Mental Health and Resources - Addendum

Since my last post, I've had a few opportunities to chat about the state of mental healthcare in the area, particularly what could be done to improve the situation. It's in the news a fair bit now, so it's come up in conversation a lot, particularly while on my Psych rotation. One idea that came up was increasing Psychiatrist work hours.

It's a valid thought. Psychiatrists do work fewer hours than most other physicians, especially hospital-based physicians. If any physician can be told that they need to work longer hours, it may be Psychiatrists. However, I'd like to push back against that notion for a few reasons.

First, while Psychiatrists work fewer hours than many other physicians, is that because Psychiatrists are working too few hours, or because other physicians are working too many? I'd argue it's the latter. Psychiatrist hours still average over 45 a week, not much below that of other specialties, particularly office-based practices. Given overall rates of physician burnout and unhappiness with work-life balance, asking Psychiatrists to work longer hours would likely help one problem by causing another.

Second, while no physician works optimally when tired, tired Psychiatrists can be particularly troublesome. Psychiatrists have to be careful not just with their clinical decisions, but their words as well. Emotional lability increases with exhaustion or chronic mental fatigue - a bad thing for all physicians, but particularly for one who has to stay mindful of their phrasing whenever they interact with a patient. With non-psychiatric patients, words matter of course, but the margin for error is much greater - a poorly phrased statement can typically be apologized for, clarified, or otherwise explained without enduring consequences. Not so with some psychiatric patients.

Lastly, there's only so much additional hours from Psychiatrists will do to help. It wouldn't help with inpatient services. It wouldn't help with community supports. It wouldn't help with long-term care availability. At best, it would help reduce outpatient wait times. That's still a desirable outcome, though I doubt that longer hours for Psychiatrists would be anywhere near enough. If wait times could be reduced from 1 year to, say, 9 months, that would be a positive change, but 9 months is still far too much time. 

It's a tough situation. As our society increasingly accepts mental health as an important priority, demand for mental health services will also increase. Realistically, all options should be on the table, including longer working hours for Psychiatrists. However, we need to avoid band-aid solutions and "work harder" is pretty close to my definition of a band-aid solution. Other approaches are necessary and, I believe, should be explored first before simply asking current workers to do more.