The internet is full of addiction and other mental health treatment websites that tout having a psychiatrist on staff. This is important information to challenge when seeking treatment, as there is a growing psychiatrist shortage in the U.S. “Psychiatrist on staff” may mean psychiatrist on call or shared with other treatment facilities and available infrequently or via telehealth. With more than one in five American adults having a mental illness, and 150 million people living in federally designated mental health professional shortage areas, the gap between need and access is growing wider (Association of American Medical Colleges).
Psychiatrist-Led Mental Health Treatment
So, what does it mean to have a psychiatrist-led approach? At Sanford Behavioral Health, our medical team is spearheaded by Dr. Gilbert Masterson. Dr. Masterson completed his Residency in Adult Psychiatry at Harvard University School of Medicine and his Fellowship in Child Psychiatry at the University of California, Los Angeles (UCLA). Dr. Masterson is on-site at Sanford West Behavioral Health Campus in Greater Grand Rapids, Michigan. Indeed, he is often the first person a patient or their family members see when admitting to treatment for substance use disorder (SUD), eating disorders, or co-occurring mental health conditions.
We sat down with Dr. Masterson to ask why having a psychiatrist-led treatment team is vital for positive outcomes. Following are Dr. Masterson’s thoughts on the subject.
Most SUD and eating disorder patients have significant depression or anxiety.
Remember the pandemic? It changed many things for those of us in addiction, eating disorders, and mental health treatment. Since the pandemic, the greatest majority of those who walk through our doors have developed significant depression or anxiety. Also, at least 75% are already taking psychotropic medications. Somebody has tried to treat their symptoms without looking at the whole picture – the whole person. We used to have the expression “self-medication” that went out of vogue. But that also seems to be happening with people using drugs and alcohol to self-medicate depression and anxiety.
At Sanford, every patient has a psychiatric and medical assessment before treatment begins. This allows us to identify the appropriate level of care, current physical and mental health symptoms, issues in life, medical and mental health treatment history, substance use history, family dynamics, trauma history, presence of risk to self or others, and more.
There is a reason those with SUD have increased anxiety.
I ask people every day, “Do you ever struggle with anxiety or overthinking?” Only once in a blue moon do they say, “No.” There is a reason for that. The old school would say, “Of course they have anxiety; they’re messing up their life with drugs and alcohol.” But alcohol tampers with your brain. It steals certain chemicals that, in turn, make you anxious. So as you drink to help with anxiety, you get more anxious. It might work in the short run but it becomes a vicious circle. If I want to help ease your anxiety, I have to give you back what alcohol stole, and antidepressants don’t fully replace those chemicals. I like to say, “Normalize, don’t tranquilize.” Treatment incorporates complex programs and processes based on understanding the patient, a sophisticated interdisciplinarity team, and excellent communication.
“The things we do at Sanford will probably be different than you have experienced before. We will not tranquilize or suppress you, but we will normalize you. If I have my way, you will be significantly better in 7 days and great in 7 weeks. If you can stay on course for seven months, we can begin to reduce or eliminate the medication. Medication is not forever, but it can improve your mental health forever.” Dr. Gilbert Masterson
ADHD and substance use disorders are associated.
Another factor in the mental health crisis is ADHD (Attention Deficit/Hyperactivity Disorder). If you have ADHD as a child, you have a 75% chance of developing a substance use disorder. Often ADHD patients come in the door having already been treated with psychiatric tranquilizers. Again, I like to normalize, not tranquilize and give back what genetics did not supply. The more I can give back to you, the less you will need alcohol or drugs to suppress what is running rampant in your head. Why is there an increase in ADHD diagnoses? During the pandemic, people started using stimulant medications such as Adderall for adults. It’s become a new trend I am firmly against. This, too, provides short-term gain and long-term pain. Adjusting or stopping inefficacious medications is another hallmark of psychiatrist-led mental health medicine.
The prevalence of telehealth during the pandemic created problems.
During the pandemic, there were relaxed regulations about getting online and making virtual mental health appointments. People were finding sources worldwide to prescribe medications most of us in the mental health field would not have prescribed. I welcome the return of more stringent regulations and lesser access to online pill mills.
Psychiatrist-led mental health treatment
Psychiatric needs are not the only thing we focus on at Sanford Behavioral Health, but they are important enough to address at the door. We require a psychiatric assessment at admission, and I see patients (and their family members) for their assessment. A psychiatrist sees patients every day when they are in the detox unit. Patients see either a psychiatrist or psychiatric nurse practitioner every day during treatment. We strongly encourage patients to step down through the full continuum of care, giving us ample opportunity to adjust medications. We also offer follow-up or aftercare. Our patients have come to expect that level of vigilance in everything we do.