Page 8 winter issue of empowerment magazine

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Page 8 winter issue of empowerment magazine

  1. 1. Reaching Across Stockton by Ron Risley, MDTake a walk along Stockton Boulevard. Head south from U Street, and on the right youll pass 2250 Stockton Blvd: theSacramento County Mental Health Treatment Center (affectionately known as SCMHTC). Keep heading south, past theCoca Cola bottling plant, and youll reach the UC Davis Department of Psychiatry and Behavioral Science. Its an attrac-tive but low-key building, also on the west side, nestled between a telephone company switching station and a La Boufast food restaurant.Now look east across Stockton and behold the monument to modern medicine that is the University of California, DavisMedical Center. The sprawling campus has it all: lush lawns, a rose garden, hospital towers, clinic buildings, parkingstructures, water fountains, the emergency room. Gurneys, elevators, operating rooms, MRIs. Theres radiology, burnmanagement, and surgery for everything from your eyes to your toenails. Theres internal medicine and family practice.You can get care for you liver, kidneys, stomach, intestines, colon, skin, lungs, heart, bones, muscles, nervous system,ears, nose, neck, spine, and reproductive organs. Oncology, neurology, nephrology, urology, pathology, cardiology, pul-monology, surgery, dermatology, ophthalmology, gynecology... it seems theres a clinic and hospital beds for everyimaginable medical problem... except mental health. For that, you have to cross Stockton. Psychiatrists are fully trainedand licensed medical doctors. They go to the same medical schools as other doctors, take the same medical board ex-ams. Yet, somehow, a year or two after graduating from medical school they pack up their MD degrees and cross Stock-ton to the mental health ghetto.The gulf between mental health and the rest of medicine might not always be as tangible as Stockton Boulevard, but thatgulf is there wherever health care is practiced. Insurance companies offer different benefits, limits, and co-payments formental health. Where the law prohibits that practice, they often farm out the "mental health benefit" to a different com-pany to manage it in a separate (but equal?) fashion. Imagine if your health insurance required you to use an entirelydifferent set of telephone numbers, forms, utilization reviewers, diagnostic codes, and procedures for a lung problem likeasthma than for a broken bone... and heaven help you if you get a rib fracture that affects your breathing! If youre a fam-ily physician, an internist, a radiologist, or a dermatologist you might practice in a fancy building with your name, creden-tials, and specialty emblazoned on a sign over your door.If youre a psychiatrist, youre more likely to be practicing in a nondescript office suite with discreet parking and minimalsignage. People hide their psychiatric medications and fear that, should they have the misfortune of having to go to theER for a medical emergency, they will get labeled a "psych case" and wont have their symptoms taken seriously. Youmight be "a schizophrenic" or "a borderline," but youll likely never be called "a colon cancer" or "a multiple sclerosis." Sowhats wrong with Stockton Boulevard? Is it really so bad to separate mental health from "real" medicine? Yes, it is. Thecombination of stigmatization and separate (but equal?) Jim Crow funding of mental health care makes it all too easy tosingle out a group whose public face is shunned by society. Use Google to search for "cancer care cuts" and you getabout two million hits. Perform the same search for "mental care cuts" and the figure climbs to over twenty-five million.The Stockton Boulevards of health care also directly affect the quality of care. Patients with psychiatric illness are usuallyseen many times by primary care physicians before being referred to a psychiatrist. Their diagnosis is often delayed be-cause primary care physicians -- who have trained and practiced east of Stockton -- dont always have ready familiaritywith the signs and symptoms of psychiatric disease. They might have a low threshold for consulting with or referring tothe cardiologist or orthopedist they had lunch with last week, but when they have to refer across Stockton they are con-fronted with an unfamiliar system of care and doctors whom they have never met. Psychiatrists often prescribe medica-tions with profound side effects such as weight gain, diabetes, high blood pressure, and high cholesterol. Yet most psy-chiatrists cant easily reach across Stockton to ask a primary care or specialist colleague how to screen for, identify, andtreat those side effects. They often arent able to do much more than say "see your primary care doctor." Yet the primarycare doctor (if the patient has one) might not be aware of the implications of the medication. Would the consequences ofstopping the medication be worse than the consequences of high cholesterol? Those kinds of decisions require an inter-disciplinary approach thats hard to maintain across a busy four-lane street.Diabetes is a particularly telling case: psychiatrists often have greater access to patients, more time and experiencecommunicating with them, and a lot of insight into how the patient perceives their chronic illness and their own role inmanaging it. The psychiatrist might also have a much better understanding of the role that psychotropic medications playin causing or exacerbating diabetes, and what other options might be available. Yet it is left to the primary care physicianto do blood tests, prescribe medications, and educate a patient who might be seen as difficult or even frightening. Continued on page 9

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