An invisible tragedy—that's how APA President Nada Stotland, M.D.,
portrayed the human experience of uninsurance and underinsurance at the
Opening Session of APA's Institute on Psychiatric Services last month in
"Most of the people who need care and don't get it shuffle
through," she said in a speech in which she reiterated her determination
to help APA members educate themselves about alternatives for health system
reform that are likely to be considered under a new presidential
"Some of [those who don't get needed mental health care] commit
homicide or suicide, and some of them become homeless, and far too many of
them wind up in jails or prisons," Stotland said. "But many of
them shuffle through, leaving scars on themselves, on their friends and
families, and on their workplace."
APA President Nada Stotland, M.D., opens last month's Institute on
Psychiatric Services with the traditional ringing of the bell. Stotland said
compromise would be inevitable for APA to come to a consensus about how the
profession should advocate for health system reform.
Credit: Ellen Dallager
She related a conversation with a Wall Street Journal reporter who
asked where patients go if they cannot afford their care. "I told her,
'It's hard for me to say these words, but often there is nowhere to get
"So we never see the patient," she said. "I believe when
most of us as mental health professionals have a patient who comes upon an
economic hard patch, we see them over it. We reduce their fees or whatever we
have to do. But what about the millions of people who never come in the first
place? Most people are not only not looking for a handout, they are mortified
at the idea that they are getting something for free.
"Many of our patients give some other excuse, because they don't want
to say they can't afford it, and they just go away," Stotland said."
So I'm concerned that so much of this crisis is invisible."
Stotland has emphasized that she wants to provide venues at which APA
members can learn about options for health system reform. "We spend more
on health care per capita than any other country in the entire world, and we
are way down the list in terms of the health we get for it," she said."
What are we doing wrong?"
At a session at last month's meeting, past APA President Steven Sharfstein,
M.D., argued for a national, single-payer health insurance system in which he
was countered by John Kay, J.D., the AMA Board of Trustees' only nonphysician
member (see Single Payer or Individual Tax Credit: Which Reform Proposal Is
Best?). Kay, standing in for AMA President Ron Davis, M.D., who could not
attend because of illness, argued for the AMA's plan for health system reform.
This plan relies on tax credits to enable individuals to buy their own
Stotland said psychiatrists could not afford to argue forever about their
differences of opinion and maintained that compromise would be inevitable for
APA to come to a consensus about what kind of reform it would advocate.
"We don't have a system," she said of the existing hodgepodge
of public and private health care payers. "So anything is going to be an
improvement. Our choice is between trying to get a 100 percent buy-in from
everyone, or 70 percent buy-in from most people."
Speaking just one day before Congress approved the Paul Wellstone and Pete
Domenici Mental Health Parity and Addiction Equity Act of 2008, Stotland
hailed the achievement as "a step out of the dark ages" (see page
1; Psychiatric News, October 17).
She added, "Thanks to our advocacy, most Americans think that mental
illnesses are real and should be covered by insurance."
Stotland also said that conflict of interest throughout all of medicine
continues to be a matter of public concern. And she reiterated the efforts APA
had made as an organization over the years to deal with issues of conflict of
interest, as well as those made to respond to Sen. Charles Grassley (R-Iowa)
after his request to APA for information about pharmaceutical-industry
relations (Psychiatric News, August 15, September
"We have done nothing wrong," Stotland said. "We haven't
even been accused of anything." ▪