AMA’s Psychiatrist President Hails Involvement of APA

Psychiatry needs the AMA, and the AMA needs psychiatry.

That’s what AMA President and past APA Assembly Speaker Jeremy Lazarus, M.D., said at APA’s 2013 annual meeting in San Francisco. In separate addresses to the APA Assembly and APA Board and in a lecture, Lazarus discussed issues of common ground between APA and the AMA including, among others, enactment of the Affordable Care Act (ACA), the movement toward collaborative care, and the AMA’s strategic plan.

David Hathcox

The latter includes three goals: improving health outcomes for patients, enhancing physician satisfaction by shaping delivery and payment models, and accelerating the pace of change in medical education. Lazarus’s presidential term ends this month at the annual policymaking meeting of the AMA House of Delegates; Lazarus was only the third psychiatrist to be president of the AMA.

Passage of the ACA in 2010 depended on the crucial support of the AMA. “When the ACA was passed, we saw it as the only available response to gross inequity in access to quality health care, soaring medical costs, and a desire to better serve this country’s citizens,” Lazarus said. “The law was far from perfect, but it was best the vehicle available to reach some important goals. . . . Besides extending coverage to millions, it will promote care coordination, improve quality, and invest in prevention, all while reducing costs. Since then, the AMA has been working hard to make sure the ACA lives up to its promise.”

He added that the new law benefits treatment of mental illness. “Because of the ACA, in 2014, plans can’t exclude people with preexisting mental illness or substance use disorders,” he said. “Moreover, they can’t discriminate or drop coverage because the person has had a psychiatric illness. Clearly the end of lifetime and annual dollar limits helps those with chronic mental illness, as does the extension of coverage to those under 26, since many of these persistent long-term illnesses can emerge in the late teens and early 20s.”

Lazarus noted that when health insurance exchanges kick in next year, mental health and substance use must be part of the core benefits package, and the coverage for mental health must be at parity with other medical benefits. Meanwhile, Medicaid expansion in a number of states will help combat the high rate of unaddressed mental illness among lower-income individuals and communities, he said.

Collaborative Care Works

Collaborative, or integrated, care has also been a focus of Lazarus’s AMA presidential year. He said the ACA’s emphasis on care coordination and team-based care creates incentives for pediatricians and other primary care physicians to work closely with psychiatrists, in-home care professionals, and others to address patient needs from a holistic perspective.

“The AMA has advocated for this approach for many years, and it is particularly important for at-risk children and adolescents,” Lazarus said.

He said several states and communities have made progress linking or integrating the various components of care to improve connectivity and secure better outcomes for children by integrating residential and inpatient care with community-based care, family priorities into professional care plans, primary medical and mental health care, and children’s mental health services and school-based services.

For adults, he cited the Diamond Initiative, a Minnesota-based program that helps primary care clinics more effectively care for patients with depression.

By the beginning of 2012, more than 8,000 adult patients with major depression or dysthymia had participated in the Diamond program. Twelve-month remission and response rates for Diamond patients were 53 percent and 70 percent, respectively, he reported.

“Because the Diamond program has been so successful, plans are under way to expand this approach to treat other chronic and behavioral health conditions and to provide a foundation for the design of a health-care home,” Lazarus said.

Issues Gain Prominence

In recent years, the presence of psychiatry within the AMA House of Delegates has grown enormously—a fact of which Lazarus’s presidency is a reflection. “Right now, the AMA has 38 psychiatrists in our House of Delegates and nearly 8,500 psychiatrists among our total membership—that’s about 4 percent,” he said. “And having psychiatrists in the highest offices of the AMA is a sure sign of the enormous respect psychiatry has attained within medicine generally.

“I can tell you that our presence has been important in keeping the focus on mental health,” he said. “Improving the AMA’s involvement in mental health initiatives has been one of my goals over the past year, because we know that you can no more separate the heart from the mind of a person any more than you can separate the heart from the lungs and expect the person to still function.”

Lazarus concluded his remarks by saying that he believes there has been a shift in attitudes toward mental health and in funding for mental health care. He said this new attitude can be seen in the mandate for mental health coverage to be an essential benefit and in the growing focus on collaborative care; the expanded mental health coverage for Medicaid patients; the emphasis on community-based psychiatric services; and in increasing public, if not legislative, concern about violence and gun regulation.

“I am still not satisfied that all Americans who need mental health care will be able to receive it, but the country seems to be awakening to the great need that exists, and I believe we are beginning to take important steps forward,” he said. “It remains up to us to maintain our vigilance so it is woven into the fabric of 21st-century health care.” ■