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Professor Fava suggested a new type of mental health clinic which may incorporate cognitive behavioral treatment in daily practice.
The role of psychiatrists into public mental health clinics has been hampered by a perceived restriction of the psychiatrist’s role to prescribing and sign-ing forms, limiting opportunities to engage in the kind of integrated care that attracted many physicians to this specialty. Over the past two decades there has been impressive progress in the effectiveness of short-term psychotherapeutic strategies such as cognitive behavioral therapies and interpersonal therapy in a number of psychiatric disorders. These psychotherapies have been found to be effective alternatives or supplements to pharmacotherapy, with enduring benefits after treatment is discontinued. However, while many clinics provide psychotherapies in various forms, true manualized evidence-based psychotherapies are often not available, and coordination with pharmacotherapy is rarely possible for most patients, because of brief “medication check” visits to psychiatrists that leave no time for consultation with therapists.
Professor Fava suggested a revision of the current model in a direction that maximizes the expertise of the psychiatrist as well as other clinicians in the health care team, using some recent developments in the UK as a starting point.
The basic unit would consist of a psychiatrist (with adequate background both in psychopharmacology and psychotherapy), an internist and four clinical psychotherapists, who may provide evidence-based treatment after the initial evaluation of the psychiatrist. According to this new model, its functioning would emphasize repeated assessments, sequential combi-nation of treatments, and close coordination of team members.
Re-invigorating the role of the psychiatrist in the context of a team in which role assign-ments are clear could result in better outcomes.
Source: Journal of Psychotherapy and Psychosomatics, via Alpha Galileo
