The Debt Crisis and A Bio-Psycho-Social-Financial Model for Psychiatry

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PSYCHIATRIC VIEWS ON THE DAILY NEWS

In recent times, there has been much discussion in our field about whether the traditional bio-psycho-social model of medicine still fits well enough. Some feel that a bio-bio-bio model would better fit our specialty’s current emphasis. Others want to add eco, for ecological, and spiritual, as have I. As we have come to emphasize the social determinants of health and mental health, the theme of this year’s annual American Psychiatric Association (APA) meeting, there is a more appropriate emphasis on the neglect of the social in the model.

As our country’s recent debt crisis has emerged, I wondered what parallels there might be in psychiatry. Though the crisis was just averted, there was much concern about how default would threaten the financial well-being of so many. In psychiatry, with government funding for much care, the deadline had to do with whether the country has enough of a financial cushion to pay its bills and continue its funding.

We in psychiatry do know that there is a strong association between higher financial worries and higher psychological distress.¹ That association is especially potent among the unmarried, unemployed, and poorer people in the United States.

Over the last generation, psychiatry has been greatly influenced by for-profit managed care.² The professional concern is that the quest for profits can trump the quality of care of patients. Though all of medicine is influenced by the business impact, psychiatry has long searched for parity and equity in funding. Idealism has had to carry those of us who work with the underserved and underfunded.

In addition, there is a clear correlation between the business control of medicine and the burnout epidemic of physicians and other health care workers. Now, that burnout is also spreading to other workers and even parents.³

Similarly, psychiatric organizations like the APA must weigh the importance of organizational well-being with the needs of their members and patients.

The importance of economics in psychiatry leaves me wondering how that has been—and should be—reflected in our models. Are finances and economics part of the social variable, or are they missing? The recent successful resident physician strike at Elmhurst Hospital in New York conveys the importance of equitable and adequate financial support of trainees. I would say we need some kind of clear focus on the financial in any model of our field because it so significantly determines what gets emphasized for our patients and ourselves.

Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times.

References

1. Ryu S, Fan L. The relationship between financial worries and psychological distress among U.S. adults. J Fam Econ Issues. 2023;44(1):16-33.

2. Moffic HS. The Ethical Way: Challenges and Solutions for Managed Behavioral Healthcare. Jossey-Bass; 1997.

3. Maslach C, Leiter M. The Burnout Challenge: Managing People’s Relationships with Their Jobs. The President and Fellows of Harvard College; 2022.