Psychiatrist Builds Bridges To Link Public, Private Sectors

If it were not for Richard Shadoan, M.D., thousands of uninsured patients in the San Francisco area would have fallen into the cracks of a system poorly equipped to help them.

His ingenuity and persistence, said colleagues, helped bring about unprecedented partnerships in the Bay Area, many of those between the private and public sectors. As a result, the city’s sickest and most impoverished patients benefit from an array of services that weren’t available to them before.

His years of service to the San Francisco community were recognized in July 2002 when he received the prestigious Dr. J. Elliot Royer Award from the Dean’s Office at the University of California, San Francisco, School of Medicine.

The award, which includes a substantial cash award and a framed certificate, goes to two psychiatrists every other year—one who is a community-based practitioner and the other an academic psychiatrist—for their significant contributions to the advancement of psychiatry.

Victor Reus, M.D., a professor of psychiatry at UCSF, received the award for his outstanding contributions to the field of academic psychiatry.

The road that brought Shadoan to the Bay Area began in Billings, Mont., where he grew up and attended the University of Montana, courtesy of a football scholarship.

After graduating with a bachelor’s degree in psychology, he entered the Army as a member of ROTC and left for Munich, Germany, on his first assignment with the medical service corps.

While in Munich, Shadoan worked both at a battalion aid station and a military hospital, where he became interested in treating patients with serious mental illness.

After his Army discharge, he attend medical school at the University of Munich and later the University of Hamburg, from which he graduated in 1962.

After medical school, Shadoan left Germany to begin a psychiatry residency at Mt. Zion Hospital in San Francisco.

After completing residency, he entered private practice and became director of an inpatient unit at Mt. Zion.

Supports Were Missing

Shadoan’s experience on the inpatient unit was a turning point in his career. “I noticed that we could help patients recover from acute crises, but there was a larger problem,” he told Psychiatric News. “Once people left the hospital, there were no supports for them.”

At the time, many patients discharged from inpatient units ended up in board-and-care homes, which provided them with little more than “three hots and a cot,” as the saying goes. “I was concerned that patients were being housed but not treated,” Shadoan said.

He also saw that there was little financial incentive to run board-and-care homes—those who did received a small stipend from the state.

“Dr. Shadoan recognized that state hospital money didn’t follow patients into the community” said colleague Robert Cabaj, M.D., director of San Francisco’s Community Behavioral Health Services. “He saw that unless something was done about this, there would be a mental health crisis.”

In the 1970s, Shadoan worked with consumers and family members to pass a bill in the California Assembly to increase payments to board-and-care operators.

As the first chair of the Residential Care Committee of the Northern California Psychiatric Society (NCPS), he created programs to provide clinical, social, and recreational services to board-and-care residents. In addition, he developed courses for board-and-care administrators on the care of residents with severe mental illness.

Commitment to Coalition Building

In the first of what would become a series of hallmark coalition-building efforts, Shadoan rallied psychiatrists and mental health professionals to offer their services at the residential facilities. “There was some stigma associated with treating these patients, so I tried to change that,” Shadoan said.

Longtime colleague and friend Lawrence Lurie, M.D., chair of APA’s Committee on Managed Care, was one of those psychiatrists. “Dick is good at getting people to try new things,” Lurie noted, adding that due to Shadoan’s “encouragement and persistence,” he has worked a number of board-and-care homes over the past 25 years.

Lurie has partnered with Shadoan on a number of projects dating back to the 1970s. One of these was the Medically Indigent Adult (MIA) Program, which Shadoan helped establish in 1983 to match uninsured patients with private practitioners in San Francisco.

To create the program, Shadoan recruited a network of 150 psychiatrists and psychologists in private practice to treat uninsured patients in their offices.

The MIA program has undergone a number of changes over the years—it was originally operated by the nonprofit San Francisco Family Service Agency and later moved to the San Francisco Medical Society.

Now operated by the city as the San Francisco Mental Health Plan, it has expanded to include patients under the state’s Medicaid program, MediCal. APA bestowed its Significant Achievement Award on the program in 1986.

Although psychiatrists who originally joined the network were reimbursed at low rates, they are now reimbursed by the city at rates comparable to those of local insurance companies.

“My main stance is that psychiatric practice is more satisfying when we see public-sector patients,” Shadoan said. “Psychiatrists get the opportunity to treat patients they wouldn’t normally encounter in private practice.”

Trust Was Elusive

Shadoan began seeing public-sector patients in an era when little trust existed between patients, family members, and psychiatrists. Psychiatrists were once taught that “schizophrenigenic mothers caused mental illness in their children,” he recalled, “and psychiatrists [were seen as] the enemy of family members.”

Shadoan said he refuted this teaching in his work with family members and colleagues. “I tried to get family members to trust psychiatrists, and psychiatrists to trust families,” he said.

To further this trust, he established the California Psychiatric Association’s (CPA) Exemplary Family and Patient Advocate Award in 1998, which is presented to a number of families each year at the annual meeting of the National Alliance for the Mentally Ill–California.

Shadoan promoted partnerships between psychiatrists and mental health professionals, legislators, and consumers as president of the NCPS (1983-1984) and the CPA (1990-1992). He also served on APA’s Board of Trustees from 1993 to 1996 and in APA’s Assembly for six years before that.

No Slowing Down

After 37 years, Shadoan’s career is still in full swing.

He divides his time between his roles as clinical professor of psychiatry at the University of California, San Francisco; private practitioner; and medical director of San Francisco’s Community Aftercare Program, in which he oversees a number of services provided to board-and-care residents. He is also chair of the CPA’s Parity Committee, whose members monitor the implementation of California’s parity law, which went into effect in 2000.

Of the legislation, he said, “Although we were pleased with this bill, we were disappointed that the legislation increased the number of mental health carveouts.”

Currently, Shadoan is building support among psychiatric colleagues to expand access to psychiatric care for all patients.

“He doesn’t hesitate to tackle bureaucracy,” said Cabaj. “He’ll often begin a conversation with, ‘I know this is going to be impossible, but. . .’ or ‘I know this can’t be done, however. . . ,’ and this usually gets us moving in the right direction.” ▪