Are psychiatrists losing their political clout when it comes to
influencing the direction of Michigan's mental health care? The last time a
psychiatrist headed Michigan's Department of Mental Health was the late 1970s,
before the deinstitutionalization movement. Currently no psychiatrist holds an
administrative office in the Michigan Department of Community Health (MDCH).
Psychiatric News asked several Michigan mental health officials
whether they thought that if a psychiatrist were again steering the
department, it would be further along in solving the serious problems plaguing
the mental health system.
"I firmly believe that a psychiatrist should have the job,"
said Michael Engel, D.O., a past president of the Michigan Psychiatric
Society. "As psychiatrists, we are losing the political battle to
advocate for patients and for the services that are essential. The political
reality is that nonphysicians have taken over the system. They have changed
its focus and don't understand the responsibility they have to
Engel believes the most serious problems can be traced back to the 1980s
when social workers took over control of the Department of Mental Health. He
noted that the director was a social worker when the state hospitals started
to be closed during the 1980s. "Psychiatrists have been relegated to
prescribing drugs, and we are disengaged from the delivery of [the rest of]
health care. Legislators seem to think that if they bring a doctor into the
decision-making process it's going to cost more money. So they changed the
system, and it is now more like a social-services program," he said.
Medical director of Detroit-Wayne County Community Mental Health Agency
Michelle Reid, M.D., sees things differently. "I feel that a
nonphysician could be a competent leader of a state department of mental
health, but the position cannot be fully developed without adequate
psychiatric leadership," she said.
Reid said that both Michigan Psychiatric Society and MDCH recognize the
importance of having a psychiatrist as chief medical officer at MDCH. "A
[psychiatrist] chief medical officer at MDCH would coordinate efforts of the
many physicians who work for MDCH and reduce fragmentation of its various
medical services," she said. "In addition, a [psychiatrist] chief
medical officer would assure that decisions related to medical practice
received input from department physicians before being implemented."
"It is incorrect to say that social workers have hurt the MDCH
system," said Mark Reinstein, Ph.D., CEO and president of the Mental
Health Association in Michigan. "I don't attribute MDCH's woes to social
worker leaders at all, but more to what the previous administration did,
including burying what had been a separate state mental health department in a
super-department dominated by Medicaid, which has proven very
Patrick Barrie, deputy director of the state Mental Health and Substance
Abuse Administration, asserted that many of the MDCH's difficulties are not
clinically based, although they might end up having a clinical impact. He said
the major problems involve finances, organization, and structure issues, some
of which can be addressed by psychiatric leadership, such as those involving
treating people with co-occurring disorders. "But, on the whole, I don't
think a psychiatrist would be any more effective at influencing legislative
decisions about funding or solving our revenue problems," he said,"
though this is not to take anything away from their clinical expertise
MDCH Director Janet Olszewski did not return several calls requesting an