Focus on Recovery, Collaborative Care Among Institute’s Highlights

I am excited about this year’s Institute on Psychiatric Services (IPS), to be held October 4 to 7 in New York City. The IPS is APA’s leading educational conference on clinical issues and community mental health for people with severe and persistent mental illnesses.

The IPS has a long history. After World War II, improving hospital services became an urgent issue, as numerous mental health institutions suffered from neglect, paucity of funds, and lack of qualified staff. In 1948 APA established a central office in Washington, D.C., and appointed a full-time medical director. It was decided that the first priority of this new office would be to address the crisis in the country’s mental hospitals. In 1949 APA launched the Mental Hospital Institute to emphasize its interest in hospital systems.

“The Mental Hospital Institute takes mental hospital doctors out of the category of forgotten men and places them back where they belong as the first priority of the American Psychiatric Association,” said Winfred Overholser, M.D., then APA president, at the closing session of the first institute. This first institute was a huge success, and went on to become an annual event.

As the field of psychiatry progressed over the next 60 years, the institute continued to evolve. The scope of topics covered at the meetings expanded and came to include the full array of clinical innovations and services provided by psychiatry. Reflecting the community mental health center movement in the 1960s, the institute’s name was changed in 1969 to the Institute on Hospital and Community Psychiatry. With further broadening of its focus, the institute later became the IPS. Each year, the IPS provides a superb educational experience to attendees, with the ultimate goal of serving our patients better. The IPS draws a cross-section of mental health professionals. It is a true gem in APA’s educational offerings.

As APA president, I had the privilege of selecting the theme for this year’s IPS, in close collaboration with an outstanding IPS Scientific Program Committee, chaired by its dynamic leader, David Pollack, M.D., which has planned a marvelous conference. This year’s program, whose theme is “Pursuing Wellness Through Recovery and Integration,” summarizes the key issues and directions that will guide psychiatric practice in the coming years. Let me explain how this theme reflects what is current and essential for psychiatry. Psychiatry will more often be looking beyond diseases and their symptoms. Our focus will shift toward promoting mental health and facilitating a healthy lifestyle across the lifespan. With a more holistic, multidimensional approach and closer collaboration with other specialties, we will be able to better serve those in need and create an environment supporting mental health in communities.

The construct of “wellness” mentioned in the theme captures the concepts of promoting health, not just health care. We are likely to achieve much better outcomes for our patients when we focus on improving the physical, emotional, social, and spiritual well-being of all the people we care for and through all stages of life. This includes the recognition that our health care system accounts for only 10 percent to 15 percent of the impact on overall health outcomes. As psychiatrists, we must pay attention to and lead the efforts to improve health via other health determinants, such as lifestyle, diet, exercise, and social connectedness, as well as the genetic, socioeconomic, environmental, and political factors that impact a community’s health.

“Recovery” emphasizes the growing and powerful movement to recognize and honor the strengths, needs, and preferences of our patients. This can be done by understanding and implementing methods of connecting with patients and their families and by providing clinical services that promote autonomy and self-determination, maximize hope, and balance our clinical judgment with the patient’s own understanding and wishes for how treatment should proceed.

Finally, “integration” refers to the evergrowing emphasis on linking psychiatric practice with the rest of health care, most notably with our primary care colleagues and settings. With the advent and rapid expansion of patient-centered primary care homes (also called primary medical homes), there is broad agreement that the integration of behavioral health is the most essential ingredient in addressing the complex needs of many of the patients seen in primary care settings. The roles for psychiatrists in these integrated programs, especially as consultants to primary care teams and mental health providers within those teams, must be clearly articulated, promoted, and compensated. Our training programs need to adapt to this newer area of ambulatory consultation to prepare future psychiatrists to be adept in this collaborative form of practice. Conversely, we must pay attention to the general medical needs of our patients, who have more serious mental illnesses and plan for how to integrate primary care services into community-based specialty programs focusing on behavioral health. There may even be some basic preventive and clinical primary care services that psychiatrists can provide for their patients in these settings.

In addition to emphasizing recovery and integrated care, the IPS will feature sessions on topics such as the use of buprenorphine to treat people with opioid dependence; working with homeless individuals in clinical settings; finding employment in the psychiatric field; improving primary care providers’ understanding of psychopharmacology; the practice of emergency, geriatric, and culturally sensitive psychiatry; strengthening the relationship between mental health and primary care providers; recovery-oriented psychopharmacology; and other key policy issues in mental health care. I congratulate the IPS Scientific Program Committee for its success in developing a comprehensive program that addresses these varied issues. I particularly wish to thank members of the American Association of Community Psychiatrists for their ongoing commitment to making the IPS a highly regarded and popular conference.

I hope to see you all at the IPS in October in the city that never sleeps.