Response to the Presidential Address

To my colleagues here with me on the stage and you out in the audience, I am humbled to stand before you as your President-Elect.

I want to take a moment to thank my family and friends, who have joined me here this evening, for the support and love which makes doing this work with APA a lot easier.

In my year as your President-Elect, I’ve spent a lot of time listening to members and thinking about what I want to accomplish as the next President of the APA.

As some of you know, I’m a history buff, so I’ve looked back over APA’s 174-year history to find inspiration from my predecessors for my term as President.

I’ve seen times when APA took a strong stance and times when we were perhaps too silent about issues affecting our patients and our world.

I’ve read the story of the Young Turks who disrupted the face and practice of psychiatry in their day and will share tonight another story that prompted changes at APA several decades later.

Tonight, I will briefly tell you my aspirations for the coming year, describing three main areas of focus for my year as APA President.

The first involves how we interact with trainees and early-career psychiatrists. I intend to actively engage our resident and fellow members and encourage all of us more “seasoned” members to become mentors, starting at the local level. If they are the future, we must extend our outreach efforts to bring these students and early-career psychiatrists into leadership positions sooner. For example, currently I am a mentor to one of the young undergraduate students in APA’s Black Men in Pipeline Psychiatry Program, a program designed to increase the number of young black men who are interested in medical careers, specifically psychiatry. I want to encourage similar innovative outreach efforts to draw men and women from other diverse backgrounds to our profession.

The APA must develop a sustainable strategy for the future that reflects the needs and the voices of our colleagues who are just beginning their careers.

I’ve taken part in many changes to medical training over the years, but now I—and other more “seasoned” psychiatrists—need to take a step up and get in step with our resident, fellow, and early-career colleagues and welcome our junior members to the frontlines. We need to ask our medical students, trainees, and early-career members how recent changes are affecting their work and lives and what additional changes need to be made.

Did the changes in scheduling and work hours help with work-life balance, stress, and the likelihood of burnout? Is the training rigorous and comprehensive enough to meet their clinical care provider needs as well as their social justice aspirations? Are we practicing what we preach? Are the faculty who are training the next generation of psychiatrists truly able to help them deal with many of the social determinants of mental health, including, racism, sexism, homophobia, and all the other “isms” that affect them, as well as our patients’ mental health?

We also must work on ways to help them grapple with their excessive educational debt. How are the burdens of student loans affecting where and how our early-career psychiatrists choose to practice?

Is the APA doing enough to creatively and innovatively help them meet these challenges?

Continuing to engage with and listen to the newest members of our profession will be a key part of my year as President, and I hope it will remain central to the APA as the leader in determining the future of American psychiatry.

The second focus for the next year is expanding our work in global mental health. I believe the APA can, and should, continue in leadership roles, working with our colleagues around the world. Our leadership in the World Psychiatric Association is an excellent example of APA forming strategic partnerships with international mental health organizations. We must continue to develop our capacity and strengths in this area, however, so answering the challenge of how we continue and expand these efforts with other psychiatric organizations worldwide will be essential.

Over the next few years, I hope to see the APA launch even more global initiatives.

We can share our expertise and knowledge in areas such as research, clinical services, psychopharmacology, and psychosocial rehabilitation and recovery models with psychiatrists and other mental health experts around the world. Taking a leading role globally will strengthen and reinforce APA’s position as the base for the highest quality, most effective treatment in the United States and give us a stronger voice worldwide.

We will also benefit from studying the best practices of our colleagues around the globe. For example, many countries in Africa have only a few practicing psychiatrists. What can we learn from how they provide mental health services to their population, and how might those lessons apply to the psychiatric workforce shortage we face here in the United States?

I was recently in Jamaica for the third annual Global Mental Health Conference and was struck by the fact that they have reduced the number of psychiatric beds available without seeing an increase in people with mental illness in prisons and jails. That is a challenge we struggle with here in the U.S. Different cultural framework and resource allocation systems to be sure, but the critical difference in Jamaica seems to be how they develop and provide community-based services for this population, perhaps another lesson for us in the United States.

We cannot be a leading voice for mental health in isolation. Building connections globally will be critical throughout my term, with attention given to those countries from which many current immigrant populations came. Learning what works in their countries of origin will be extremely helpful in planning for the services many will need here in the U.S.

Lastly, my term as President will explore issues that are often described as “social” issues that continue to affect the mental health of many Americans—and how organized psychiatry can and should respond to these issues.

Racism, sexism, ageism, and homophobia have been front and center in many events and conversations over the past few years. We’ve seen how these issues affect everyday lives through Black Lives Matter, the MeToo movement, the recent issues facing transgender Americans serving in our military, and more.

The evidence is clear that discrimination and many forms of harassment have a lifelong negative effect on mental health for all, but especially people of color, women, gays and lesbians, immigrants and others.

Since its founding, the APA has often delved into issues of diversity and inclusion, but even we may have stopped short of what we can and should do.

We know the psychological impact of all these “isms” on the people we serve. But how are we at the APA dealing with social issues that arise and affect our members who provide those services?

The APA has a long history of acknowledging the challenges presented by our nation’s diversity. Let’s take the example of racism. We can go all the way back to 1844, when one of the APA’s founders, Dr. Francis Stribling, insisted there be a Committee on Asylums for Colored Persons, which assured segregation of treatment by race.

In the 1950s, there is no publicly available evidence that APA filed an amicus brief in the Brown v. Board of Education case, despite the urging of prominent APA members like Dr. Charles Prudhomme, elected APA Vice President in the 70s, the first black elected to office in the APA.

By declining to engage in this “social” issue, the APA missed an opportunity to make a statement about the negative psychological effects of racism, now scientifically proven to be more than a “social” issue.

In the 1960s, as the Civil Rights Movement grew, the APA continued to grapple with issues of race. A group of black psychiatrists led by Dr. Chester Pierce came to a meeting of the APA Board of Trustees in May 1969, presenting a list of 10 demands to the organization. The New York Times reported that black psychiatrists demanded the APA acknowledge racism as a mental health problem, deny membership to psychiatrists who practiced racial discrimination, and work to desegregate all public and private mental health facilities in the United States.

And while a few demands were not met, the act signaled a shift in how the APA worked with its diverse membership and opened the door for those members to have a stronger and more visible voice in the organization. But more importantly, this shift also moved the needle on how we deal with the growing diversity in our patient population. At the end of the day, it’s about the patients and the care they receive.

We are the American Psychiatric Association, and our mission is to promote the highest quality care for all individuals with mental illness.

In order for the APA to be successful in the future, we must serve as a role model for how we might use our unique skills in understanding how organizations can deal with cultural differences, behaviors, and needed changes in the rest of medicine and the nation. To do that, however, we must overcome this gap between the people we serve and our words and actions as an organization.

I know we will not resolve these issues in a year, but maybe we can find our north star to guide us toward a more inclusive and accepting culture of medicine.

Our country and our profession have changed tremendously since 1844. A quick look around this room shows how psychiatry is becoming more diverse, more inclusive, and more innovative.

As your next President, I want to see the APA take a leading role on issues of diversity and inclusion, use of innovation and technology led by some of our younger members, and become more engaged in keeping a focus on improving practice conditions and continually improving the quality of care provided.

So, in closing, thank you for putting your trust in me to lead the APA over the next year. I know that we can advance our organization and profession and create a future of which we will all be proud.

I look forward to working with you all and seeing where we guide psychiatry, both in this year and the years to follow.

Thank you.