FIG1 Professor/Director of
Public Psychiatry, University of Massachusetts
APA Assembly: Area 1 Representative, 2002-; Deputy Representative,
Distinguished Fellow (Member Since 1976)
Massachusetts Psychiatric Society: Representative, 1993-2001; Lead
Psychiatric Services: Editorial Board, 1992-2000; Column Editor,
1994-; Book Review Editor, 1995-
Officer, Center for Mental Health Services National Advisory Committee,
APA Van Ameringen Award for Psychosocial Rehabilitation, 2003
An Area trustee (AT) has to represent her/his area at APA and APA in
his/her Area. To do this effectively, an AT needs to work to enable APA to
meet the needs of both patients and its members while ensuring that APA is
representational, responsive, respectful, and respected.
The challenges that face North American psychiatry are myriad.
Access. Individuals who are in(patients) can't get out, and persons
who are out(patients) can't get in. This is a function of both inadequate
funds and misapplied resources. The system is awful for adults and abysmal for
children and adolescents.
Recovery. The current focus of services for persons with serious
mental illnesses is recovery. Despite APA issuing the position statement"
Use of the Concept of Recovery" in mid-2005, psychiatrists remain
too far from this endeavor. We are at risk of being marginalized beyond
Equality. The quest for parity has made gains in the states but
languishes at the federal level. Stigma continues to plague those with mental
illness and those who treat them. We fail to fund treatment for
psychiatric disorders in any way proportionate to the burden of disease they
Autonomy. Psychiatrists are being strangled by encroachments on
freedom to practice. Managed care is managed practices. Decision making is too
far from direct patient encounters. Psychiatrists are being blasted by
encroachment on their scope of practice from those who want to practice all
manner of psychiatric treatment, from psychologists to most recently
What can you and I as AT do to help APA address this?
Openness. Work to have APA extend its efforts to be open to its
members: open in its advocacy, open to provide meaningful benefits to members,
open to psychiatrists in all practice settings, and open in an activist
New and now. Continue to think outside the box—to push APA to
think in new ways and to do so now. We, the APA membership, are an eclectic
group but we cannot allow our diversity to become the engine that drives
immobility. Et l'APA doit maintenant se souvenir que son membership ne
provient pas seulement des États-Unis et sa nouvelle pensée doit
ainsi inclure ses membres canadiens.
Economics. Work to overcome the economic uncertainties of our
patients and our members. Hurdles are everywhere: Medicare's new
conundrum—Part D—affecting those dually eligible (Medicaid and
Medicare); threatened cuts in insurance-covered antipsychotic medications in
response to the first reading of the CATIE study; and falling
reimbursement rates that lead to bankrupting private hospitals, general
hospital psychiatry programs, and child/adolescent services systemwide. To be
an effective agent in addressing these, APA must keep its own economic house
in order. Recent efforts are promising; renewable vigilance is the order of
Beyond enthusiasm, practicality, and advocacy, one attribute I would
proudly bring to the AT position is that I have many friends in"
low" places. It is they and their peers who can inform our work
and to whom we owe a great duty.
As professor and director of public sector psychiatry, I am full time at
the University of Massachusetts Medical School, where I do administration,
teaching, supervision, patient care, and research: 75% of income. On my own
time I do state and agency consultation and other forensic work: 25% of