Monday, May 24, 2010

From the APA Convention in New Orleans

Everywhere I went at the American Psychiatric Association’s 163rd annual meeting in New Orleans, mental health professionals were in contortions over coercion and treatment. But most of the time they seemed almost completely unaware of it.

The contortions were semantic. E.g., in Course 17 on Sunday: “Treatment of university student populations must be based on a collaborative model; and your best ally will be campus security.”

That one came from Ayesha Chaudry, M.D., a psychiatrist employed by Duke University’s center for student counseling and psychological services. The question apparently never occurred to her, and was not asked during the course: What exactly is the role for the police within a collaboration between a student and a counselor? – or even more fundamentally: Who is a doctor and who is a cop?

Dr. Chaudry cited statistics that almost half of all college students have psychiatric disorders, but only 25% are ever treated. The number of these students prescribed psychotropic medications has gone from 9% in 1994 to 25% in 2006, but it’s not enough. Therefore, it has become the task of clinicians to develop every possible trick and contrivance to get those kids on meds in the face of the irrational and unfair stigma against it.

One of the best tricks has to do with getting around the pesky confidentiality rules, like HIPPA and FIRPA. It turns out that even if a kid refuses to sign a release of confidentiality for a psychiatrist to talk to his parents, he'll often allow her to talk to the dean, or a professor, because he may need permission to drop a course without penalty, or extra time for an exam. The dean or professor is not bound by doctor/patient confidentiality and can call the kid's parents without a release. What a clever betrayal of trust!

Dr. Chandry doesn't know if she's a doctor or a cop, really. Maybe no psychiatrist does, maybe that's the big problem and the reason the stigma seems so intractable. They ought to be more honest about it, at least with themselves.

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