PRESIDENTIAL ADDRESS : PSYCHIATRY IN TRANSITION

1. Work actively for the adoption of the major recommendations of the Joint Commission on Mental Illness and Health in your state and at the federal level. It offers to psychiatry the greatest opportunity that will be given in this decade to advance research, training and treatment.

2. Social change is often dependent upon political action. The American Psychiatric Association has an obligation to express itself vigorously in support of social issues with relevance to medicine. We must oppose discrimination against the mentally ill in any local, state or federal legislation.

3. The time is at hand to rethink the national and international responsibilities of the association. To sharpen discussion, I have advocated that the Canadian members be given an opportunity, if they want it, to express their primary allegiance to the Canadian Psychiatric Association. The American Psychiatric Association would then become a national society for United States psychiatrists. If this proposal becomes a reality, I would urge an enlarged function for the Committee on International Relations with active permanent sub-committees in liaison with the Canadian Psychiatric Association and with the psychiatric societies in Central and South America. I would strengthen participation in world affairs through the World Psychiatric Organization and in Pan-American cooperation. As a national society, interested in common problems, the separateness and the nationalism of countries would remain in focus.

4. Psychiatry is in transition. I would encourage movement toward closer relationship with the traditions and practice of medicine. We must first be good physicians. The pursuit of excellence in our specialty of psychiatry is our second major goal. To be worthy of the name of "Psychiatrist" the specialist must be broadly prepared to meet the major problems in his field. In this decade our psychiatric institutions should press toward the acceptable standards of quality practice. We can no longer in conscience excuse second class medicine in public mental hospitals for any cause.

5. The American Psychiatric Association expresses in its constitution the obligation to improve the treatment of patients. In this decade the physiological, psychological and social problems of aging compel our attention. Already the dominant mental health problem in the United States is old age. From the known facts, we can make assumptions that may lead in turn to formulated objectives. The challenge to psychiatry of un-met needs illuminates some of the major issues presented.

a. Social issues have relevance to medicine. The way one practices and one's ability to achieve a standard of excellence may be determined by legislation. No plan for health care or for public assistance should discriminate against the elderly who are mentally ill. Both Kerr-Mills and the King-Anderson legislation do discriminate against the elderly patients with psychiatric illness.

b. Those over 65 years of age require service for medical disorders from the same agencies, in the same clinics and hospitals that treat younger patients. The diagnosis, evaluation, and treatment of the elderly must be a part of the training of all physicians. No resident in psychiatry can be considered properly trained for the practice of his specialty if he has a blind spot for the management of about a third of all hospitalized mentally ill patients.

c. The public mental hospital has a positive contribution to make to the treatment of the elderly patient. The stereotype of the confused oldster with memory impairment is the exception, not the rule. "Dumping" the aged into mental hospitals actually seldom occurs. The majority of the patients admitted at 65 or over need a period of hospital care, for they have exhausted families and require more specialized medical and psychiatric management than agencies, general hospitals and nursing homes are able to provide. A third of elderly patients admitted are returned to the community. With improved initial management, progressive care and rehabilitation, more may survive and recover sufficiently to leave the hospital and return home.

d. Training in administration has been neglected in psychiatry. The planning of comprehensive programs, of new programs based on new concepts of psychiatric illness, and the translation of paper plans into effective action programs require able administrators. We must initiate the action to seek out creative and imaginative individuals with a potential for leadership and train them properly.