Outgoing APA President Looks Back on Year of Many Lessons

If the global COVID-19 pandemic has made anything clear, it is that public health must be a priority, said outgoing APA President Bruce Schwartz, M.D.

And there is no public health without mental health. “This epidemic has made it an imperative that health and mental health care become a national priority,” Schwartz said at the Opening Session of APA’s virtual Spring Highlights Meeting in late April. “The complacency and predictability of the world that were previously a part of our day-to-day lives are gone.”

He opened his remarks with a solemn and heartfelt tribute to psychiatrists and other physicians in his native New York City.

“None of us will ever forget 2020 and the coronavirus pandemic, which has created a new normal that we never could have imagined. I work in New York City, which so far has experienced the worst of the epidemic in the United States. We have lost colleagues, friends, and neighbors. The heroes of this pandemic are the health care professionals and workers who risked [or] sacrificed their own health and well-being, as well as those of their families, to minister and care for their fellow human beings. I especially want to acknowledge the heroism of our residents and fellows, many of whom interrupted their training to help provide acute medical care in the hospitals and ICUs, being a visible reminder that we are physicians first.”

For the frontline responders, the trauma of witnessing so much illness and death will have lasting effects for many, Schwartz said. “Amid the epidemic, one of the greatest needs of our fellow health care professionals, after their need for personal protective equipment, was for counseling and treatment,” he said. “We were there as well as psychologists, social workers, nurses and nurse practitioners, counselors and support staff to continue to meet the needs of our patients and colleagues. The entire mental health workforce had to be mobilized, and interdisciplinary collaboration was all that allowed us to cope with the health and mental health emergency. We will need this full workforce to cope with the psychiatric effects after this epidemic passes as well.”

Revisiting his presidential-year themes focusing on quality, access to care, and reducing stigma, Schwartz said a key to enhancing access to quality care is collaboration among mental health professionals. He highlighted the January meeting of the APA Task Force on Interprofessional Collaboration, which brought together many of the organizations representing mental health disciplines (see Psychiatric News).

“This meeting was a powerful first step in developing and agreeing to principles of collaboration around which we can coalesce and a demonstration of the leadership APA can bring to a long-standing major public mental health crisis.”

Improving quality in education, clinical care, and research is “the key to many of the issues we face,” he said. “I fear we have lost control over the definition of quality.”

Schwartz said electronic medical records have made data readily available but have not yet impacted quality. Their capacity to store data has driven what he called “measurement mania” focused on symptom-reduction checklists at the expense of real improvement in functioning and quality of life.

“We have to ask ourselves: What really is quality?” said Schwartz. “It should not be how much the care costs or the production of quarterly treatment plans which regulators or payors use to judge the quality of care. We need to think about quality in terms of improved patient short- and long-term outcomes and maintenance of or improved quality of life or functional status. We need to be focused on helping patients with severe mental illness live better lives.”

Finally, he commented on the stigma and discrimination that continue to impact people with mental illness. “During my presidency, APA continued to be an important voice in combating the prejudice surrounding mental illness,” Schwartz said. “Many of our members participated in a series of reports on ‘CBS This Morning’ that aired this spring about mental illness.” He added, “That work—which is all our jobs—continues, and I think that the psychological trauma and distress that have been so much a part of the pandemic for so many people in our nation will lead to changes in our society where there will be a better understanding of what mental illness is, what it means in people’s lives, and the importance of receiving treatment.”

Schwartz commented that during his presidency, one of the things that really struck him was understanding how powerful APA’s voice is. He had the opportunity to represent APA in meetings with leaders of psychiatric societies from around the world.

“You should all be proud,” he told his audience. “It reminded me that we all have an important role to play in being part of APA. If I leave you with one last thought, it is this: All of us as the APA membership are essential to the future of the profession. Please continue to raise your voice and demonstrate the highest professionalism as psychiatrists in service of the well-being of our society and patients. Be involved in this powerful organization. It does make a difference.” ■