Facing the Unseen: The Struggle to Center Mental Health in Medicine

“When a system marginalizes mental health... patients pay the price,” according to this ardent call for change. Tweedy (Black Man in a White Coat) draws on his career as a physician and psychiatrist to examine how the medical system fails people with mental illness. The trouble starts in medical school, he contends, recounting how he completed his psychiatric rotation at an inpatient ward that was miles from the nearest hospital and staffed by doctors who resented their patients, creating the impression that psychiatry fundamentally differs from other medical fields. Illuminating the complex ways that physical and mental health intersect, Tweedy discusses how a bifurcated health system hampered his attempts to treat a veteran whose opioid addiction stemmed from a need to quell persistent knee pain. To integrate care, Tweedy recommends providing mental health services in the same setting as primary care, which might take the form of a psychiatric evaluation immediately following an annual checkup within the same facility. As proof of concept, Tweedy describes how he helped a suicidal man brought to him after an annual primary care appointment the patient had intended to be his last. The personal anecdotes will help readers understand the view from the doctor’s chair, and the argument for a “collaborative care” model convinces. It’s an edifying proposal for overhauling psychiatric treatment. (Apr.)