Then and Now: Dr. David Bean, Psychiatrist
For anyone who truly wants to understand the history of psychiatric medicine – or, even the history of medical education – in the South Dakota region there are few better resources than David Bean, MD, a board-certified psychiatrist with Avera Medical Group University Psychiatry Associates in Sioux Falls, a USDSM Professor of Psychiatry, and Vice Chairman for Forensic Services. As the psychiatric residency program prepared to celebrate 27 years this summer, Dr. Bean shared some of his recollections, as well as his wit and wisdom, with MED.
Dr. David Bean, one of the best-known psychiatrists in the region, did not start his career in psychiatric medicine. After graduating from the University of Minnesota School of Medicine and joining the Air Force in the early 60s, Dr. Bean spent several years delivering babies in Minot, North Dakota. “At the time, they said, ‘what do you want to do?’ and I said ‘I want to do surgery.’” Bean says the program’s director simply ‘declared’ him an orthopedic surgeon and he became a part of a preeminent pediatric orthopedic surgery program. But that’s another story.
Bean was not destined for a surgical career. More than a decade later, in 1977, Bean was moving to South Dakota to chair the growing medical school’s department of psychiatry and to help transform the state psychiatric hospital in Yankton – whose name had changed from the Yankton State Hospital to the South Dakota Human Services Center in 1974 – as its new director. Bean was hired through a joint agreement between the South Dakota Department of Corrections and the state Board of Regents.
“The treatment programs were slightly better than nothing when I got there, but by much,” recalls Dr. Bean, who, along with one other psychiatric colleague, was responsible for the care of 700 hospital patients. While attitudes toward the mentally ill had changed dramatically since Austrian physician Leo Kanner, the world’s first child psychiatrist, worked at the facility in 1924, Bean says they still had a long way to go.
“The long and short of it was that I said I would come if we could take over the state hospital and turn it into a modern hospital. That was the deal.”
He started with the staff. “At that time, unlicensed doctors could be certified to work in the state hospitals as psychiatrists. This was not uncommon in states. The idea seemed to be that, even if you weren’t good enough to treat regular patients, you were good enough to care for the mentally ill.” The woeful understaffing with unlicensed doctors had much to do with the pay scale – about $20,000 a year.
“The Kneip [Governor Richard Kneip] administration said ‘How much do you need?’ and I told them that we needed to be paying these people $50,000 a year. We began to advertise for competent physicians who could teach medical students and were willing to work in a hospital to resurrect it. I let the unlicensed doctors know that they had to get licensed or leave. We became the highest paid psychiatric institution in the nation and eventually we got a full complement of ten fully-trained psychiatrists.”
By the time Dr. Bean left the hospital in 1984, the modernized facility was delivering higher-quality psychiatric treatment, had restarted its adolescent unit, and had added a geriatric psychiatric program which became Medicare-certified.
While the state hospital was changing, so was psychiatric education in the region. The psychiatric residency program, which welcomed its first residents in 1987, was the first residency program offered after USDSM became a 4-year medical school. The program recently expanded from 4 to 6 residents per year. As of last June, it had graduated 79 fully-trained adult residents, 24 of whom extended their residency training to include a two-year child fellowship. The Child and Adolescent Fellowship program was approved in 1995 and has graduated 33 Child and Adolescent Psychiatrists, currently one of the most-needed specialties nationwide.
While, Bean is excited about the future of the program and the specialty, he is also eager to remind anyone who will listen of its proud history. As we wrapped up our interview, he added, “There is only one medical specialty board represented by a signer of the Declaration of Independence and that was Benjamin Rush, a psychiatrist from Philadelphia. He wrote the book on psychiatry in America and was the father of the American Psychiatric Association, which was the first medical association, established even before the AMA.”