The Sabshin Legacy of Hope

Ironically, I was on my way to a "Blue Sky" meeting chaired by APA's CEO and Medical Director, Jay Scully, M.D., when I received an e-mail that former APA Medical Director Mel Sabshin, M.D., had died. It might have brought a smile to Mel's face to learn that this news was communicated to the APA senior staff and its president, immediate past president, and president-elect as we gathered for an annual meeting convened by Jay to do some blue sky, out-of-the-box thinking about how best to serve the organization that Mel loved and led for 23 years. I won't even try to summarize Mel's many accomplishments throughout his remarkable career, but his near-legendary stature and his importance as a forceful leader in the field of psychiatry are not in dispute. And Mel was, through and through, a visionary thinker, wisely watching the world change day by day, while passionately promoting psychiatry's growing importance in that changing world.

Some time ago, I put together my own "big picture" chronology of the changing face of psychiatry, to use when talking to patients and families at The Menninger Clinic. The chronology looks like this:

Some of these are my own designations, and some are the National Institute of Mental Health's (NIMH) designations. The current decade has been referred to in NIMH postings as the Decade for Psychiatric Disorders, as shown, but I also applied my own label, the Decade for Integrated Care. As many of you have heard me say, I believe that integrated, collaborative, patient-centered care is today's biopsychosocial model of health care—a systems version of the country doctor of simpler times. We must be active members of teams of experts working efficiently together, in partnership with our patients and their families.

In our Blue Sky meeting, we spent time talking about the implementation of parity, the changing nature of health care in this country, the move away from fee-for-service models, workforce issues, membership issues, and scope-of-practice concerns. We talked about reducing stigma in many forms, including within the medical profession itself—for example, by taking a leadership role to sunset the term "international medical graduate." We reviewed the expanding range of CME opportunities within APA and the rapid transformation from print to electronic publishing. We discussed the new APA Web site that is well along in construction, and we thought about ways to involve our MITs and ECPs in order for them to teach us better ways to communicate using new technologies. We reviewed the many research programs being carried out under the leadership of the American Psychiatric Institute for Research and Education, including an extensive discussion about DSM-5. And we talked at length about how to partner with allied organizations both at home and abroad. Finally, of course, we studied what the budget looks like and how to prioritize what we need to do.

One theme throughout the day was that the good work being carried out by APA staff in the Association's many divisions and departments needs to be better integrated with the work of the councils and components. Ultimately, we want all of our systems, large and small, to serve the goal of strengthening scientific progress, leading to better prevention and treatment for our patients, a goal to which Mel Sabshin devoted his long and fruitful career.

In his wonderful 2008 book Changing American Psychiatry, Mel said that one of his motives in accepting the position of APA medical director was "to assist in a transition from an ideologically oriented profession to one that developed and maintained a genuine scientific base." He went on to say that "psychiatry needs to be a stronger advocate of understanding the relevance of biopsychosocial factors to normal human development and resilience as well as to psychopathology. The 21st century will include a strong surge in this direction. The next period of a changing American psychiatry will include a newly emerging group that wishes to see psychological hypotheses integrated systematically with social and biological variables. Academic psychiatry ... will ultimately need to support this new generation of empiricists who must also fully comprehend the fundamental importance of neuroscience."

Mel's spirit was with us during our Blue Sky meeting, and I believe that he would be pleased at the tone of teamwork, optimism, and future-thinking that characterized the day—a day that could be described as right down Mel's alley.