Who is mentally ill?

My fellow psychiatrist and blogger Dinah Miller raised this simple yet profound question on Shrink Rap the other day. Who is rightfully labeled mentally ill? Is it anyone with a psychiatric diagnosis, past or present? Anyone with currently active psychiatric symptoms? Anyone receiving psychiatric treatment? Dr. Miller observes that “the mentally ill” is an oft-cited […]

Third-party payment for psychotherapy: (2) Medical necessity

In my last post I outlined some complexities of third party payment for office psychiatry, and especially for psychotherapy. As my example I used Medicare, the only third party payer I bill. Some of the problems include complex billing (i.e., collecting from multiple parties), partial reimbursement, unrealistic documentation requirements, loss of patient confidentiality, and a […]

Third-party payment for psychotherapy: (1) "Do you take Medicare?"

From late 1996 to early 2007 I was medical director of a low-fee mental health clinic where psychiatry residents and psychology interns receive training. Since the clinic accepted Medicare for payment, I did as well. I signed on as a Medicare “preferred provider” and have remained on the panel ever since, even though I left […]

Online commentary: marketplace of ideas or shouting match?

A central disruptive technology of our online world is the breaking down of unidirectional communication. In years past, newspapers and other media published articles without immediate feedback from readers. True, a few readers might telephone the editor’s desk, and the paper might print a select handful of “letters to the editor” in the next issue. […]

The APA annual meeting: a photo essay

As posted previously, last month I attended the American Psychiatric Association’s (APA’s) annual conference. Straying from my usual format, I thought I’d post pictures from the meeting and, of course, offer comments. The meeting took place in Moscone Center, a conference center complex located just south of Market Street in downtown San Francisco. Depicted here […]

Going to the APA meeting?

The annual meeting of the American Psychiatric Association (APA) is in San Francisco this May. I’ve attended twice before as I recall, both times when it was here. I enjoyed it, and even felt it was worth the $1000 we non-members pay to get in, although in my opinion it’s not worth doubling that for […]

Our response to regretted suicide attempts — Sloppy thinking in psychiatry 5

A person is drunk or angry or momentarily distraught. Or all three. He or she takes an overdose or cuts a wrist, then reconsiders — or never intended to die in the first place — and either calls 911 or tells someone else who calls 911. The police come and transport the person to a […]