Steven S. Sharfstein, M.D.
Distinguished Fellow (Member Since 1972)
Our mental health system is "in shambles," "broken," and "a national disgrace." How many times have you seen a study or editorial that starts or ends with these observations about our mental health system? As psychiatrists, we have watched the crisis develop from the front row over the last decade. We have seen patients who could not get the care they desperately need, clinicians struggling with managed care to get basic support from insurers to heal the sick, and government programs so starved for funds that any promise of effectiveness is lost.
Today there is widespread recognition of the system’s failures. The real challenge, however, is what to do from here. How do we, in organized psychiatry, structure and prioritize reform and lead the way to meaningful change? I believe our profession must come together in support of a basic principle: To change and reform the mental health system, we must start with access to quality psychiatric care for our patients.
This principle provides a way to understand and evaluate various proposals for reform. For example, some view parity as the answer to the mental health care system’s problems. Parity is essential; however, parity alone will not improve access as long as psychiatric care remains subjected to unfair and disproportionate utilization review and harassing business practices.
Some states have sought to look to nonphysicians to expand access to care. But psychiatry remains a medical specialty and as such has only become demonstrably more effective and complex over the last decade. When states draw patients to caregivers without the medical training of psychiatrists, quality suffers, and there is no real benefit.
The President’s New Freedom Commission report emphasizes the social needs of the mentally ill. However, a social investment in housing, job assistance, and other support will be wasted unless patients have access to quality psychiatric care that will help them succeed in the community.
As a voice for the profession, APA must stand up for access to quality psychiatric care at every opportunity. We can play a critical role in three ways:
1. Bring the profession together. APA brings together private practitioners, academicians, public and private psychiatrists, hospital-based clinicians and community psychiatrists, the various subspecialties—all sharing the commitment to quality psychiatric care. A strong, united Association is essential.
2. Form coalitions that matter. We must strengthen our ties with patient and family advocates, primary care physicians, and allied nonmedical professional groups. We must join together creatively to have maximum impact.
3. Challenge psychiatrists to action. Advocacy begins with you, working in state and local district branches, participating in the political marketplace with energy and vigor.
My experience over 30 years as a clinician, government official, academician, and administrator uniquely qualifies me to lead APA at this critical time. As an APA leader, I waste no time in bringing all the profession’s power to bear on policy development. I can also draw upon longstanding relationships with patient advocates and leaders in medicine and allied professions to join forces to achieve our goals. My work on the economics of psychiatric care and in government opens doors to top national policymakers. As president of Sheppard Pratt, I have toiled in the trenches for almost two decades in developing a community care system that works for patients, their families, and psychiatrists in Maryland.
I have devoted much of my professional life to APA. I have been APA vice president and secretary, chaired numerous committees and task forces, and served as deputy medical director in the mid-1980s. Last year, I chaired the Task Force for a Vision for the Mental Health System, which served as a blueprint for our dialogue with the President’s New Freedom Commission.
In short, I will hit the ground running, with your input and counsel. I ask for your vote and support.
80%—Leadership (administrative)—Sheppard Pratt Health System
10%—Teaching—Sheppard Pratt Health System
10%—Clinical care—Sheppard Pratt Health System
100%—Sheppard Pratt Health System