Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

The Accessible Psychiatry Project

Name of Innovative Program: 
The Accessible Psychiatry Project
Sponsoring Organization
The Accessible Psychiatry Project
Name of Innovative Program Lead: 
Dinah Miller, M.D.
E-mail Address of Innovative Program Lead: 
DinahMiller@yahoo.com or ShrinkRapBlog@gmail.com
Physical Address of Innovative Program: 
1501 Sulgrave Avenue, Suite 202 Baltimore, Maryland 21209
Project Description: 

Our project is a collaborative effort by three psychiatrists that strives to encourage dialogue about psychiatric disorders and their treatment in order to explore issues of controversy and misunderstanding in our field. Through open dialogue, in both new media and print, we foster discussion about the work that psychiatrists do, and endeavor to decrease the stigma associated with the treatment of mental disorders. This project has many components including a blog (Shrink Rap, started in 2006), collateral blogs on Clinical Psychiatry News and the Psychology Today website, an iTunes podcast, Twitter feeds, a Facebook page, and we've written a book, Shrink Rap: Three Psychiatrists Explain Their Work (Johns Hopkins University Press, 2011).

Our more recent efforts include a website to facilitate rapid entry to outpatient psychiatric care in Maryland, and we have a book that will be released this fall, Committed: The Battle Over Involuntary Psychiatric Care.

How does the innovative program work to improve behavioral health access?: 

Please visit http://www.marylandpsychiatrists.net/

This is a volunteer effort to connect patients to available psychiatrists and lists psychiatrists who have said they have openings for new patients within two weeks (often sooner). The site is free to both potential patients and to psychiatrists. It includes a form to list a psychiatric practice, and we solicit psychiatrists from the Maryland Psychiatric Society's listserv.

In addition, our blog, articles, podcasts, books, and social media all contain information to educate people about psychiatric care in a way that empowers.  Just one example would be Dr. Miller's article on the Psychology Today website called "What Makes a Good Psychiarist."  Our book, Shrink Rap: Three Psychiatrists Explain Their Work is, in part, a consumer's guide that includes how to navigate the system and explains why some psychiatrists do psychotherapy and others do not, and discusses care in a wide variety of settings.

How does the innovative program work to improve behavioral health quality? : 

Our work improves quality of care through multi-media education that allows those with lived experience to understand the complicated mental health arena and what choices are available to them. 

In addition, our work targets mental health professionals in ways that provoke clinicians to challenge the status quo.

Some examples:

Dr. Daviss has written about why psychiatrists don't like to use Xanax.

Dr. Hanson has written about an instrument, the Cal-VAT, being used in California state hospitals to predict and prevent aggression

Dr. Miller has written about why psychiatric hospitals should stop the routine strip search of patients

We also have the ability to interact with our readers--an example being that when a transgender person in Australia asked questions we couldn't answer, we invited an expert to be a guest on our podcast. Please feel free to listen to our banter (our expert starts at 5 minutes): http://podcast.mythreeshrinks.com/mythreeshrinks21.mp3

How does the innovative program work to address behavioral health costs? : 

We believe an educated consumer who understands the available treatment options is best able to make cost-effective choices, and our writing promotes this.

The Access to Care website (MarylandPsychiatrists.net) provides a mechanism to allow people to enter treatment quickly,  with the hope that this might prevent unnecessary ER visits or hospitalizations -- the most expensive forms of psychiatric care.

As an example from our work, Dr. Hanson, who is a forensic psychaitrist, has written about why correctional health care costs are worth defending.

Dr. Miller has written about why psychiatrists don't accept insurance and this has been reprinted on the KevinMD website -- understanding this allows consumers to decide whether they wish to pursue treatment inside or outside of their networks.

Creativity and Innovation: 

Please visit the description of our project at http://shrinkrapbook.blogspot.com/2011/06/accessible-psychiatry-project.html. This site includes links to the different components.

Our blog, Shrink Rap,  is now 10 years old  (the longest running psychiatry blog) and has been the foundation of the project. It is hosted on a free blogger website, has over 2,000 posts, including guest posts from experts in many areas of psychiatry.  Dr. Daviss started the My Three Shrinks podcast  and we recorded 70 episodes in our dining rooms, and also hosted expert guests.  We initially reached out to psychiatrists, but our audience has grown to include other mental health and medical professionals and those with lived experience and their family members.  Our lively discussions have inspired us to write two books.  No other psychiatrists are doing this type of work on this scale.We have used social media to gather data. Most of the projects are unfunded or self-funded.

Leadership: 

We foster communication in an open and direct way, and have both reached out to others and been solicited by others to spread our work.  As examples, earlier this month, Dr. Miller spoke at the University of Maryland's Cultural Diversity Day on Access to Care, and Dr. Hanson recently arranged to have the proceedings of the American Academy of Psychiatry and the Law available on open video streaming-- see her article "Hello, World: AAPL invites Global Participation: bit.ly/1Ufqhsk.  We have a taught a course at the American Psychiatric Association's annual meeting on blogging and podcasting, and given talks on the public face of psychiatry, and on using social media to gather data.  In addition to professional audiences, we have talked on the radio (NPR's Talk of the Nation) and at events for the public.

Sustainability: 

We have the longest running psychiatry blog on the Internet. With a proven record of success, and support from print media sources (Johns Hopkins University Press and Clinical Psychiatry News) as well as online sources such as Psychology Today and a number of other medical and mental health blogs, we've been able to sustain this project by varying the activities and venues over time as our interests have expanded.  With proven sustainability, our strength has remained with our creativity, persistance, and flexibility.  Chili, beer, and friendship have helped.

Replicability: 

Yes! While our project is innovative in that we have formed an on-going collaboration and friendship, every aspect of our work can be, and often is, achieved by others who wish to use these venues to communicate and educate.  As mentioned above, we have given a half-day course at APA, as well as many other presentations at APA.  Dr. Miller has mentored a Johns Hopkins resident who was interested in writing -- he started his own blog, Twitter feed, and had an article published.  We have had ongoing communications with other psychiatry and mental health bloggers.

Results/Outcomes: 

There are many components to The Accessible Psychiatry Project.  Shrink Rap has had millions of page views and over 22,000 comments from readers.  Our podcast had 55 reviews on iTunes and tens of thousands of downloads.  Our publisher keeps sales records.  Clinical Psychiatry News has a distribution to 40,000 psychiatrists, and our posts are consistantly in the most popular of those read on line.  Our twitter feeds are separate (we each have one), with growing numbers of followers, and our Facebook page has over 600 followers.

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