DB Presidents Describe Troubled MH Systems

With last month's Board of Trustees meeting being held in New Orleans following the close of the Institute on Psychiatric Services, it was fitting that Board members received a report from the presidents of two local district branches (DBs)—those representing Louisiana and Mississippi—on issues they and their colleagues face in the post-Katrina environment.

Daphne Glindmeyer, M.D., of the Louisiana DB, said her organization is dealing with a greatly reduced membership roster and an attendant loss of income that has added to their struggles. Many members resigned after the state granted psychologists prescribing privileges, with some blaming the local DB and national APA for not doing enough to head it off, she noted. In 2003, the year before the prescribing bill passed, the DB had 464 members; by 2005, there were only 392. And then Katrina hit, further devastating the membership as psychiatrists moved to other states where they didn't have to cope “with a broken system” and a lack of health-system“ infrastructure.” Membership has recently edged up to 403.

Now the remaining psychiatrists face far more patients who are very sick, and waits for care are growing rapidly.

Further complicating the lives of Louisiana psychiatrists, she said, is the imminent application of a term-limits law in the legislature, which means there will be a major turnover, “and we don't know who our friends and foes are” and thus who to target in lobbying efforts.

Philip Scurria, M.D., president of the Mississippi DB, also described how Katrina devastated an already seriously underfunded and understaffed mental health system in his state. He noted that he is the only full-time psychiatrist in the Mississippi Delta region between Baton Rouge and Memphis. In many parts of the state waits of two to three months to see a psychiatrist are the norm, putting “a tremendous load on emergency rooms.” In the storm-ravaged Gulf Coast area, the suffering is particularly dramatic, and while he expressed gratitude for the volunteers who provided mental health crisis intervention after the storm, he said there are far too few clinicians left there to treat people who will be “suffering with lifelong illnesses.”

Incarcertaing mentally ill individuals is common in the state, he added, with the state hospital routinely having a three-week wait for beds to become available. “Some are just sent home to wait for a bed, even though they may have been declared dangerous to themselves or others,” Scurria said.

Mississippi's clinician shortage is most severe for children needing psychiatric care. There are fewer than 20 child psychiatrists in the state, he pointed out, with 90 percent of them located in Jackson, the state's largest city and site of its only medical school.

The Trustees also heard from psychiatrist Anand Pandya, M.D., president of the National Alliance on Mental Illness (NAMI), who discussed the organization's new initiatives. One effort, NAMI Connections, is to have a three-year roll-out of a peer-support-group model to be available in every state and major metropolitan area. As is the case with Alcoholics Anonymous, people who participate in one of these support groups could find one in any state to which they traveled and understand the concept and terminology being used. He said that these programs were already operational in 12 states through funding from AstraZeneca.

NAMI is also focusing on lesbian, gay, bisexual, and transgender people with major mental illness, Pandya explained, including the difficulty some of these individuals have in getting a psychiatrist or mental health professional to treat them unless they agree to discuss their sexual orientation as a major part of therapy.

He also urged APA to add “consumer members” to its Academic Consortium, which lobbies Congress on research funding for mental illness research.

The Board took action on several issues at last month's meeting. Among them, the Trustees voted to