What do you think the future of psychiatry looks like?

1. The Future of Psychiatry Looks Like
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The Future of Psychiatry Looks Like - Dr Risley
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Magazine Seeking Sponsors Gail: What do you think the future of psychiatry looks like?
Sponsorship Opportunities Risley: There will be a lot more accessibility to Mental Health Services and our knowledge
About Empowerment Mag of the brain will greatly increase. We know so much more about the brain than we did 15
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COMMISSION 22%-25% people got sick, that they have “fever.” Now we look at fever as a symptom of a larger
problem of different illnesses. So I think the day will come when we look at depression or
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2. The Future of Psychiatry Looks Like
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Gail: Who are the people who significantly influenced you in Gail: In your writing you mention the importance of an Interdisciplinary
Who Makes the Empowerment your life? approach to medicine. What does that look like?
The Future of Psychiatry
Risley: The first person that comes to mind is my godfather. He was an inventor Risley: An interdisciplinary approach to medicine is one of those things that is a
and was really interested in science and technology. When I was barely old great concept, but really hard to execute. Medications don‛t make the world a
enough to read, he bought me a subscription to Scientific American magazine. I better place. I can give you all the Prozac that‛s made and it is not going to
would look at the pictures and I would kind of read what it said without really improve your world. What is going to improve your world is how you approach it
understanding much. It set the stage for some of my interests. He had a garage and how you think about it. The medication has a real role if you are overcome
just full of junk which I always called Joyland. Then growing up I lived across the with symptoms and you can‛t do those things you need to make your world a
street from a guy by the name of Bob Herman who designed the first better place. Medication, if properly used, controls the symptoms well enough so
commercial minicomputer. He would give me computer parts and I would fiddle you can do the work you need to get better. The work might be something
with them. Eventually I became an engineer. I did a lot of computer design internal you do, it might be just having the energy for paying your bills, or it
stuff. might be getting to a cognitive behavioral therapy group. It takes all forms, but
Gail: That‛s incredible, and now you are a medical doctor, how did the medication is a small portion of the care. What we have is a health care
you transition? delivery system that says, “Well you are a doctor, you make way too much money,
and the only thing we are going to pay you for is writing those prescriptions.”
Risley: I really loved the computer stuff, but I got more into the esoteric stuff Healing takes a lot of effort.
like cryptography. It is not a field where you can spend a lot of time talking with Gail: What do you think are some of the important things we need to do as
other people. So it is kind of a closed world. I ran a consulting firm and spent a a mental health community to achieve better quality of care and life for our
lot of time with machines. I started feeling like I wanted to work more with members?
people. I really wanted to directly affect people‛s lives. I thought that I could
be a farmer or a doctor and the farming sounded like a lot of hard, dangerous
Risley: The number one thing is that we have to get rid of the stigma around
work.
mental health. One of the things that I am amused and really heartened by is
The really interesting part is that I was sitting in a pizza parlor with a girlfriend
that we providers have people who walk in the door and say, “ I am having this
and she said, “You know you really seem like you want to make a change.” I said ,
muscle ache,” and then we start talking, and the real reason they are here is
“Well, what I would like to do is go to medical school, but I can‛t do that!” and, as
something else. We have been able to break down that barrier at the Oasis.
I said it, even before she said, “Why not?”, I said, “Why not?” So I did my whole
Generally speaking, Mental Health services are very separate from the rest of
undergraduate program over again. I went to San Diego City College. Then I
medicine and people in need don‛t know how to access the mental health system.
transferred to UCSD and got a degree in literature and writing. I read all the
The doctors doing the work don‛t have access to the tools they need to make it
stuff that said once you get into medical school all you will be doing is science. I
easy to make that happen. So people are stuck, and they are stuck really only
found that in doctoring my communication training is more valuable than organic
because we refuse to acknowledge that psychiatric illness is cardiac illness, it is
chemistry. Knowing how to communicate with patients and other doctors has
cancer, it is foot pain, and everything overlaps. I used to think there were clear
served me well. I had this vision of medicine as sitting down with someone and
cut illnesses. But if somebody has a broken bone, how did they get that broken
talking about what was bothering them, and then coming up with a plan for dealing
bone? What kind of behavior were they engaging in? It may be an insignificant
with it. Instead, I found medical school was a world where you are constantly
piece of it, or it may be really significant. But until you ask, you do not know.
pressured to see people and to focus on what medicine you are going to give
them. The only people who were actually sitting down talking to their patients
were psychiatrists. I really had my focus on primary care medicine. It was what Gail: Your patients have told me that the Oasis has made psychiatric care
I wanted to do, but I saw that psychiatry was much closer to my vision. very accessible to them. What else do you see unique about the Oasis?
Gail: How did the Sacramento Medical Oasis come into
being? Risley: What isn‛t unique about it? It is a big experiment in a lot of ways. It
Risley: first struck me when I was at Massage Envy getting a massage.
They have a way of reducing the anxiety about getting a massage. I found a lot
This place came into being about this time last year when we all thought we would of parallels with what people experience in accessing psychiatric care to the
anxiety that might be provoked around getting massage. I was president of the
be out of work. We were wondering where patients were going to go. We thought
Psychiatric Society for about twoyears.
it would be nice if people on disability income could afford care. We looked into
whether we could accept Medi-Cal, could we get insurance money, could we get
When I went to look for a doctor, here I was on the inside, about as inside as you
grants, was there a way to fund this new concept? What we found was that the
could get, and I felt the same anxiety. You end up making a lot of calls. There is
minute you buy into that insurance system, the costs pretty much triple. There
a shortage of psychiatrists. It is hard to find someone who is taking new
is billing, collections, and a whole bunch of regulatory agencies you have to keep
patients. Here I was on the inside and it was an intimidating, expensive, scary
happy. You don‛t have to deal with all of that if you don‛t take insurance money.
system. Imagine what it must be for someone who has no connections? My co-
What we came up with, after a lot of number crunching, was that we could see
conspirator, Sonny Cline, and I have similar backgrounds. We are both trained in
people for $79.00 a month and treat their psychiatric illness and their general
primary care as well as psychiatry. At the Oasis, we believe strongly that we
medical illness. We don‛t make a distinction. You don‛t make a “psych”
have something to offer people and people have something to offer us. That is
appointment , or a “ medical” appointment. Instead, we treat the whole person.
what it is all about. We have a relationship with the patient, we don‛t have a
Gail: If you had to say what your philosophy of medicine is, how relationship with the insurance companies.
would you sum it up? At the Oasis patients are invested in their own care. We try to keep our rates
as low as possible, but it is still a significant amount of money. They are buying
Risley: To borrow from a colleague friend of mine , “We meet over the patient‛s it, they are the customer. They have certain rights to expect that people with
suffering,” that is really what it is all about. People don‛t need doctors unless private insurance or the county system don‛t feel that they have. A consumer will
they are suffering, and our job is to address that suffering. Whether the job is go to the doctor and say “well I really want this,” and the doctor says, “well, the
to treat their physical pain, or their psychic pain, or to help them integrate into insurance company isn‛t going to pay me for that, so you are not going to get it.”
society better, or to help them heal their bones. It is about caring for their I often say it is like having an insurance executive there in the room with you
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3. The Future of Psychiatry Looks Like
suffering. when you are getting an exam. We have people who come to the Oasis with
insurance because they like the one on one, people without insurance come here
Gail: I learned from one of your patients, who highly recommends you, that because they don‛t have a lot of options. I have a couple people who have
you manage your own bipolar disorder. How would you say the bipolar followed me from the County and say it‛s worth $79 bucks a month to not have to
challenge affects your ability to be a psychiatrist? deal with the appointment system and not to have to worry about getting a
different doctor every time. Some people think I am really critical of the
Risley: I don‛t think my illness has ever really impacted my ability to provide county system, and actually I am not. I have worked in that system since 1997,
patient care. I think it is important that the world recognize that psychiatric and I think it is remarkable what they do with the resources they have, but
illness can be managed well. I got my diagnosis in medical school. A lot of people there is a huge bureaucratic overhead. We are different from the county
I know with bipolardisorder are self-employed so they can have flexibility in system, but we can never be a substitute. We just provide an alternative for
their schedule. A lot of it is about perspective. When you go from a state, say, some.
of being profoundly depressed, to being really up and being hypo-manic, you begin
to realize that the same situation can be perceived on one day as being bone
crushingly depressing and on a different day as being an exhilarating challenge. Gail: What do you think the future of psychiatry looks like?
To recognize that has been a real gift. To be able to have some perspective and
not to just go through life feeling that I am the pawn of forces greater than I Risley: There will be a lot more accessibility to Mental Health Services and our
am is a true gift. knowledge of the brain will greatly increase. We know so much more about the
brain than we did 15 or 20 years ago, and it is still nothing. It is a growing field.
Gail: What do you think about the influence of the pharmaceutical industry We used to say that when people got sick, that they have “fever.” Now we look
on the way medicine is practiced? at fever as a symptom of a larger problem of different illnesses. So I think the
day will come when we look at depression or anxiety or psychosis as symptoms of
Risley: The pharmaceutical industry currently is the whipping boy because they a broad spectrum of illnesses instead of taking one treatment modality.
are the ones making the most money. When a lot of money is involved, you have Gail: What brings you the greatest joy in practicing medicine?
to be really careful with the amount of influence it has. Many doctors I have
talked to say, “Oh well, I know they are big, but that doesn‛t influence my Risley: What brings me the greatest joy is seeing people who have resigned
prescribing at all.” I think that‛s dangerous. They do provide some education, themselves to being sick, turn a corner and experience a sense of empowerment.
but they also have a lot of money and influence and I try to be aware of that. To see them make a positive change is never just about their medication. It is
never just about getting a therapist, it is never just about finding a resource like
the Wellness Center. But it is a combination of using many opportunities and
resources. Then one day they wake up and say, “I am a human being, I am a
productive person, and I can bring joy to others.” They come here and they tell
me that. Then I realize that I have been a part of that transformation. What
can you do in life that brings more joy than that?
Dr. Risley is the first graduate of the combined residency program in family medicine and psychiatry at UC Davis. He is
a former assistant clinical professor and physician diplomat at UCD. In addition to practicing psychiatry at TCORE,
he integrates family medicine and psychiatry at Sacramento Medical Oasis, Inc (www.sacmedoasis.com).
Interview conducted by Gail Erlandson, MA.
Gail has a Master of Arts Degree in Pastoral Ministry from the University of San Francisco and a Bachelor of Arts Degree
from the University of Portland in Interdisciplinary Studies. Gail taught at Loretto High School for eleven years and has served
on staff at Loaves and Fishes. Gail is a mentor at the Wellness and Recovery Center North.
Please send additions, Corrections or suggestions to info@sacpros.org
If you, or someone you know, experiencing disrupting symptoms
of mental health, please call Adult Access Team: at (916) 875-1055
or Children's Access Team @ (916) 875-9980. For a
psychiatric emergency, please call 911 as soon as possible or go
to nearest hospital emergency room.
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