Presidential Address: Addressing Patient Needs: Access, Parity, and Humane Care

APA President-Elect, Dr. Carolyn B. Robinowitz; Assembly Speaker, Dr. Michael Blumenfield; APA Medical Director, Dr. James H. Scully; past presidents and officers of APA; fellow psychiatrists; friends; ladies and gentlemen. I am honored and privileged to be here today as your APA President.

Before I proceed to make my official remarks, I would like to take a moment to introduce my family members who have joined me for this very special gathering.

First of all, my son, Pedro Pablo Ruiz, who is here with his wife, Julie, and their two sons, Francisco Antonio and Pedro Pablo, Jr. My son is an attorney and currently a judge presiding in the State District Court of Fort Bend County, Texas. His wife, Julie, is a teacher in a private school in Fort Bend County, Texas. My grandchildren, Francisco Antonio and Pedro Pablo, Jr., will always be my ideal APA campaign managers. They represent the future of the Ruiz family.

My daughter, Angela Maria Ruiz Holguin, and her husband, Omar, as well as their son, Omar Josef III, could not be here tonight because my daughter delivered her second son, Pablo Antonio, just a few weeks ago.

Finally, here with me tonight is my friend and partner for more than four decades; the person who has supported and guided me during my entire professional career; the person who deserves to be recognized for all of my personal and professional achievements: my wife, Angela Ruiz.

Let me now focus on my official comments for this special occasion in my professional career. I should begin by saying that, as your APA President, this year has been the most wonderful and rewarding year of my entire life. I feel accomplished, fulfilled, self-actualized, and grateful to all of you for the opportunity you extended to me to serve as your APA President. The APA is not only the oldest medical association in this country but also the most generous, sensitive, and rewarding medical organization in the United States, as well as across the world.

My fellow psychiatrists, the mandate that you gave me during my election as your APA President was very strong and unambiguous. It permitted me to be forthright and decisive in all the initiatives and actions that I undertook during my tenure as your President. I am therefore deeply appreciative to you for your continued confidence and unwavering support.

This past year I was very industrious and addressed most of the problems that I observed and/or detected in our organization. It was a very difficult and complex year, but also a very productive and rewarding one. I am happy to inform you that I adhered to all of the promises that I previously made to you. I also sincerely think that today our association stands on a solid foundation and is once more moving in the right direction. In this regard, I am deeply appreciative to our Medical Director, Dr. James H. Scully, for his willingness to work together with me for the benefit of our APA membership, our profession, and the field of psychiatry at large. As I look to the future and see the APA leaders who are following me, I feel extremely reassured and comfortable. Our organization will certainly be in good hands.

As I reflect on my year as APA President, my tenure began with a formidable challenge. The DSM-V project was already underway for several years and it was time to select the leadership who would take this very important APA project to a successful completion. At the same time, the field of medicine, including psychiatry, faced serious and ongoing criticism due to grave ethical violations and irresponsible behavior on the part of some professionals within the medical field. In this context, it was required that I rise to the occasion and protect the future of our organization, as well as the future of our DSM-V project. We therefore decided to address the APA’s policy on conflict of interest and change it to the most transparent and ethically driven policy that one could humanly design. I asked APA Vice President, Dr. Nada L. Stotland, to chair a Board of Trustees (BOT) task force to design a new model of ethical standards for the DSM-V project. Of course, Dr. Stotland and the members of her task force did an outstanding job and drafted a disclosure form that is second to none in the medical field. I am fully aware that this process was both difficult and painful, but I decided that it was no longer going to be business as usual. I also knew that I had the full support of the APA membership on this issue.

This decision was followed by the appointment of a second BOT task force, led by our Secretary-Treasurer, Dr. Donna M. Norris. Dr. Norris and the members of her task force have completed the screening of all of the nominees for the DSM-V Task Force and are currently screening all of the nominees for the DSM-V work groups. Some difficulties arose here and there, but Dr. Norris and her task force pursued their objectives extremely well. This task force has worked very hard and has done an outstanding job for the APA, as well as for our profession, and they deserve our full recognition. I am very happy to report to you that our DSM-V project is as protected as it can possibly be.

My fellow psychiatrists, when I became APA President I clearly said that in order to achieve access, parity, and humane care for our patients, we needed to build a strong and genuine partnership and/or coalition with patient-oriented advocacy groups. Therefore, during the traditional Board of Trustees retreat and meeting of last July, I proceeded, at full speed, to achieve this objective. I invited Dr. Suzanne E. Vogel-Scibilia, the President of the National Alliance on Mental Illness (NAMI), to address both the retreat and the board meeting. Needless to say, Dr. Vogel-Scibilia rose to the occasion and, in so doing, helped me to organize a formal APA/NAMI leadership meeting. This meeting took place in December 2006. Subsequently, I appointed a joint APA/NAMI work group under the leadership of Dr. Carolyn B. Robinowitz from APA and Dr. Suzanne E. Vogel-Scibilia from NAMI. I have no doubt that this work group will achieve all of our objectives in this regard.

My fellow psychiatrists, 2 years ago no medical organization was effectively pursuing access, parity, and humane care in the health care and mental health care fields. At that time, no one felt that these health and mental health priorities were realistically feasible; however, sometimes in life having vision, commitment, will, and courage can bring great rewards. Today several states have already passed legislation on universal access to health care and on full and comprehensive parity of psychiatric care. In 2008, as a result of the national presidential election, I envision that every person living in this country will finally have universal access to health care, as well as full and comprehensive parity of psychiatric care.

My fellow psychiatrists, it is our social responsibility as psychiatrists and citizens to ensure that humane care is not just a privilege for some but a right for all who live in the United States, as well as across the world.

At the board retreat and meeting last July, I also led a discussion on membership recruitment and retention and on the relationship between APA and its three subsidiaries: APPI, APIRE, and the APA Foundation. These discussions led to the appointment of several work groups, including one on membership, led by Dr. James E. Nininger; one on APA subsidiaries, led by Dr. Marcia K. Goin; one on access to care, led by Dr. Roger Peele; one on parity, led by Dr. David Fassler; and finally, one on public affairs, also led by Dr. David Fassler. The Work Group on Public Affairs presented its final report to the Board of Trustees in December 2006, leading to a restructuring and expansion of APA’s public affair efforts; this decision will certainly result in greater advocacy efforts and an improved public image of the Association.

During the September 2006 Fall Component Meeting, I proudly saw hundreds of our members working hard to make our Association more effective and productive. I was also happy to see many of the new members whom I appointed to these APA components, who depicted quite well the diversity of our membership.

In early October 2006, I led our traditional APA Institute on Psychiatric Services in New York City with the strong collaboration of NAMI, the American Association of Community Psychiatrists (AACP), and the American Orthopsychiatry Association (AOA). I am happy to report that this 58th Institute on Psychiatric Services was the best one ever in the history of APA. Not only did we have a record attendance of about 2,300, but scientifically this Institute was second to none.

In November 2006, I faced another major challenge. As I was about to initiate a trip to Las Vegas, Nevada, to attend one of the American Medical Association meetings as part of the APA delegation, I received an invitation from the U.S. Department of Defense to visit the U.S. Naval Base in Guantanamo Bay, Cuba, together with a group of senior military officers, as well as leaders from a variety of professional and medical organizations. The decision to go to Guantanamo Bay rather than Las Vegas was not an easy one; not because it was “Las Vegas,” but because other factors needed to be taken into consideration. For instance, I am among those APA leaders who strongly oppose the participation of psychiatrists in the interrogation of prisoners and detainees. I also reflected on the fact that I am a Cuban-born U.S. citizen who was invited to participate in an official U.S. visit to a naval base located on the island of Cuba.

So, early one day in November 2006, I found myself flying to Cuba in a Navy jet. During my visit to Guantanamo Bay, I saw physicians, psychiatrists, and other health and mental health personnel working under the most difficult and challenging circumstances. They were not volunteers but military, assigned to this detention camp.

My fellow psychiatrists, I decided, as your APA President, to visit Guantanamo Bay in order to pay respect to these psychiatrists and health care practitioners who were working in this detention camp. As your APA President, the well-being of even one APA member is as important to me, if not more so, than any political ideology, including my own.

This visit to Guantanamo Bay also led me to appoint another Board of Trustees work group, chaired by Dr. Mary Helen Davis, to focus on the health and mental health needs of our men and women in the military, as well as their family members. Additionally, I also invited Dr. Stephen J. Cozza to address the APA BOT during our December 2006 meeting on this topic.

Throughout the year I also paid attention to our relationship with the federal institutes, that is, the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). In this respect, I invited the three directors of these institutes, Drs. Thomas R. Insel, Nora D. Volkow, and Ting-Kai Li, to address board meetings during this past year and to lecture at a Presidential Symposium at this year’s APA annual meeting. As you well know, these institutes work very closely with APA in organizing scientific tracks for our annual meetings, and I hope that our efforts this year will enhance and strengthen our relationship with these institutes, in every aspect.

My fellow psychiatrists, let me now turn to the central theme of my presidential year. When I appeared before you a year ago during the 2006 APA annual meeting in Toronto, I focused my opening remarks on principles, values, social responsibilities, and advocacy efforts on behalf of our patients, particularly the severely and chronically mentally ill, as well as the disenfranchised and socioeconomically deprived mentally ill patients. For instance, I spoke about the vast number of mentally ill persons who are denied full and comprehensive parity of psychiatric care; I spoke about the countless number of persons living in this country without proper access to health and mental health care (last year 46 million, today 47 million and still rising); I spoke about the large number of mentally ill patients who are devoid of quality psychiatric care; I spoke about the extensive number of ethnic minority mentally ill patients who are divested of culturally competent mental health services; I spoke about the tens of thousands of mentally ill homeless persons who live and sleep under bridges and highways; I spoke about the huge number of children, adolescents, women, and older adults who are mentally ill and are disallowed adequate and sensitive psychiatric care; I spoke about the great number of mentally ill persons who are unfairly and unnecessarily sent to or held in jails and prisons rather than in psychiatric institutions. For example, I read in the Houston Chronicle on April 1, 2007, that an inmate undergoing psychiatric evaluation in Massachusetts hung himself in a shower room with a shoelace. This person was the tenth inmate to commit suicide in the Massachusetts state prison system in the last 15 months.

My fellow psychiatrists, what I am talking about is humane care. Our federal, state, and local governments are, for the most part, disallowing our mentally ill patients from receiving humane care. This is taking place not only in the United States but, to different degrees, all over the world as well.

My fellow psychiatrists, what are we going to do? Are we going to wait until all mentally ill persons who are unfairly and unnecessarily sent to or held in jails and prisons commit suicide?

My fellow psychiatrists, how much inhumane care do we have to observe in our daily practices and society at large before we say enough is enough?

My fellow psychiatrists, today, contrary to a year ago, we have built a strong and solid coalition between APA, NAMI, and Mental Health America (MHA). Today, contrary to a year ago, we have a stronger and more transparent APA. Today, contrary to a year ago, our profession is beginning to regain its image and stature. My fellow psychiatrists, I know quite well that we have the awareness and sensitivity required, the empathy and dedication needed, the necessary commitment and will, and above all, indispensable courage. I know it because this year we have demonstrated it. I also know that the two APA Presidents coming behind me also have these personal and professional qualities. Thus let us continue to use our principles, let us continue to use our values, and let us continue to operate our APA within a framework of social responsibility.

My fellow psychiatrists, it is imperative that we do so. Twenty or 30 years from now, the medical students who are in this hall tonight; the psychiatric residents who are in this hall tonight; the early career psychiatrists who are in this hall tonight; even my grandchildren who are with me in this hall tonight will ask: “What has Dr. Ruiz done, what has Dr. Robinowitz done, what has Dr. Stotland done for APA, for the profession, for the psychiatric field at large?”

My fellow psychiatrists, this is what it is all about. We must show them where the promised land is.

My fellow psychiatrists, we have to remove all barriers to mental health care. We have to bring back to our communities and to society all the mentally ill persons who, although in the 21st century, are still living in the shadows, under the bridges and highways, and in our jails and prisons.

My fellow psychiatrists, we must have the courage to do it. We must provide humane care. The future and image of APA and our profession depend on it. We must do it, and we will do it, together with NAMI, together with MHA, and together with any other advocacy group that has the courage to do it with us.

My fellow psychiatrists, at the end of this annual meeting my tenure as your APA President will end, but I am not planning to fade away. As long as there is a mentally ill patient without access to health or mental health care, without full and comprehensive parity of psychiatric care, without proper humane care, and still living in the shadows, whether in this country or in any other part of the world, I will return and join you in the trenches again, and again, and again.

Many thanks for listening, and best wishes to you all.