MONTGOMERY – Department of Mental Health & Mental Retardation Commissioner Kathy Sawyer, Associate Commissioner for Mental Illness Kimberly Ingram and Associate Commissioner for Substance Abuse Services Kent Hunt want to encourage Alabama’s medical students to become more familiar with the public network of mental illness and substance abuse treatment programs. "It is critically important that doctors, especially new physicians, familiarize themselves with available mental health and substance abuse treatment programs," Sawyer said. "Left untreated, these conditions represent a public health epidemic."

The recommendation is in response to a survey of medical students published on September 5, 2001 in the Journal of the American Medical Association (JAMA) and reported upon in the September 7, 2001 edition of The Birmingham Post-Herald. According to the Post-Herald, 2,626 medical residents in eight specialties – internal medicine, pediatrics, family practice, obstetrics/gynecology, psychiatry, general surgery, orthopedic surgery and anesthesiology – were surveyed during their final year of graduate medical studies at institutions of higher learning across America.

Respondents revealed concerns that they might be less prepared for medical careers because they were unfamiliar with important treatment components related to their areas of expertise. "Particularly concerning are the statistics about mental health issues," said Ingram. "42 percent of internal medicine residents said they were not prepared to counsel patients who are victims of domestic violence, which is a major contributor to low self-esteem and possibly post-traumatic stress disorder."

Ingram was particularly disturbed by the results of survey questions dealing with specific mental illnesses. "The results show that 19 percent of obstetrics and gynecology residents feel unprepared to counsel patients about depression. The recent tragedy of Andrea Yates, which allegedly involved severe postpartum psychosis, and a relatively high prevalence rate of postpartum depression in many women currently exists. This indicates that appropriate training in counseling patients about the true nature of these biological brain disorders and providing them with referrals for appropriate treatment and care is of paramount importance."

The survey also revealed that more than 10 percent of psychiatry residents said they were ill prepared to treat substance abuse problems, to provide short-term or long-term psychotherapy, or to diagnose and treat eating disorders. "There is a serious problem with medical training when a trained psychiatry resident does not feel prepared to provide psychotherapy," Ingram said. "The correct diagnosis of substance abuse disorders and eating disorders is critically important to the successful completion of the next step – providing an adequate and appropriate referral for mental health services. These are potentially life-threatening conditions."

The survey results also indicate that, aside from psychiatry residents, medical students in other specialties also feel unprepared to deal with counseling patients on the complex problem of substance abuse and substance abuse treatment. Over 20 percent of primary care residents and 11 percent of family practice residents are unprepared to counsel substance abuse patients. "This causes concern because prolonged substance abuse takes a devastating toll on physical health," said Hunt. "With substance abuse widely recognized as one of the most pressing contemporary public health issues and being a top priority on the public policy agenda, medical residents should be very familiar with indicators of substance abuse as well as the treatment referral process."

"We urge Alabama’s current physicians and current residents to familiarize themselves with Alabama’s excellent public system for mental health, mental retardation and substance abuse treatment services," Sawyer said. "By doing so, we can improve the continuum of care for all patients, as well as work towards U.S. Surgeon General Dr. David Satcher’s recommendation of viewing and treating mental health and physical health conditions as related."

RESOURCES

• Information about programs and services offered through the Division of Mental Illness can be obtained by calling (334) 242-3643. Referrals to local community mental health centers across Alabama are available by contacting the Bureau of Mental Illness Community Programs at (334) 242-3200.

• Information about programs and services offered through the Division of Substance Abuse Services can be obtained by calling (334) 242-3961. Anonymous referrals for local community substance abuse treatment facilities across Alabama are available by accessing the DMH/MR website and clicking on the "Substance Abuse" link. You will find a "Substance Abuse Treatment Facility Locator" which matches treatment facilities to ZIP codes. The 24-hour, 7-day-per-week substance abuse crisis line is 1-800-SOBER90.