Past Issues

Using Professional Skills and Teamwork to Address Modern Mental Health Issues

Cheng-Chung Chen, M.D., Ph.D

Taiwanese society has progressed in an unprecedented pace, including freedom of speech, laissez-faire (free commerce), civil independence, public social insurance, uprising human rights, etc. The continuous evolution has changed some of the structure of psychiatric clinic and hospitalized patients, including depressed or suicidal cases. Furthermore, policies have been closely involved in treatment of the severe mental ill patients due to emerging development of community treatment program. The halfway houses and community rehabilitation centers in various districts have also gradually matured.

Traditional psychiatric medical team includes psychiatrists, social workers, psychologists, occupational therapists, and psychiatric nurses. The teamwork environment has been critical in solving problems, yet recent laws rely solely on psychiatrists to assess psychiatric disorders and the mentally disables. Therefore, psychiatrists have been granted power that without consultation can be easily misused. This problem can be solved if we incorporate the psychiatric team by consultation. This is similar to the history of power, tyrants are overpowered and only with a sharing of power to prevent the abuse of such power. In general, psychiatrists as I imagine are good human beings and most of the time, such abuses do not exist. However, there are always exceptions and because of these minor flaws, as governing bodies, we should invent rules to prevent such flaws undermining the integrity of our society.

The handicap assessment has been one of the most severely misused area because of defraud from the patients or greed from very few psychiatrists. The handicap assessment is critical to receive government charity and personal different insurances. These benefits granted in attempt to improve the condition of minority, however, stimulated the growth of such delinquency. This delinquency consumes the charity that is essential to the patients and undermines the idea behind such good deeds. The solution as suggested earlier is to allow opinions from the entire psychiatric team, not just psychiatrists. I have to restate that most psychiatrists are not in this category. Therefore, it might required more work from all psychiatrists to accomplish this goal; however, I believe, as psychiatrist, we should regulate and prevent such crime that would destroy the integrity of psychiatrists.
Next, the current law states that psychiatrists are responsible for diagnosis and assessment of the mental disorders and disabilities. This is a common problem in legal and commercial practices, so called the “conflict of interest.” Explicitly, “conflict of interest” is a violation of fairness. Psychiatrists are required to treat patients with patient-centered models. This influence on the professional judgment is often related to personal relationship between the prosecutor and the criminal, in our case, the psychiatrist and his or her patients. In legal practices, the judges or the prosecutors usually avoid being involved with their relatives.Psychiatrists who have made diagnosis for the patients could be easily affected by other personal conditions of the patients. For example, the psychiatrists who diagnosed the patient might be told that the patient just lost his or her job. This is not critical to the assessment of the disorder, however, with this in mind, the psychiatrist could find that having a handicap document would relieve patients' financial stress and therefore with this additional information on the patient, the assessment might bemisled. This is just an example of how additional information can build up prejudice before the professional judgment.

The solutions to the two previously stated problems are clear, however, the solutions are not without flaws. The involvement of the psychiatric team can easily be granted power that would be misused by other professions in the team. The prohibition of same psychiatrist to diagnose and assess can raise the question that who is more familiar about the patients than his or her caregiver. Moreover, these improvements require additional time and money commitment. This will prolong the process of handicap assessment, which is already a difficult and tedious process. As a result, this is not something that would happen overnight. Further consultation is needed to evaluate the validation of these suggestions.

Lastly, our society needs your support to thrive.You can participate inmaking a difference in this society by providing information and suggestions. This journal provides a panel for everyone in the society to communicate his or her new ideas or better policies to all the members. Furthermore, it also educates all the members with novel inventions in all different psychiatric areas. This journal also provides this excellent chance of permanent learning for psychiatrists. In conclusion, I would like to encourage all members of this society to inspire your colleagues by participating in contributing to this journal.
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Editorial Committe, Taiwanese Journal of Psychiatry
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