for their patients, even if that meant that they elected to use only medications that had been on the market for more than 5 or 10 years.

Psychiatrists and other phsycians would, of course, be delinquent if they relied on medications only when other adjunct treatments should be used. Additionally, they would be delinquent if they used medications (with no proven benefits, but known and unknown risks) to treat symptoms of a condition which was not accurately diagnosed. I would also argue that psychiatrists and other providers would be delinquent if they failed to obtain informed consent outlining specifically the diagnosis/diagnoses under consideration, all treatment approaches, the quality (or lack) of evidence-support for the treatment recommended, and the known and likely theoretical risks and benefits.

Still, though psychiatrists (and pediatricians) don’t make the same money as orthopedic surgeons, they aren’t impoverished. They certainly do better than clinical psychologists, licensed psychological counsellors, clinical social workers, etc. I know a few who do quite well with relationships with psychiatric hospitals, residential treatment facilities and community mental health centers while delegating much of the work to “mid-level providers.”

Certainly monitoring labs do not require a changes in office structure. There are plenty of commercial labs who will do the work, and send the results directly to the physician. A psychiatric office can operate with minimal overhead, especially relative to other medical specialties.

Of course I’m not a psychiatrist, so many would argue that I don’t know what I’m talking about. Some will also likely argue that I’m advocating the use of unsafe/inappropriate medications, though in fact, I’m not. I do advocate responsible treatment consistent with treatment guidelines/practice parameters and the most current, best avaialable evidence.

As for financial incentives being “out-of-whack.” That’s nothing but true. I believe in the golden rule of healthcare - “He who has the gold makes the rules.” There is a logical follow-up to this: “You get what you pay for.”

Until the people who actually purchase mental health services - that would mostly be us, the taxpayers - determine that medication management is not as valuable as providing/coordinating more comprehensive services, this is what we get.

I’m not very happy with it. Are you?

My apologies Justice …
Mistake on my part..

you gotta be kidding Justice right?

Even with studies that are done on the brains of the mentally ill such as genetic markers for schitzophrenia etc , who is to say that it’s not the drugs which have caused these changes in brain matter? ..
How are we to know?
How many studies have been done on those who have never taken drugs for their “mental illness”? Where’s the evidence and research?

They are prescribing these meds now as “medication management” without having those things available now. Go sit in a psychiatrists office…q15 minute visits. No therapy going on there.

If you want therapy find a Psychologist, if you want a drug go to a Psychiatrist.

There is certainly also a role for “talk” therapies, and if the financial incentives are out-of-whack, then that’s something that should be examined. But last time I looked, psychiatrists were towards the bottom of the physician income scale. Also, many psychiatrists don’t take insurance so they don’t need all the billing and support staff costs. If they shift to doing more medication management, will they need to change the infrastructure and staffing of their office to accommodate labs, blood draws and other equipment for physical examinations that may be required with some of the new medicines?

I’d also say that it is less important that psychiatrists personally do therapy than that _someone_ does it in the right instances. But clinical psych and social work must also function within very limited ocverage in most instances.