Brendel Charts A ‘Roadmap for the Future’

Public engagement, professional encouragement, and policies that enhance the care of patients—those are the landmarks of the “roadmap for the future” that incoming APA President Rebecca Brendel, M.D., J.D., invited psychiatrists to help chart during her address at the Opening Session of APA’s 2022 Annual Meeting in New Orleans. Speaking at the first in-person meeting in three years, Brendel said psychiatrists face enormous challenges in the wake of the global catastrophe of the COVID-19 pandemic, and she called for a moment of silence during her remarks to remember the millions of lives lost.

“Now, as we emerge from pandemic to endemic, let us take a moment to recognize the devastating loss that COVID-19 has left in its wake: more than one million lives lost in the United States alone, and more than six and a quarter million documented lives lost globally, a number that most certainly underestimates COVID-19–related fatalities.” Introducing her theme for the coming year, “A Roadmap for the Future,” Brendel said the pandemic has left in its wake a vast mental health crisis—its own pandemic—while revealing stark inequities in medical and psychiatric care. “Some of the psychiatric consequences of COVID were to be anticipated based on the historical emergence of neuropsychiatric sequelae following widespread outbreaks of viral illness,” she said. “Others, such as the racial disparities in our society laid bare by the pandemic, are but one stark example of health inequity in the U.S. and the necessary and painful journey ahead of us to achieve health equity and racial justice. …

“The challenges before us—as citizens and as psychiatrists—are daunting,” she said. “Suicide deaths increased in 2021; we lost more than 100,000 Americans to opiate overdose in 2021; and our youth in particular are reporting unprecedented levels of anxiety, depression, and psychological distress.”

However, she pointed out, when Americans seek mental health care, they often can’t access it at all or in a timely fashion, and parity remains an elusive goal. Meanwhile, psychiatrists are struggling to practice within a health care system characterized by low reimbursements and administrative burdens. There are far too few psychiatrists to meet the demand, and physicians are reporting high rates of burnout, while the next generation of doctors is facing staggering amounts of debt, she said. In addition, the psychiatric workforce lacks the diversity to provide high-quality, evidence-based care to an increasingly diverse population.

“We cannot and must not just stand by or, worse, retreat in the face of these substantial challenges to our profession and those we serve. Instead, faced with these current challenges before us—and those of which we are not yet aware—we must seize existing and create new opportunities to advance psychiatry and mental health care. There is no doubt that this path ahead will be hard work requiring bold ideas and interventions. Yet we must embrace this time of challenge and need as a once-in-a-lifetime opportunity for psychiatry and our APA to lead in ensuring that mental health, once and for all, permanently establishes its place as an integral part of overall health on par with all other medical care.”

Brendel said the “roadmap for the future” will build on the work of APA presidents who preceded her and will emphasize three broad areas: public-facing activities, activities that support and promote psychiatrists and the profession of psychiatry, and policy initiatives.

“APA’s public engagement is critical at this time when Americans are experiencing heightened mental health symptoms and when mental health and wellness have prominence on the national agenda from the White House and the Capitol to state capitals and local government,” she said. “We owe it to ourselves, and to the patients we serve, to ensure that APA and psychiatry are not just a part of the conversation, but drivers of information and treatment of mental health and substance use disorders.”

To that end, she noted that this past year APA launched a culturally competent Spanish-language outreach initiative, instituted public opinion polling, increased social media engagement, and fostered innovation through the publicly available SMI Adviser App. “Psychiatry must continue to change the conversation around mental health to reduce stigma, encourage treatment, and save lives. We must clearly define our roles as medical doctors with unique and extensive knowledge, training, skills, and professional responsibilities to patients as we join in implementing and publicizing the availability of the new, national, mental health crisis hotline number 988, which goes live this July 16.”

The current shortage of psychiatrists will only get worse if action is not taken, Brendel said. “We must end the structural stigma of lower reimbursements for psychiatrists for the same services rendered and codes billed by other physicians. We must continue to advocate for patient safety by opposing expansion of prescribing and independent practice to mental health colleagues without medical knowledge, training, and experience, and we must continue to fight discriminatory administrative burdens for mental health care that simply do not exist for medical care.”

Psychiatrists must be vocal advocates for the laws, regulations, and business and social structures that advance mental health and sound medical practice, she said. “We must fight against racism, discrimination, and hate as toxic to health, psychological well-being, and humanity itself, and we must continue to fight government intrusion in medical care—most recently reproductive care—that belongs solely within the province of the physician-patient relationship,” Brendel said.

“Perhaps charting and implementing this ‘roadmap for the future’ seems too lofty for a one-year term for an APA president,” she said in conclusion. “But we have no choice. There is no greater opportunity to lead and to succeed than in this time of unprecedented need for mental health care and resources. We will have to work hard, we will have to focus, and we will have to be innovative and creative. But there is no more urgent time to rise to the challenge than now. Together, we will succeed.” ■