With this issue of Alberta Doctors’ Digest, we are pleased to continue our series on the Foundation Stones of Medicine.
When walking across the floor of a building, we may not be aware of the foundation stones that keep it in place. Similarly, patients travelling across the health care system are often unaware of the intricate structure of specialty care that lies beneath what they see on their individual journeys.
So we are featuring an ongoing series of articles highlighting some foundational specialties. We think the perspectives of these colleagues will be illuminating for the public and perhaps even for medical professionals.
For the current issue, we introduce general psychiatry.
Psychiatry focuses on mental health, mental disorders and the treatment of those disorders. Psychiatrists work at the individual level with the purpose of trying to make a difference for the well-being of individuals and the greater population. One of Alberta’s practitioners in this field is Dr. Sudhakar Sivapalan, the President of the Section of General Psychiatry for the Alberta Medical Association.
Dr. Sivapalan says psychiatrists are involved in many areas of the health system. The role encompasses a wide scope that includes working on in-patient units in hospitals, providing community care and consulting with family physicians. He also notes that psychiatrists provide mental health support to specialized health programs from cancer care to obstetrics and gynecology.
“Our main focus is the mental health and well-being of the population,” says Dr. Sivapalan. “Depression, anxiety and psychosis are all unfortunately fairly common problems. We have received specialized training in the management and treatment of those various conditions and also work to appreciate how that actually intersects with the rest of your health care.”
Dr. Sivapalan acknowledges a common question that arises is: What’s the difference between psychology and psychiatry?
Psychologists also work in the field of mental health, Dr. Sivapalan explains. However, the key difference is that psychologists haven’t had the same level of extensive medical training as psychiatrists. Furthermore, psychologists cannot diagnose or monitor an individual for other medical conditions or prescribe any medication, whereas a psychiatrist can provide that level of care.
“A psychiatrist is a physician. Number one, we have gone through medical school. We have received the same basic medical training as every other physician that’s practicing in the country and the world,” says Dr. Sivapalan. “With that [training] comes a knowledge of pharmaceuticals, as well as an appreciation of other medical conditions. Afterwards, we specialize in the area of psychiatry.”
The field of psychiatry is undoubtedly important to Albertans. Dr. Sivapalan stresses its importance both at an individual level and from a larger perspective. Primarily, one’s mental health plays a critical role in how one moves through life and performs in areas such as school, work and relationships.
“Mental health disorders that aren’t well managed cost the economy billions of dollars every year in this country,” states Dr. Sivapalan. “That happens through individuals who are taking time off of work, or they’re at work and not being as effective and not able to maintain their degree of productivity.”
Dr. Sivapalan says psychiatrists can build a complete picture of an individual before beginning treatment plans. He also notes that psychiatrists offer more than just medication as a way of treatment. “It’s something that I don’t think a lot of people expect when they come to see a psychiatrist. It’s not as simple an answer as finding a medicine and prescribing it.”
He goes on to explain: “Part of our training does include therapy, and various modalities of talk therapy. We have an appreciation of how we bring together multiple types of treatments to best help somebody. We tend to look at an individual very comprehensively. It’s called the bio-psycho-social model. What that means is we look at the whole individual.”
In Alberta, the field of psychiatry does have its challenges. For starters, Dr. Sivapalan notes that there aren’t enough psychiatrists in the province and, as a result, it’s a resource that’s stretched incredibly thin.
“We ask ourselves ‘why is it hard to attract people to the work of psychiatry?’ A big part of that is appreciating we look at the whole picture – we’re not adequately resourced to address all the concerns. When we talk about social challenges, that includes things like homelessness, limited finances and drug coverage. The work that’s involved in trying to help individuals access those types of resources is actually work that’s not covered in any of our fee schedules or payment models.”
Dr. Sivapalan states that psychiatrists are among the lowest paid of the specialist physicians in Alberta. He says this is not a new issue but rather a very long standing one that could make it difficult to attract and retain physicians to practice in this field. He’s hopeful that if concerns in the field of psychiatry are better addressed, then a positive transformation would occur in how care is delivered to patients.
“We need to start looking at models that allow a patient to be able to come see a psychiatrist, but also have some of those other issues get addressed, whether it is finances or housing and these kinds of things.” Dr. Sivapalan adds: “I think we need to have better public support of the types of services that work closely with a psychiatrist who is leading the treatment plan.”
Dr. Sivapalan mentions that he would like to see the system support patients to stay in the community so people wouldn’t have to be hospitalized just to access a social worker. With a model that was appropriately funded, he foresees this would result in having patients who are better supported. Psychiatrists then would be able to use their knowledge and training as medical professionals to guide treatments.
“I think it will be really important as we move forward through this health system reorganization, that we don’t lose the connections between the various groups that need to be involved in an individual's care through their lifespan,” he says.
Overall, Dr. Sivapalan says he’s hopeful that connections will be established and well maintained going forward, all resulting in positive impacts in the field of psychiatry.
Banner image: Dr. Sudhakar Sivapalan (photo credit: Marvin Polis)