Rethinking the Assembly

Who runs APA, and how well do they do it? In an earlier column, I discussed the role of the Board of Trustees and the recommendations of the Long-Range Budget and Planning Task Force for a more efficient structure for the Board. As a reminder, several of the changes suggested by the task force and adopted by the Board are on this year’s APA ballot, which should have arrived recently at your home or office. Please take the time to vote and return your ballot by the February 6 deadline.

The other major component in the APA governance structure is our Assembly. When it was first organized in 1953, the Assembly consisted of representatives from each of APA’s district branches. As it approaches its 50th anniversary, the Assembly has grown in both size and importance to play a major role in APA. Its 246 members include representatives from each district branch, minority and other underrepresented groups, younger members, allied organizations, and Assembly leadership. More about the makeup of the Assembly shortly.

Assembly meetings are held twice yearly: every November in Washington, D.C., and immediately prior to the annual meeting in the meeting city. Typically, the meetings extend over three days and are focused on discussion and approval of action papers that call on APA to adopt policies or take actions on particular issues of concern. Action papers from the Assembly are routed to the Joint Reference Committee, composed of three members each from the Board and the Assembly, along with the medical director, and then many make their way to the Board for final action.

The Assembly also reviews and must approve major APA documents, including position statements, task force reports, and practice guidelines, prior to their formal adoption.

Each Assembly member is also assigned to one of seven Area Councils, geographically arranged. Most Area Councils also meet twice yearly, though the two Areas that correspond to New York state and California have much more frequent meetings. Several Area Councils are experimenting with scheduling their meetings just before the Assembly meetings in an effort to reduce the cost of meetings, but the majority still meet to formulate and review action papers and to exchange information at other times in the year.

Who are the 246 members of the Assembly? Every district branch (DB) has an Assembly representative, and DBs get another representative for each multiple of 450 members that they exceed. Thus, there are 112 Assembly representatives from our 74 DBs. DBs with fewer than 450 members (that is, with only one Assembly representative) have a deputy representative as well, accounting for 54 people in this category. From each of the seven Areas come a representative and deputy representative. Also included are 14 members-in-training, 14 early career psychiatrists, and 14 members from minority and other underrepresented groups. At this time, 17 allied psychiatric organizations also send liaisons to the Assembly. The remaining slots are filled by Assembly officers and three past speakers. APA Area trustees and officers of the Board also usually attend Assembly meetings.

As one walks into an Assembly meeting, one is struck immediately by the size of the group. A friend once quipped to me that it was like walking into the United Nations General Assembly. Clearly, the Assembly plays an important role in representing the diverse views of members and in providing a channel for members to initiate actions that can ultimately affect APA policy. But at a time of increasing fiscal stress, when we are rethinking the role of every component of the Association, the question must be asked whether the role and tasks of the Assembly are being fulfilled in the most efficient way possible. To put the question starkly, does spending roughly $800,000 a year on the Assembly represent the best value we can offer to our members?

The Long-Range Budget and Planning Task Force was of the view that the representative function of the Assembly could be maintained, but its cost trimmed and its effectiveness as a deliberative body increased, if its size were substantially reduced. By eliminating all deputy representatives and apportioning representatives to district branches for each 500 members, the size of the Assembly would be reduced to 164 members, and its costs decreased by approximately $275,000. I had the pleasure of presenting these recommendations to the Assembly at its November meeting.

How was the plan greeted? Let’s just say that it is remarkably difficult for any group to believe that it is too large or that its budget should be trimmed. Indeed, several members of the Assembly told me with great earnestness that they thought the Assembly was too small and should have additional members. The belief is fairly common among people involved in APA governance that the way to help members feel involved with the organization is to expand substantive and governance components, bringing more people to Washington for meetings. Since the cost of bringing a single member to one meeting, however, generally exceeds the annual dues that a member pays, this is obviously a self-limiting strategy.

I suspect that what most members want is not more or larger meetings, but more action from APA. More lobbyists on Capitol Hill and in the states. More work with news organizations to get the message out about the need for and effectiveness of psychiatric treatment. More assistance to members who are struggling with insurers and managed care companies. More guidelines to help members cope with new federal rules, like the HIPAA medical privacy regulations. More regular updating of our practice guidelines. Every dollar we spend bringing members to meetings, paying for airfare, hotel, and food, is a dollar less that we can spend on the things that I think our members really care about.

To its credit, the Assembly Executive Committee and Assembly Committee on Planning have agreed to consider models for revamping the Assembly at their joint meeting in Tucson this month. Since under APA’s Bylaws, the Assembly determines its own structure (though the Board ultimately has control of the purse strings), the participation of the Assembly and its leadership in this process is essential.

But other members of APA also have a critical role to play here. The Assembly represents you. Letting your Assembly members know how you feel about the current Assembly structure will allow them to represent your views in the discussion process. Organizations that fail to change with the times wither and die. APA is much too important to American psychiatry and to persons with mental illness for us to let that happen. I hope we can work together to make this the most efficient and effective organization it can be. ▪