COMMENTARY

A New Era, and Marketing Plan, for Psychiatry

Stephen M. Strakowski, MD

Disclosures

March 26, 2019

This transcript has been edited for clarity.

Hello. I'm Dr Steve Strakowski. I'm associate vice president for regional mental health and professor and chair at the Dell Medical School in the Department of Psychiatry at the University of Texas in Austin.

Today I want to wind up our series, Branding Psychiatry, that we've been discussing for the past three video conferences.

First, we recognized that our brand is not optimal. The general population and public really don't understand us. Our first step was to define what we are. We came to a definition that we are a medical specialty, specifically managing disturbances of brain function that affect behavior. We frame this management within biopsychosocial treatment paradigms that use our medical expertise and training, which separates us from other mental health care providers.

[W]e're not going to formally talk about building commercials for the next Super Bowl, but we do want to make sure we think about how we present ourselves to the public.

In the second step, we talked about placing ourselves more completely into the larger medical context. We are, in fact, physicians, and it is very important for us to be part of the larger medical environment. We provide an important subspecialty that is a critical component of optimized healthcare.

In step three, we talked about making sure we understand what we do and what our treatments do so that we can present them in the clearest way to help people manage expectations of what we can and cannot provide.

Today we're going to talk about the final step, which I frame as demanding of ourselves and our organizations a clear marketing presence or plan. Obviously, we're not going to formally talk about building commercials for the next Super Bowl, but we do want to make sure we think about how we present ourselves to the public. In the end, branding problems are always the responsibility of the brandee, not the public. It is our responsibility to improve them.

Within this context, and reiterating much of what we have talked about, we need to be clear. We are medical subspecialists who manage brain disorders that impact behavior, including substance abuse, which we often forget. We're unique in the field of mental health because we have medical training, and it is critical that we use that expertise in our work.

Because of that training, we integrate a bunch of different treatment modalities that other providers don't have access to or cannot use. That includes medications and psychotherapies, electroceuticals (eg, ECT or TMS), more aggressive approaches (eg, ketamine infusion), and even neurosurgical approaches in some cases. It's our responsibility to understand and provide those within the context of a team providing mental health care.

We need to remember that untreated psychiatric illnesses [contribute to] major costs in medicine. Again, we want to be integrated in medicine so we need to remember that our treatments work. Studies are fairly convincing that the interventions we provide are as effective as interventions in almost all other branches of medicine. We do not need to apologize for taking a long time to manage some chronic illnesses—that is true in all of medicine.

Finally, the piece that sometimes we forget or organizations aren't clear on is that we are advocates for the people for whom we provide care. We have to be patient advocates because, in fact, there are few others who can do it from the perspective we have, based on our training and experience. With that in mind, we need to expect our organizations to stand up and provide that type of branding.

The Role of Societies

Obviously, our primary guild is the American Psychiatric Association (APA). The APA provides many important services. As some of you may know, I unsuccessfully ran for president of the APA last year. I'm a strong advocate for the organization, believing that it does important things.

However, within the APA, I think we could do a much better job of being clear that our primary commitment is to our patients and their care. That often gets lost in our APA rhetoric when we are worrying more about ourselves. The effectiveness of our brand is that we're providing excellent care.

What's missing within the APA, at times, is that we aren't clear on our value statement to the public. What is it that we bring to improving the lives of people struggling with mental illnesses, and to improving mental health (in this case, in the United States, but also across the world)?

We need to be very clear through the APA that what we do is unique, our training is unique, and explain how that integrates into other people's unique trainings—not as better training or a superior approach, but as an alternative that brings in different experiences and expertise that complement other existing mental health providers. We sometimes take a position that diminishes others, which is not particularly helpful.

We want to avoid distractions on trivial problems. I'm going to offend some of you, so I apologize. When I ran for APA president, I was disappointed to learn that many psychiatrists' primary concern was the recertification process. I am the first to agree that recertification probably provides no real value to anybody. It's an unnecessary waste of expense and time that a more rigorous CME follow-up could easily rectify and is already being done. In the lives of psychiatrists who are well-paid, mostly wealthy people, yes, it's an inconvenience, but it's really not the primary problem we're facing in mental health right now.

The primary problems are improving access for people and getting better evidence-based care delivered in all of our sites. It was disappointing to see that our own inconvenience was viewed as more critical than the major inconveniences for people suffering mental illness. I'd like to see us step above that.

The APA is only one of our societies. There are many others. I belong to the Society of Biological Psychiatry and the American College of Neuropsychopharmacology. These also have commitments to improving the lives of people with mental illness that aren't always clearly stated in their more narrow goals. The two I mentioned are primarily research organizations, but there are others that are more clinical—Community Psychiatrists, for example.

Within these smaller societies, again, there are the same emphases on what we do and what's unique, and on how adding value to mental health in society and people suffering from mental illnesses becomes a critical part of a consistent brand.

A big part of what we do to improve our brand is to eliminate the mystery that is always present in the media about how we sneakily solve problems...

Within our own practices and our own day-to-day lives, we have many of the same obligations, including being clear about what we bring for value to the care of people with mental illness and to improving mental health in society. Being clear on the value will make it easier to get some of the other things in which we more selfishly are interested, including better pay, better reimbursement, and better recognition.

The first part is to be clear about what it is we do to earn those things, and not only to make demands because we can. I think, again, we need to be very clear in our practice and behavior about what we bring that's unique, and how that complements other mental health providers. Avoiding language that sounds like it's superior will help us improve how we are viewed by society.

A big part of what we do to improve our brand is to eliminate the mystery that is always present in the media about how we sneakily solve problems without clear communication and understanding of our methods. I think we can improve that. As I've said before, let's be doctors, not shamans. I think that will go a long way toward improving how we're viewed. We need to be clearly committed to patients and patient care in our day-to-day work. Nearly all of us are, but sometimes we don't speak the language to make that obvious. I think it's important that we do so.

It's important for us to be part of our mental health communities and be active in organizations that support patient advocacy and peer support. Finally, like the guilds, let's avoid being distracted by trivial issues when we have a major problem we are helping to solve, which is improving the delivery of mental health care in the United States.

Part of why I have emphasized this four-part series is because I truly believe that psychiatry is near a potential pinnacle for our specialty. Medicine finally seems to understand more broadly how important good mental health care is to all medical outcomes.

Consequently, states are beginning to increasingly attend to mental health care provision. Texas, for example, is in a legislative session now, and we've been very engaged with the legislative process. There are massive goals being set by the state to improve mental health care, which is exciting.

Large, self-insured businesses increasingly are looking for solutions to manage mental health for their employees, to both improve their employees' lives and manage their healthcare spending. There's an opportunity for us to step in and come up with new solutions.

We're fortunate in this time that neuroscience continues to make very impressive advances, and as technology improves, allows us to study the mysterious brain. We increasingly are able to translate those advances into something meaningful for people.

For the first time in my lifetime as a psychiatrist, psychiatric residencies are now in high demand and are very competitive, which has really been fun to watch. With that unusual opportunity, let's leverage all of these things, optimize our brand, and try to maximize our ability to help people with mental illness.

With that, I want to end this series. We'll move on to different topics next time. Thanks to all of you who responded and watched this series. I appreciate it, and I hope it's been helpful for you. Thank you.

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