Who says psychiatry is a profession in an ivory tower, alone? The image many have of psychiatrists is that of a scholar working at the elite level of psychological theory and practice, working with wealthy clientele in a private practice setting or forced to render judgement on the problem cases of others in a hospital or corrections setting. But there is a distinct subset of psychiatrists working in and around American communities, universities and clinics (none too small, but lesser known about) whose work is actually antithetical to this image.
These professionals practice in an area best described as community psychiatry, or as it is often called, public service psychiatry.
Now, community mental health is not such a foreign concept. However, one tends to think of social workers, agency directors, caseworkers, addiction counselors, psychologists and therapists as those who hash out details of mental health consumers’ needs. Indeed, it is the psychiatrist who must be called upon to do the initial assessments and diagnose disorders, but their active role usually diminishes, as they bow out (for the most part) of the developing psychosocial picture.
Not so for public service psychiatrists. In addition to their regular duties, they truly partner with urban and rural health service providers and consumers in their region. They look to the unique psychological needs that arise in specific environments and individual communities, and always aim to serve the underserved.
The department of psychiatry at the University of Pittsburgh (Penn.) Medical Center, along with their esteemed affiliate Western Psychiatric Institute and Clinic (WPIC), operates one such Center for Public Service Psychiatry (CPSC). The Center is “dedicated to the development and practice” of this subset of psychiatry, “providing leadership, collaboration, education and community based research.” Input from consumers and others ‘affected’ is especially fostered, with weekly discussion meetings open to community service providers, family members and interested others. Along with graduate fellowship students in the program under the mentorship of Dr. Wesley E. Sowers, CPSC director, and associate director Robert Marin, it makes for a colorful mix of an informed and invested population of consumer-providers both.
Wes Sowers certainly is not the stereotypical psychiatrist. He doesn’t attend the CPSC meetings in white coat or even suit and tie. Both he and his colleague Dr. Marin are unassuming leaders of this relaxed weekly gathering on the periphery of the Pitt campus, albeit with ambitious three-part curriculum content (and suggested reading material) and teleconferenced seminars with their colleagues around the United States.
“Wes,” as fellows and others in the group call him, has a background that naturally fits the mold of a person dedicated to applying his expertise in underserved communities. He began international work in public health after his internship, spending a year in Sudan, working with Ethiopian refugees, and helping to train local health workers in Nigeria and El Salvador.
Once back in Pittsburgh, in the early to mid-1990s, he became the medical director of St. Francis Hospital. It is one of two major institutions in the region (WPIC the other) that served the psychiatric and substance abuse populations in surrounding Allegheny County. This writer once worked with a psychosocial agency in the Oakland area on the Pitt campus, interfacing with doctors, clinicians and therapists from both institutions. St. Francis had a reputation as humane, compassionate and collaborative.
Although St. Francis no longer exists, to this day, individuals comment favorably in support groups and other forums about the unique care that came out of its rehab facilities. Well-respected clinician and author Abraham Twerski, former rabbi, served as clinical director of the department of psychiatry there, and he would later found Pittsburgh’s award-winning Gateway Rehabilitation Centers.
How does Dr. Sowers describe public service psychiatry and his connection to this work he does? It is in his opinion “what psychiatry ought to be.” He brings up the words “value-based, social justice, and a desire to serve the underserved” (and that this subset of psychiatry is underfunded). The reward to him from his service and leadership — besides natural gratification in healing within populations that he has had “pretty consistent interest in” since early days working in public health and prevention — comes also from just getting to know these “interesting and culturally diverse” people whom he comes into contact with regularly.
Dr. Sowers also serves as medical director for the Office of Behavioral Health in the Allegheny County Department of Human Services, as well as clinical associate professor of psychiatry at WPIC. He became especially interested in addictions when “superiors early in his career apparently didn’t know much about them.” Yet he found himself in the field of psychiatry when co-occurring addictions and mental illness were becoming better known. While at St. Francis, and beyond, Dr. Sowers saw that “the more he became immersed in mental health, addictions became a more relevant paradigm…” related to all mental illnesses.
“A focus on health, instead of illness” is Dr. Sowers’ stake on his and colleagues’ research and practices in public service psychiatry. Indeed, “holistic” is what Dr. Sowers offers up as descriptively distinguishing his program. This mindset even approximates some of that of the anti-psychiatry movement so well-known from the 1960s and 1970s. Discussed in one of the weekly CPSC meetings, the theories of Thomas Szasz, R.D. Laing, Elaine Showalter and Phyllis Chesler, “though a bit extreme,” according to Dr. Sowers, have “important implications” for modern-day community psychiatry.
Dr. Sowers unabashedly states that diagnoses are perhaps best useful for billing purposes (a fact that other clinicians, liberal or otherwise, have no problem expressing equal agreement to, at least behind closed doors); as well, he feels that Western medicine “pathologizes a lot of things that are really problems in living.” As such, the work of public service psychiatry truly speaks to and significantly serves not only myriad people but many other facets of American society.