Second Opinions in Psychiatry: A Review.

BACKGROUND: Although second opinions are rather restricted to the surgical disciplines, they have become more and more important to the health system in the last 20 years. The demand has been triggered by rising health costs and the economization of the field. The Internet has also made a considerable contribution to the demand for patient-initiated second opinions. Given these developments, it is surprising that second opinions have not become more important in the field of psychiatry. This article highlights the special situation of second opinions in psychiatry, discusses possible barriers to the adoption of second opinions in psychiatry, and the potential for greater use of second opinions in this field. OBJECTIVE: In psychiatry, second opinions have been neglected by the typical drivers of innovations in health care, including insurers and other commercial drivers as well as psychiatrists and patients themselves. This review identifies current barriers to widespread adoption of second opinions in psychiatric practice, discusses the benefits of second opinions that have been demonstrated in other disciplines, and outlines the potential gains to be realized through use of second opinions in psychiatry. METHODS: Literature in the area was reviewed through a search of the main medical databases. This literature review was supported by in-depth interviews with health care personnel and insurers. CONCLUSIONS: Second opinions are rarely obtained in psychiatry and there is little literature on this subject. The stigmatization of psychiatric disorders and patients and the uniqueness of the patient-doctor relationship in psychiatry, especially in psychotherapeutic care, may pose considerable obstacles to the use of second opinions in this field. In addition, more stakeholders, such as social workers, government agencies and regulators, health care and disability insurers, and social security agencies, are involved in the mental health compared with the somatic health sector, which may make it more difficult to achieve a coordinated approach in psychiatric care. However, we have found no convincingly good reason why second opinions have not been at least discussed in psychiatry. Psychiatry could benefit from ongoing discussions concerning the outcomes of second opinions in other medical disciplines.

TARPSY: A New System of Remuneration for Psychiatric Hospitalization in Switzerland.

As financing mental health care is becoming more challenging, governments are progressively introducing new remuneration systems. At the beginning of 2018, Switzerland introduced TARPSY, a new tariff system based on diagnosis-related psychiatric cost groups that takes into consideration ratings of severity and complexity. TARPSY is expected to provide incentives for medically and economically meaningful treatment, increase transparency, and improve the quality of the provided services by triggering competition between hospitals. Yet some fear that TARPSY will lead to an economization of mental health, encouraging a reduction in length of stay and medically indicated treatment.

The Swiss Mental Health Care System.

The United States and Switzerland are among the world's wealthiest countries. Both are highly innovative and entrepreneurial, ranking high in global competitiveness and innovation and with similar liberal economies. This column highlights features of the health care system in Switzerland, a country with an exclusively private health insurance system, with federally mandated universal health insurance. Residents can choose from about 58 insurance companies. Switzerland regulates these companies and negotiates reimbursement rates. The Swiss model of health care and its provision of comprehensive psychiatric and substance abuse treatment could inform policy as the United States considers major changes to its health care laws. Switzerland could serve as an example for developing a mental health care model that ensures appropriate services, with a high density of psychiatric inpatient facilities and mental health care providers, while maintaining affordable care.

Beyond Watches and Chocolate-Global Mental Health Elective in Switzerland.

Despite increasing interest in global mental health training opportunities, only a few psychiatry residency programs offer global mental health training experiences in developing countries and even fewer programs offer it in other first-world countries. The authors developed a global mental health elective giving US psychiatry residents the opportunity to visit Switzerland to study and experience the mental health care system in this European country. This elective focuses on four major learning objectives: (1) the system of training and curriculum of postgraduate psychiatry education in Switzerland, (2) clinical and organizational aspects of Swiss mental health, (3) administrative aspects of Swiss mental health care delivery, and (4) scholarly activity. This program was uniquely tailored for psychiatry residents. The preliminary experiences with US psychiatry residents show that they value this learning experience, the opportunity to access a different mental health care system, as well as the potential to build international connections with peers.

The Tarrytown Chief Residents Leadership Conference: a long-term follow-up.

OBJECTIVE: Creating training opportunities for the development of effective leaders is an increasingly important goal in psychiatry residency training programs. This article examines the long-term perceived impact of the Tarrytown Chief Residents Leadership Conference on preparing psychiatric residents for future leadership positions. METHODS: Self-report surveys from attendees who participated in the conference between 1998 and 2011 were examined. RESULTS: Five hundred and forty-one completed surveys were returned (43 % response rate). Eighty-six percent of respondents reported moderate to extreme improvement in leadership confidence post-conference. Most respondents indicated at least moderate improvement in self-awareness (93 %), understanding of group process (92 %), and willingness to address conflict (89 %). Ninety percent felt the conference was important to their residency training, and 80 % indicated increased interest in leadership post-conference. CONCLUSIONS: Responders reported lasting improvements in their confidence in and perceived ability to utilize skills necessary for effective leadership, demonstrating the value of this experiential learning opportunity.

Lessons learned from a colocation model using psychiatrists in urban primary care settings.

OBJECTIVES: Comorbid psychiatric illness has been identified as a major driver of health care costs. The colocation of psychiatrists in primary care practices has been proposed as a model to improve mental health and medical care as well as a model to reduce health care costs. METHODS: Financial models were developed to determine the sustainability of colocation. RESULTS: We found that the population studied had substantial psychiatric and medical burdens, and multiple practice logistical issues were identified. CONCLUSION: The providers found the experience highly rewarding and colocation was financially sustainable under certain conditions. The colocation model was effective in identifying and treating psychiatric comorbidities.