My Final Column as President: Impact of APA

In February, I received an email from the counsel for the commandant of the U.S. Marine Corps. He asked for APA’s help in dealing with the problem of suicide in the Marines. The scope of this problem was recently described in two New York Times articles about suicide in the 2nd Battalion, 7th Marine Regiment. That military unit returned from a dangerous tour in Afghanistan in 2008, where it had been deployed behind supply lines and had been under fire almost daily. During eight months of combat, the unit killed hundreds of enemy fighters and suffered more casualties than any other Marine battalion that year.

Since the end of deployment, 14 members of the unit have died by suicide, and many others have attempted suicide. The suicide rate for the 1,200 Marines who deployed with this unit is nearly four times as high as for young male veterans as a whole and 14 times as high as that for all Americans.

In March, Drs. Paul Summergrad and Maria Oquendo and I, together with APA’s administrative leadership, met with the leadership of the U.S. Marine Corps. In attendance was Gen. Robert Neller, a four-star general who is the commandant of the Marine Corps and a member of the Joint Chiefs of Staff. In addition, the meeting was attended by another general, an admiral, and the heads of both the behavioral health and psychological health units for the Marines.

Gen. Neller started the meeting by saying that two active duty recruits had died by suicide in the previous week. He said that 60 percent of the Marines are under 25 and that he is motivated to prevent suicide in these brave young men. He specifically wanted APA’s help with prevention, identifying tools for early recognition, and decreasing stigma so that the Marines would seek help. He spoke about the military culture and how it doesn’t work to say to a Marine: “You did the best you could.” He explained that Marines are trained to think that there is a “right way” and a “wrong way” and that there is always the “one best way” to do things.

APA plans on working with the leadership of the U.S. Marines with a multi-pronged approach to prevent suicide. This is an example of the ability of APA to try and improve the mental health of our country.

In addition to the above example, I have participated in other experiences in which APA has been able to exert its influence to impact public policy. In the last seven months, I chaired three congressional briefings to educate members of Congress about mental health issues. The briefing in October addressed the decriminalization of people with mental illness. In December, the briefing included a panel of experts to address the importance of eliminating the Medicaid IMD (Institutions for Mental Diseases) exclusion as part of mental health reform to increase the number of available psychiatric beds. Another briefing in April dealt with the importance of collaborative care.

Other recent APA activities include the establishment of a mental health registry to help with quality measures and help our members meet the increasing regulatory requirements of Medicare and other payers. The registry will also have utility for research, improving care, and meeting ABPN MOC requirements. We are starting to look at potential revisions to DSM-5, which is probably our most influential APA document.

Also, as was exemplified in the incredibly successful APEX awards event, where we honored the cast of the “Orange Is the New Black” Netflix series, we also are beginning partnerships with Hollywood and other media outlets to get our message across about decreasing stigma and promoting mental health. Coverage of this event will appear in the next issue.

During my year as president, I have learned to appreciate the value of APA membership and APA’s influence. I am immensely thankful to have had the opportunity to lead this great organization and to work with outstanding individuals in the administration, such as our CEO and medical director, Dr. Saul Levin; in the APA Assembly, especially the speaker, Dr. Glenn Martin; and with the outstanding members of the Board of Trustees, especially the immediate past president, Dr. Summergrad, and the president-elect, Dr. Oquendo.

It has been a privilege and an honor to represent our members and move our organization and our field forward for the benefit of our patients. ■