Narrowing the `Credibility Gap'

In his July 1 “From the President” column, APA President Steven Sharfstein, M.D., addressed some of the economic issues that plague psychiatry, such as losing ground in reimbursements with a decrease in expenditures, as a percentage of total health care dollars, from 8.2 percent in 1991 to 7.6 percent in 2001. The problems that plagued psychiatric reimbursement 20 years ago have grown worse. As Dr. Sharfstein noted, the cost shift to states' fee-for-service and managed Medicaid programs have become primary payers—and poor ones at that. With imminent cutbacks amid Medicaid financial shortfalls, that payer system continues to implode.

Dr. Sharfstein's responses to this dismal outlook are APA's Business Relations Initiative and federal and state legislative lobbying efforts and advocacy to increase access as “more and more individuals realize that treatment works and seek to obtain it.”

Those initiatives haven't had much success in the past. And repeating those same initiatives is not likely to produce broadly better results in the future.

It is my opinion that psychiatry has a credibility gap and that credibility gap is widening as the disclosure of public psychopharmaceutical embarrassments continue to destroy its image. Why should this be the case? Why should one of the most fundamentally important medical specialties—one that seeks to address the medical, emotional, cognitive, and spiritual components of a human being—lose its luster vis-à-vis other medical specialties as it loses its competitiveness for the health care dollar?

I don't pretend to have a comprehensive answer to that question. But I offer this suggestion: psychiatry must address its internal issues before it seeks to blame others for its failures.

What are the issues that compromise its integrity, attractiveness, competitiveness and credibility?

A fundamental problem for APA's governing bodies is denial. It is not unlike the denial pervasive in drug and alcohol addictions or any other problem when a person, group, or organization either refuses or—for whatever reason—cannot deal realistically with issues that confront it. APA and its governing bodies need to look within themselves—with the capacity for honest and revealing gut-wrenching, insight-oriented organizational analysis. Until APA is able to shake loose the chains that bind it to the pervasive influences of pharmaceutical and technical-gadgetry corporations (whose hefty price tags include an assault on the credibility of every research and clinical psychiatrist), the golden age of psychiatry will be only a glimpse of what has been, since the seeds of psychiatry's future failures will have been nurtured by psychiatry's current inability to address the prostitution of its core values and worth.