Don’t Look Away

In the last month of 2021, the darkly cynical film “Don’t Look Up” was released. The plot revolves around the impending end of the world brought about by a collision with a comet. Despite scientists’ attempts to alert the government, the media, and the public, most people did not focus on this important news from NASA. Their heads filled with inconsequential trivia and the government’s unwillingness to act on the scientists’ advice, they were unable to notice or comprehend their imminent extinction. This farcical allegory points out how the denial of science and truth can be reinforced by destructive aspects of societal structures. When the comet finally becomes visible to the naked eye, people start to recognize the urgency of their dilemma, but by then it is too late.

This doomsday tale may have some cautionary insights for psychiatry. Pre-COVID-19, there was consistent news about the collapsing infrastructure of health care. Two years into the pandemic, it is undeniable that COVID-19 has placed unanticipated and extraordinary demands on our already beleaguered health care system. Psychiatry in particular has faced an enormous increase in demand for mental health care along with significant changes in the structure of the workplace.

Psychiatrists might want to look up, so to speak, and ask what are the plans for the future of psychiatric systems? Are psychiatric services facing this kind of imminent destruction? And if so, what can we do now to change this trajectory? One place to start is the structure and policies of health care workplaces.

For example, in one Connecticut health care system alone, 400 nurses have reportedly resigned or moved. Additionally, nurses who get sick with COVID-19 or test positive must stay home without pay. In part, traveling nurses are filling empty spots; however, these nurses are new to their workplace and its procedures and staff, which is causing turmoil in everyday operations.

In contrast, in another hospital system in Connecticut, 10 surgeons were terminated between 2020 and 2021 because there wasn’t enough work to keep them employed. As one talented working surgeon told me: “I’m at the beginning of my career, and I’m worn out. I was lucky not to be furloughed last year. I don’t want to hear anything about COVID anymore. I spent 13 years in training, and I can barely get through the day to use all that experience. I’m worried about patient care. I just started directing a surgical center, but I’m looking forward to an early retirement.”

This surgeon’s story is not an isolated one. The demand for health care varies by specialty because of the pandemic, and the health care system is under enormous strain.

For physicians, looking away is certainly not a solution. We must look to secure the future of our health care system and our profession. So, what are the plans for the future of psychiatry? Motivation to become a psychiatrist for many is based on a desire to diagnose, treat, and care for individuals with psychiatric illness. However, the reality is that pre-COVID-19, psychiatry, as a profession, was already wrestling with fundamental problems such as parity and reimbursement, moral injury, medical corporatization, the advent of neuropsychiatry, maintenance of certification requirements, emphasis on psychopharmacology, demise of psychotherapy, and exclusion of social determinants of psychiatric illness, just to name a few. The pandemic has only compounded this state of affairs by exponentially increasing the demand for mental health services and expertise.

Structural change in the health care workplace is critical for the future of psychiatry and psychiatrists regardless of the work they do or where they practice. Health care employers need to do the following:

While genetics, novel treatment approaches, and new investigative targets such as inflammation and the microbiome will give better insights into psychiatric illness and its management, trust in institutional data is decreasing. People live in a wind tunnel of information frequently lacking accuracy and transparency. Discernment of information should not be ceded to another authority lest “fake news” becomes the norm even in matters of life and death. Regarding speaking truth to power, as the Rev. Martin Luther King Jr. so eloquently said, “The day we see the truth and cease to speak is the day we begin to die.”

Lastly, physicians must acknowledge that discrimination of all kinds exists in health care systems that must be addressed by employers. If discrimination continues, innovations in health care may disproportionately reach only a small segment of society. Organizations such as Physician Just Equity are dedicated to improving justice for physicians and surgeons who face discrimination in the workplace. It is focused on building an inclusive work environment at systemic levels.

We can’t look away—we must look and recognize that the U.S. health care system is in crisis, and psychiatry even more so. Only by acknowledging this can we secure the future of psychiatry and start to reform the psychiatric workplace by demanding that employers must act to ensure equity and make structural changes to support their workers. Lives depend on this. ■