2022 Annual Meeting: Presidential Address

Thank you, Altha, for your warm introduction and all of your support over the years. I remain truly inspired by your words and efforts in this field. You continually challenge us to be better, and I did my best to follow your example. And a special thank you to the APA membership for electing me to serve you as your President. I hope I have met your expectations. I can truly say that it has been an unforgettable year.

Also, I want to remind everyone that the APA Board of Trustees is composed of elected members who volunteer their time to oversee the direction of this organization in order to fulfill its mission. To them and the many other APA members who selflessly volunteer their time, energy, and expertise, in addition to their day-to-day professional work. I want to say that it has been a privilege to have worked with every one of you.

Moreover, I would like to acknowledge the administrative staff of the APA who truthfully do not receive the credit they deserve. We have over 200 employees at the APA who are responsible for the daily operations and functioning of the APA. Virtually every aspect of the APA that you come into contact with is produced by our staff, from the new APA website to our many publications, to this meeting, and everything in between. Despite the difficulties of the pandemic, the APA staff forged on, many going above and beyond. Without them this organization could not fulfill our shared mission of improving the lives of people living with mental illness.

And last but not least, I thank my entire family for supporting me through thick and thin this past year. I’m so glad they are here.

Over the years, I have been inspired by all those who volunteer their time and energy to psychiatry. It is a field with a strong ethos of working in the public interest. I originally ran for President with the belief that when we act together, we can effect change. When we advocate together with one voice, we can wield substantial influence for the greater good. This motivated me to propose the theme for this year’s work: the social determinants of mental health.

It’s been said that your ZIP code or the color of your skin has the potential to influence your general health. But it’s also clear that not enough attention is paid to how these factors influence your mental health, both negatively and positively. In light of these considerations, I appointed a Presidential Taskforce on Social Determinants of Mental Health. I asked them to pursue four areas—research and education, clinical practice, public health, and policy.

I did this because I feel strongly that psychiatry, as a profession, should resume its focus on prevention of the social, economic, and political factors that impact mental health outcomes. It may seem like these issues are outside our “traditional lanes,” but mental health does not occur in a vacuum, and our models of mental health should similarly not ignore evidence of factors that affect our patients—such as racism, violence, migration, neighborhood, and climate change. And how our patients’ ancestry, their traditions and culture that are transmitted from one generation to the next, influence their mental health. Our Native American reservations are an example of our past history that remains essentially hidden and neglected.

Then comes the question of how we can use this knowledge in our research, education, and practice. The bright inquisitive minds of the task force have developed models that integrate the insights of social determinants into how we treat and advocate for patients. We must ask our patients more about their lives. What does their average day look like? How they’re paying their bills. We must ask them more about violence—any kind of aggression, but particularly domestic violence, not just today, but also in their past. We know that often they won’t volunteer this information, so we must ask. If we are genuinely interested, they will trust us and share their lived experience.

So how can we achieve and maintain the needed momentum to effect positive change in this area? There are many possible approaches. The primary vehicle I prefer is advocacy. I believe we can, and must, work to prevent the social problems that cause mental health disorders, and to promote those factors that lead to positive outcomes. And we can do this through social policy, whether it has to do with the dismantling of structural racism, the eradication of human trafficking, the elimination of violence, and the neglect of children.

We can also be ambassadors, educating students, other clinicians, and other disciplines, about the importance of acknowledging the social determinants of mental health. Our current work can remain grounded in medicine, diagnoses, and procedures—no one is proposing that psychiatry abandon our medical precepts. But it is undeniable that understanding the social context in which our patients live has the potential to enhance care and their well-being. We have to extend ourselves to all stakeholders, local community groups, Black churches, reservation councils, law enforcement, schools, and so on, and not wait for them to come to our siloed offices.

The bottom line is that we are the experts on mental health and mental illness. Thus, we have a collective and individual duty to not stand by, but to act where we can help those who cannot help themselves. The world will listen to us if we are genuinely caring. And this effort will go far to eradicate the stigma that exists within psychiatry.

And so, it is most fitting that I thank the Presidential Task Force on Social Determinants of Mental Health for their incredible work. Dr. Dilip Jeste led this effort with energy, expertise, and grace. Their efforts educated us and raised our awareness of the impact that the social determinants can have upon our patients and their lives.

For a fuller exposition of the work of the task force, including a brilliant white paper, I invite you to attend their presentation on Monday at 10:30 a.m. I would also like to call to your attention to a reprise of the Mental Health Services Conference that was held last fall where two rising stars, Dr. Peter Blair, an economist, and our own Dr. Sarah Vinson, will engage on the socioeconomic and political factors that intersect with mental health. This will occur at a special plenary session on Monday at 8 a.m.

I will leave you with the idea that your voices—individually and collectively—are powerful and necessary in this conversation. Please continue to speak up, ask questions, and join in when circumstances call for it. We must not remain silent. Our combined efforts can change minds and perceptions, and hopefully will ultimately change lives for the better.

Thank you.