Our Future is Now

Dear friends, colleagues, and distinguished guests, I have a confession to make that may shock you to hear. I know I was when I came to this realization. After the tumultuous year we’ve just been through, and despite the multitude of challenges—many meetings, long hours, and extensive travel that comes with leading this great organization—I really have enjoyed being President of the APA.

The experience of being surrounded by the members and staff—people who are committed to lofty goals and passionate about what we are doing today and aspire to do in the future—has been incredibly rewarding. More than I ever could have predicted. It has been gratifying and inspiring to help psychiatrists do what they are trained for: to help people with mental disorders. Over the past 2 years as President-Elect then President, I have seen firsthand what we are capable of doing when we set our minds to it and work together. We have done much to help psychiatrists and their patients, and for that, I want to applaud you.

In deference to David Letterman who will depart his Late Show just after I leave office, it seemed appropriate to do a top 10 list. In fact, I will do two: one of some of our accomplishments during my tenure, all due to the efforts of people you know and are here today, and one at the end of my talk about our future.

So what have we done in the past year:

1) Dilip Jeste, our Past President, and Becky Rinehart, Publisher of APPI, along with a behind-the-scenes cast of dozens, pulled off the near miraculous completion and launch of DSM-5, which has been on the Amazon Best Sellers list since it was released at last year’s meeting. Not many other medical textbooks can claim that distinction. Moreover, clinicians like it. You can’t expect to revise a staple like DSM for the first time in 20 years without experiencing some glitches. And we had more than our share of them. But the APA kept its composure and rallied, when under attack by our enemies and occasionally our friends, to make DSM-5 a resounding success. What a difference a year makes.

2) The APA tackled the health care reform process head-on and effectively influenced legislation, including the Affordable Care Act, the Mental Health Parity and Addiction Equity Act, the Excellence in Mental Health Act, and we are currently working with Congressman Tim Murphy on the Helping Families in Crisis Act and will begin to work with the Democratic Mental Health Bill that is about to be introduced.

Mental illness and addiction are not partisan issues, but we must manage the political realities such as they are. APA also helped Congressman Murphy to successfully reverse the misguided decision to restrict medication formularies for antidepressant and antipsychotic drugs by the Center for Medicare and Medicaid Services.

This string of legislative successes didn’t just happen by accident. John Oldham began the process when he was President by tapping Paul Summergrad to chair a health care reform workgroup, which Howard Goldman subsequently took over and recruited a team of experts to work with the indefatigable Sam Muszynski and staff to build an effective government policy and legislative capability, which is now firing on all cylinders.

3) A key person in our legislative initiative has been Patrick Kennedy, with whom the APA has formed a wonderful partnership. In his postcongressional life and following his triumph with the Parity Act, Patrick is fast becoming Americas most visible and effective spokesperson on mental illness and addiction. The courage and eloquence that he has displayed in sharing his and his family’s experience with mental illness and addiction have been enormously helpful in raising public awareness. Patrick will be introducing Vice President Biden at the Convocation Lecture tomorrow.

4) Under the leadership of Ron Burd and Allan Anderson, the APA won another victory with the Centers for Medicare and Medicaid Services by increasing reimbursement values for Medicare coverage of psychiatric services.

5) In the wake of the tragic, violent incidents involving persons with mental illness, the APA’s Office of Communications and Public Affairs, under the new APA Chief Operating Officer Shaun Snyder, was mobilized and engaged outside public relations expertise to assist with mounting an effective media campaign to bring accurate and constructive, as opposed to inflammatory, information to the public. We sent Paul Appelbaum to the emergency White House Meeting on Mental Illness and Violence to represent the APA and deployed him as our media spokesperson. Let me tell you that you can’t find a more capable and knowledgeable person to speak for the APA on such an emotionally charged and politically controversial topic than Paul.

6) APA has assumed a watchdog role to protect consumers and psychiatrists from insurance companies that were not complying with the Parity Act. APA Counsel Colleen Coyle has been brilliant in challenging the insurance behemoths with compelling legal arguments, while the feisty New York State Psychiatric Association successfully filed a class action suit against United Behavioral Health for violating the Parity Law.

7) To assess the APA’s performance in achieving diversity in its membership and leadership roles, Maria Oquendo took on the important assignment of chairing a Trustees and Assembly workgroup on under-represented minorities. Now it’s incumbent on us to follow through with the recommendations, including working with the minority caucuses to identify candidates for component appointments and elected office.

8) Training psychiatrists and early-career practitioners are among the APA’s most precious constituencies, but we were losing them in record numbers. To determine why and what could be done, we asked two young psychiatrists, Carolyn Rodriguez and Yoni Amiel, to lead a workgroup to advise us. Nine months later, they presented a fabulous report and set of recommendations to the Board of Trustees, which we are already putting into action, beginning with the hiring of John Fanning as the Chief of a newly established Training and Early-Career Psychiatrists Office to address their specific needs.

9) A less visible but no less important accomplishment, to my mind, was the revision of the APA bylaws to bring them into compliance with the new District of Columbia Nonprofit Corporation Act. I can’t tell you how impressed I was by the professionalism and diligence with which Rebecca Brendel and her committee carried out the arduous task of going line by line through the bylaws. Rebecca gave up many weekends to present these at Board of Trustee meetings and personifies what is best about our organization.

10) APA underwent a leadership transition this past year. Jay Scully, after a decade of dedicated service, was succeeded by Saul Levin as CEO and Medical Director. Saul has wasted no time formulating his priorities for the APA being membership, partnerships, and the strategic issues, revamping the central office, and reaching out to members by crisscrossing the country to visit the area councils and district branches. Saul is going to do great things for the APA, and we need to do all we can to support him. This is his first APA Annual Meeting as CEO, so let’s give him and the staff who have newly joined APA a warm welcome.

Now let’s give ourselves a round of applause for what we have accomplished this past year together.

There are so many unsung heroes in this organization who have worked hard and made many sacrifices for our cause, too many to name and more than I surely know. But please hear this: It is your amazing dedication and tireless efforts that have inspired me as President this past year and what motivates me every day to try to do more and better. I thank each and every one of you from the bottom of my heart.

But we are here today not only to celebrate our progress as an organization and a field of medicine but also to lift our eyes to what lies ahead.

In doing so, we can see the disruptive forces that make our future simultaneously promising and unsettling. However, I believe we are fortunate that the convergence of scientific progress and the government’s focus on health care reform has put psychiatry in a unique position. Add to this the increased public attention to mental health care, and you will agree that psychiatry has reached a point of a distinctive opportunity.

When a year begins with New York Times columnist Nick Kristof declaring mental health as the most important topic for America in 2014, followed just weeks later by mental health being the most frequent topic discussed at the World Economic Forum in Davos, where celebrities like Goldie Hawn, Arianna Huffington, and Glenn Close decried the stigma of mental illness and called for better care, and the President, just this week, declares May National Mental Health Awareness Month, you might almost think that mental illness and psychiatry were becoming cool. I said almost.

But if we want to take advantage of the biggest scientific, economic, and legislative changes in mental health care in our lifetime, then we need to seize this opportunity, right now. We need to understand and believe in the core of our professional being that our future is now.

I have another confession to make, when I was elected APA President 2 years ago, I was not completely confident that we were up to the challenge. But after seeing how we have responded with our backs against the wall, I now know that we can handle the tasks at hand. Hence the theme for this year’s annual meeting: “Changing the Practice and Perception of Psychiatry.”

My friends, our future is now. We have been waiting, many of us our whole lives, for the chance to change the way the world thinks of psychiatry and the way we think of ourselves as psychiatrists. Let’s use the momentum we have to plunge ahead into the next year with our confidence brimming, our energy renewed, and our sights set high.

The APA is a much different organization today than it was several years ago. I ran for President out of frustration over what was happening to the field of psychiatry and what the APA was not doing about it. What I saw then was a lot of lamenting, wallowing, rationalizing about what was then the present, and denying the future. Today, 2 years later, I can say, looking you straight in the eye, that this organization has what it takes to advance our interests, achieve our goals, and overcome the historical prejudice and discrimination toward mental illness and psychiatry.

Yogi Berra famously said, “It’s difficult to make predictions, especially about the future.” But I am so confident that I will venture another top 10 list. So here are 10 goals that I predict we can and will achieve going forward:

1) Public perception of mental illness and psychiatry will change.

We will better educate the public and the media about what mental illness is, what psychiatry does, and what our role in the future of health care in the U.S. will be. As a result, the public will gain a more accurate and respectful understanding of mental illness and psychiatry.

2) Psychiatry will return to its rightful place in the house of medicine.

Only a very few major developments have fundamentally changed psychiatry throughout our history: moral therapy and the asylum movement, Freud and psychoanalysis, psychopharmacology, and modern neuroscience.

I believe that another such inflection point is imminent. Driven by scientific advances and economic forces, psychiatry will increasingly become a scientifically based discipline, achieve capabilities to diagnose and treat patients with mental disorders that previously would have been unimaginable, and, in doing so, rejoin the family of medicine. The presence of our own Jeremy Lazarus, who is here with us following his successful term as President of the AMA, is a good omen.

3) APA will become a strong voice and respected presence in the political arena.

The APA, with Saul Levin’s leadership and through its Division of Advocacy under Kristen Kroeger, will be proactive in developing productive relationships with the administration and Congress. This will foster constructive legislation and policies favorable to psychiatry and people with mental illness. Simply put, to win the game we must be in the game.

4) Psychiatry will benefit from biomedical research.

No medical specialty stands to gain more from biomedical research than psychiatry. Only recently have we had the tools to begin to deconstruct the brain in ways that could explain how the mind functions and malfunctions. Just as Galileo could not prove heliocentrism before the telescope was developed, we could not possibly have known what makes people’s brains malfunction before the advent of modern neuroscience. Mental illness is right in the sweet spot of the Human Brain Initiative that President Obama announced this year, which will support the development of powerful new forms of neurotechnology.

To maximally benefit from research, we need to work hand in glove with the NIH and aggressively advocate for increased funding for biomedical research. Among other planned initiatives, we have started discussions with NIDA Director Nora Volkow about launching a smoking cessation campaign in mentally ill populations and a longitudinal cohort study of the effects of marijuana on the brains of young people. I am confident that we will not have to wait nearly as long as we did for Eric Kandel to be the first psychiatrist to win the Nobel Prize for the next psychiatrist to be so honored. And I will go further out on a limb by predicting that Karl Deisseroth will likely be the next Nobel-winning psychiatrist.

5) DSM will be a living instrument.

The DSM is arguably the most important product of the APA. Not only is it an important resource for doctors, patients, companies, and government agencies, but it is also the symbol of psychiatry. If anything stands for the scientific credibility of psychiatric medicine, it is its diagnostic system. As the caretaker of the DSM, the APA will ensure that it is managed responsibly and by the most rigorous scientific and ethical standards. Toward this end, we have convened a DSM Steering Committee, chaired by Paul Appelbaum and co-chaired by Ken Kendler and Ellen Leibenluft, comprised of elite clinicians and top researchers to iteratively revise DSM-5 following nosologically significant scientific breakthroughs rather than at decades-long intervals.

6) APA will work with a coalition of mental health stakeholder organizations to ensure that health care legislation, such as the Affordable Care and Parity Acts, are implemented properly so that mental health providers and patients receive all the benefits to which they are entitled.

The goals of providing quality mental health care and eliminating stigma are too important to allow parochial interests to limit progress. Kristin Kroeger has already been working hard to develop closer partnerships with our allied health care organizations and stakeholder groups.

7) Training programs will change to reflect the impact of health care reform and scientific progress.

APA, working with AADPRT and the American Board of Psychiatry and Neurology, will revise and update training programs to prepare future generations of psychiatrists for the roles and services they will be called upon to provide in the brave new world of 21st-century health care.

8) Our government, health care policy makers and providers, and nonpsychiatric medical colleagues will finally understand that there is no health without mental health.

As a result, psychiatry and mental health care will be integrated into diverse health care settings with an emphasis on primary care, and the changes that will occur in mental health as a result of scientific advances and health care reform will lead to improved quality of care that will produce the same striking declines in morbidity and mortality in mental illness that we have seen in cardiovascular disease and cancer over the last few decades. As Patrick Kennedy is fond of saying, “Everyone deserves a checkup from the neck up!”

9) APA will get its “mojo” going!

Under the aegis of the new CEO and Medical Director and continued strong elected leadership, the APA will more effectively represent the interests of psychiatry and the mentally ill.

10) We will dispel the ambivalent relationship that our society has historically had with psychiatry.

Most people, at some point in their life, will need a psychiatrist, although they may not know it or will not admit it. Yet psychiatry is a mystery to most people, and many are ambivalent about its value. At the end of the movie Annie Hall, Woody Allen tells the story of a guy going to see a psychiatrist who asks him, “How can I help you?” The man tells the doctor, “It’s not me, it’s my brother; he thinks that he is a chicken.” The doctor asks, “Why don’t you bring him to see me, and we’ll fix him up?” To which he replies, “I would except that I need the eggs.”

I believe that psychiatry has reached a point in its evolution where it can break free of the ignorance, mystery, and stigma with which it has been historically associated. And the APA must lead the way.

Today, we celebrate the progress we’ve made—as an organization, as a field of medicine—and the prospect of a better future. This is our opportunity to change the practice and perception of psychiatry for the better and as never before.

Last year, standing on the stage in San Francisco, I told you that our time has come; today I say to you that our future is now!

Thank you for giving me the opportunity to serve as your President. I hope you have a wonderful meeting.