Too many mental health challenges and not enough psychiatrists (with Jacob Appel)

1. Eliminate Suicide Liability

Remove legal liability for psychiatrists for patient suicides (when no medical error occurred) to enable authentic clinical judgments and prevent over-hospitalization that deters future care-seeking.

2. Implement Comprehensive Mental Health Support

Establish scattered-site housing in diverse communities and structured, full-day treatment programs (8 AM-5 PM) offering psychiatric care, therapy, recreation, education, and training for severely mentally ill patients to improve long-term outcomes.

3. Allocate Genetic Treatment Ethically

Society must decide in advance, using a rational and equitable framework, which expensive genetic diseases to treat, involving diverse stakeholders to prevent haphazard, politically driven choices and ensure fair resource allocation.

4. Prioritize Invisible Victims

Reallocate healthcare funding from high-cost, visible victim care to preventative measures and less immediate needs, which can save more lives long-term, even if politically unpopular, to address systemic biases.

5. Boost Psychiatric Residency Funding

Increase government funding for psychiatric residency programs to address the critical shortage of mental health providers, which is currently exacerbated by artificial limitations supported by the profession.

6. Reform Psychiatric Insurance Reimbursement

Adjust insurance reimbursement rates to adequately compensate psychiatrists for time-based care, rather than procedure-based metrics, to incentivize private practitioners to accept major insurance and improve patient access.

7. Integrate Community Preventative Care

Embed preventative care into communities by addressing structural barriers to health, such as providing fresh produce at hospitals for patients advised to eat healthier, rather than solely relying on individual compliance.

8. Legalize Medical Aid in Dying

Allow medically assisted dying for individuals with capacity, incorporating safeguards like waiting periods for impulsive decisions and accurate education on palliative care, as the option itself can provide comfort and autonomy.

9. Complete Advance Directives

Fill out an advance directive (living will or healthcare proxy) and discuss end-of-life wishes with family to ensure patient autonomy, as the default in healthcare often prolongs life at all costs without clear patient wishes.

10. Involve Diverse Stakeholders

Ensure a wide range of stakeholders and perspectives are involved in major medical ethics decisions (e.g., resource allocation) to prevent groupthink, identify blind spots, and avoid tragic outcomes.

11. Routine Mental Health Screening

Implement routine screening for suicidality and depression at every well-patient visit, as this low-cost practice offers significant benefits in early identification and intervention without inducing suicidal thoughts.

12. Empower Patient Agency in Care

Give more credibility to patients’ subjective feelings about their safety to leave the hospital, as over-restriction can deter them from seeking help when truly suicidal, fostering trust and engagement.

13. Consider Limb Removal for BID

For Body Integrity Disorder (BID), if a limb causes extreme distress and evidence suggests removal improves function and reduces self-harm, physicians should consider it as a harm reduction strategy.

14. Medication for Severe Mental Illness

For conditions like bipolar disorder and schizophrenia, medication is an essential part of the treatment program, complementing psychotherapy and social services.

15. Strategic Choice of Mental Health Pro

Choose a mental health professional based on primary need: a psychologist for therapy for mild-to-moderate issues, or a psychiatrist for medication for severe impairment or medication preference, noting good providers will refer.

16. Utilize AA for Addiction Recovery

Explore Alcoholics Anonymous (AA) or similar secular communal programs for addiction recovery, as they can be highly beneficial for individuals who connect with their spiritual or communal aspects, complementing other treatments.

17. Support Consensual Polygamy

Morally support consensual polygamous relationships between adults based on genuine affection, provided logistical and legal challenges can be resolved without economic fraud.

18. Reframe Work as Enjoyment

Cultivate a mindset where work is viewed as enjoyable and fun, rather than a chore, to increase productivity and reduce misery.

19. Prioritize Social Connection

Actively foster social connections and address societal disconnections, as isolation and lack of social support contribute significantly to mental health decline across all age groups.