Candidate for Area 1 Trustee

Full-Time Private Practice, 1986- ; University Health Network, Toronto General Hospital, Associate Staff, 1986-

Assistant Professor of Psychiatry, University of Toronto, 1974-

Ontario District Branch: Deputy Representative, 1981-85; Representative, 1985-88, 2001- ; Legislative Representative, 1988-

Member, APA Nominating Committee, 1993-94

International Advisor to DSM-IV, 1990-93

Ontario Medical Association, Section on Psychiatry: Member, 1984-90; Chair, 1986-88

Deprofessionalization

Burgeoning demands for mental health care in America coupled with the helping attitudes and openness of the professional psychiatric community have led to the downloading and outright transfer of many aspects of diagnosis, treatment, and rehabilitation to nonphysicians. Social workers, psychologists, mental health care workers, HMOs, and drug companies not only have stepped into the breach but also have demanded greater scopes of practice for themselves. Yet, psychiatrists are left with the burden of legal and ethical accountability for the care of patients. Psychiatrists need to show effectively how our skills, training, and experience qualify us for the authority to make clinical decisions so that we can continue to accept the professional accountability expected of us. I regard this as a major task for the years ahead.

Fragmentation

One response to the loss of professional status and the invasion of “competitors” into our field has been to take refuge in practice niches that seem to allow us to retain a sense of authority in order to cope with our considerable burden of accountability. This has led to an estrangement between practitioners who discover themselves split into factions: town and gown, researcher and clinician, inpatient and outpatient psychiatrists, doctors of the brain and doctors of the mind, managers and the managed. APA has suffered losses because of this divisiveness. We need to rejoin one another and learn to value our collective contributions to patient care.

Demoralization

Psychiatry and its major organizations continue to struggle with the ethical dilemmas resulting from the restrictive and inadequate treatment options created by profit-driven managed “care.” As a consequence, we are becoming transformed from professionals into workers with accountabilities that no similar group faces! Other professions challenge psychiatry’s basic entitlement to treat both body and mind. As a result, our members are often discouraged, professionally disenfranchised, and unsupported, leading to increased stress and demoralization. APA needs to provide leadership and support in these areas in order to regain the trust and allegiance of its members.