Tuesday, May 08, 2001

Psychiatric institute to expand


More training could increase services for teens

By Tim Bonfield
The Cincinnati Enquirer

        The Cincinnati Psychoanalytic Institute has obtained $2.75 million for an expansion to allow it to increase training of child psychiatrists and provide psychoanalysis services to more low-income families.

        The institute, founded in 1974 and based in Corryville, is one of 27 facilities nationwide that still teach how to provide the once-common, in-depth type of mental health therapy that increasingly has been replaced with medications and short-term counseling.

        The institute's leaders hope the expansion will reverse some of that trend and make a dent in the shortage of available mental health services in Greater Cincinnati, especially for troubled teens. In December, an Enquirer investigation detailed the extent and effects of that shortage.

        “It isn't just that people aren't being treated; the psychiatrists themselves aren't being trained,” said Dr. John MacLeod, co-founder and faculty member of the institute.

        “We recognize that families and children need more low-fee service. We also need additional trainees. With more trainees, we'll be able to offer more treatment.”

        Some of the expanded services will be available this year. Other aspects will take several years to complete, institute officials said.

        Over the years several Cincinnati inpatient mental-health facilities have closed. Pediatricians complain that patients they refer for psychiatric services sometimes must wait months. Meanwhile, families are struggling to find effective care and adequate insurance coverage to help their children with complex problems.

        The institute's plans calls for:

        • Opening this fall a community clinic in the institute to provide in-depth analysis to children and adults who lack the insurance coverage or the income to afford such care.

        • Establishing a child analytic division to increase the training of child psychiatrists and other children's health care professionals, in a region that includes Indianapolis and Lousiville.

        • Building a wing at the institute's offices, at 3001 Highland Ave., to provide more space for training and treatment.

        The project runs counter to many trends in mental health.

        Psychoanalysis is based on the concepts of Dr. Sigmund Freud, who introduced the world to concepts such as the subconscious, the Oedipus complex and the Freudian slip. Refined over the decades, psychoanalysis was the foundation of psychiatric care for many years and dominated the field into the 1970s.

        In general, psychoanalysis patients spend several sessions per week on a couch for several months — sometimes several years — as the analyst helps the person probe the roots of their behavioral, emotional and psychiatric problems.

        More recently, new approaches have taken root, including a rapidly growing list of medications people can take to chemically control mental illnesses.

        Meanwhile, heavy cost-control pressure from managed-care insurers has forced long-term analysis to give way to short-term counseling, often by people who have less training than psychoanalysts.

        In Cincinnati, Dr. Othilda Krug, a psychoanalysis devotee, established the University of Cincinnati's division of child psychiatry in the 1940s. Now retired, she provided the largest financial gift to the $2.75 million institute project.

        “The problem now is that children only get drug therapies and short-term therapeutic care,” she said. “There is no long-term therapy for children.”

        But some see the institute's methods as outdated and say its expansion efforts won't make much difference.

        “For many years, the leading edge of psychiatry has not been psychoanalysis,” said Dr. Randy Hillard, chairman of the UC department of psychiatry.

        “I agree that the pendulum may have swung too far in terms of treating things with medicines without providing follow-up therapy. But a full-time psychoanalyst can handle only about 10 patients a week. From a public health point of view, that kind of care is not going to make much of an impact.”

        About 6,300 fully trained child psychiatrists are practicing in uneven clusters nationwide, according to a 1999 surgeon general's report. However, it would take 30,000 child psychiatrists to fully meet the demand for care.

       



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