Citing Importance of Advocacy, Robinowitz Urges, 'Just Do It'

From the April 2007 shootings at Virginia Tech to soldiers returning from Iraq and Afghanistan with PTSD and traumatic brain injury, the need for increased access to treatment for mental illness has been in the news this past year.

It was a month after the Virginia Tech shootings that Carolyn Robinowitz, M.D., began her APA presidency, which she devoted to advocacy and public education. In an address at the Opening Session at this year's annual meeting in Washington, D.C., she highlighted the public response to the killings as evidence of advances in public understanding of mental illness and the success of APA's efforts.

“Although there was much opportunity for media overreaction and blaming, I was struck and consoled by the many media reports and politicians' comments that demonstrated a greater understanding of psychiatric issues; the importance of psychiatric treatment and its role in preventing violence; the complex issues of confidentiality, culture, and stigma; and the importance of adequate funding for a public mental health system, as well as for care of college students away from their home environment,” Robinowitz told annual meeting attendees.

She noted that APA is prepared on an ongoing basis to help victims of disasters and traumatic events through efforts coordinated by the Office of Communications and Public Affairs and provide assistance and support to district branches when needed. Through these efforts, the Association has“ also been able to educate and increase public understanding about psychiatric issues in general,” she said.

The Virginia Tech shootings highlighted the need for mental health services for college students away from home. “Our own Committee on Mental Health on College and University Campuses took on this challenge and has begun a number of important national efforts and alliances to educate the public and improve mental health care—including prevention and early intervention—available for college students.”

Robinowitz also emphasized the importance of advocacy for treatment of service members returning from the wars in Iraq and Afghanistan and has taken an active and personal interest in the cause of mental illness among veterans. She drew attention to the continuing stigma attached to mental illness among military personnel, underscored by a survey commissioned by APA asking military members and their spouses about perceived mental health needs and attitudes toward mental health care. The results of that survey were released in a press conference in late April (see APA Survey Documents Extent of MH Problems in Military).

“The VA system is flooded with patients who need treatment, as is the military, and both systems are in need of more mental health professionals, especially psychiatrists,” Robinowitz said. “I have encouraged residents finishing training to consider spending a year or more as civilian employees of the Department of Defense, working with active duty military or in the VA system.”

She added that she would like to see a program of loan forgiveness for psychiatrists who choose to work in these settings.

“APA has joined other groups in promoting Give an Hour, a private not-for-profit mental health organization that encourages mental health professionals to provide one hour of care a week to returning military and their families,” she said. She noted that she has joined and will be participating actively now that her presidential term has ended.

Robinowitz also said that APA was surveying members about administrative burdens and other problems associated with Tricare, a component of the military health care system. “Meanwhile, I am putting my own voice into action and signing up to be a Tricare provider,” she said. “I also am keeping a diary of the process and will report back on my experience.”

In the legislative arena, Robinowitz highlighted APA's continuing work to achieve parity mental health coverage in insurance plans. “While the provisions of the initial Senate parity legislation left much to be desired, especially in those states where parity was already enacted, we could not walk away from the collaborative efforts of the business community and advocacy groups after years of effort (see When Health Reform Is Discussed, APA Will Be There, Stotland Vows).

“We continued publicly to support the Senate bill while constantly working to improve it and also supporting the House proposal with its stronger provisions that were more patient friendly,” she continued. “Now, nine months later, we are seeing a potential plan for compromise and eventual passage of a stronger bill. Of course, we must view whatever final product as a beginning—a floor, not a ceiling.”

With the development of DSM-V now under way, Robinowitz stressed APA's commitment to transparency at a time of heightened public concern about pharmaceutical industry and other special-interest ties to medicine.

“APA set stringent principles to be followed for contributors to DSM, including extensive disclosure of potentially competing interests, as well as divestiture of industry support,” she said.“ These standards represent a new level of openness, going beyond previously published rules in other medical specialties or those set for consultants to government agencies.

“In recognition of the importance of transparency, disclosures of work group and task force members have been posted on the DSM Web site,” Robinowitz said (see DSM-V Development Will Be Complex and Open Process).

As her address came to a close, APA's outgoing president asked members to do two things: spread the word about APA and commit to one advocacy activity.

“We need a robust membership base to inform our directions and actions, as well as provide through dues resources to do our work,” Robinowitz said. “Spread the news about what has been the best-kept secret—how much APA does for our profession and for our patients.

“Pledge to engage in at least one advocacy activity,” she urged. “Call or write your legislators, meet with them or their staff at home, write a letter to the editor, communicate online to media Web sites or blogs, speak to clergy or other religious groups, join and become active in the AMA and/or your local or state medical society, work to educate other health professionals, volunteer with Give an Hour or another community service organization.

“Just do it,” she said, citing the famous Nike advertisement.“ It will feel good as well as do good.” ▪