Mental Health Consult

Policy Segment 4: What is ‘enough’ team care training?


Who is in this video: Dr. James Griffith, the Leon M. Yochelson Professor of Psychiatry and Behavioral Sciences, and chair of psychiatry and psychosomatic medicine at George Washington University School of Medicine. Lauren Alfred is policy director at the Kennedy Forum.

Dr. Griffith: There’s also the training of our educators. There has been too much focus simply on counting symptoms. If you have sleep problems, if you have no energy, if you’re not enjoying things, then you have depression. That kind of definition of depression catches too many different things that shouldn’t be addressed in the same way.

“There has been too much focus simply on counting symptoms.”
– Dr. James Griffith
That’s distress. In primary care there are a lot of people with, often, very malignant mood disorders – major depression, bipolar disorder. They generally need not just a prescription; they need a program. Medication may be part of it. It also needs to address lifestyle. It also needs to address relationship problems. Many different things, which if done well can help people live good lives without being held hostage to having a psychiatric diagnosis.

When I said distress – these are not mental illnesses, but yet it all gets called depression. Often in the public discussions, it’s treated – “We just need to identify the depressed patients, give them medications.” That serves few people well. There are ways of doing very effective, targeted work depending upon, initially, an accurate assessment of what is the problem. Is it demoralization? Is it grief? Is this a relationship that is abusive, for example?

Now the other piece - and this is a big one. This is one that we’ve got to figure out how to address, and this is no different in the Middle East, where I’m doing work, as it is here. People come into primary care complaining of dizziness, headaches, physical pain problems, not sleeping well, fatigue. Wherever in the world you’ll go, what they get is a lot of tests, vitamins – not identifying or addressing that underneath this there is psychological distress or a mental illness driving it.

This puts a focus on detection and formulation of the problem. You’re right, the doctors aren’t going to do all the treatment, but this is where the doctor pretty much does have to do, on the front end, the identification. That’s our training issue.

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