Pharmaceuticalization and Care Coordination in New York City Outpatient Mental Health

ABSTRACT

US government quality measures prioritize pharmaceuticalization and care coordination to promote patient treatment adherence. How these measures affect outpatient mental health service delivery and patient-provider communication where psychiatrists and nonphysicians collaborate is understudied. Analyzing 500 hours of participant-observation, 117 appointments, and 98 interviews with 45 new patients and providers, I show that psychiatrists and social workers coordinated care by encouraging medications and seeing two mental health providers as the default treatment, irrespective of patient preferences. Ethnographic perspectives crucially account for models of service delivery and provider behaviors in researching treatment adherence.

KEYWORDS:

• United States of America
• medications
• mental health
• psychiatry
• split treatment

Acknowledgments

I thank the patients and staff at CMHC for providing their time and experiences during the study, along with the journal’s anonymous reviewers and editors who encouraged me to sharpen my arguments. IRB approval was obtained from Columbia University/New York State Psychiatric Institute.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by grant [MH102334] from the National Institute of Mental Health.

Notes on contributors

Neil Krishan Aggarwal

Neil Krishan Aggarwal is a cultural psychiatrist and social scientist. His primary areas of research are translating anthropological theories and practices for use in clinical settings, the anthropology of mental health and illness, and psychological anthropology. He teaches courses in psychiatric and psychological anthropology to graduate students.