APA’s Road Map, Psychiatry’s Future

Over the 171 years of the American Psychiatric Association’s life, a five-year forecast at any given moment could have run the gamut from uncertain to bright.

Today, it is not news that there are major changes occurring in all of medicine. So while we are well positioned, due to the strength of the science undergirding psychiatry and increased public attention to mental health, as we look toward the year 2020, the environment is changing. Now is the time to recommit ourselves to thinking strategically about the road ahead and to do so with the broad input of our membership.

Near the beginning of my presidency, I asked the Board for its support in launching a strategic-planning process. We had just completed the successful launch of DSM-5 and a planned CEO transition, and while much was changing in the environment, we were also not in crisis. Two things were clear: we were going to take on the next five years from a position of vigor, and we needed to have a north star, a direction in which to head. Our goal was to determine how best to meet the challenges and opportunities

ahead, internally and externally, and have a multiyear focus so as not to be overly buffeted by the crisis du jour or the changes in leadership that are inevitable in a membership organization.

As I write this column, the APA Work Group on Strategic Planning’s recommendations are being readied for review and action by the Board of Trustees, which is meeting as this issue goes to press. Upon Board action, the final plan will be shared with the entire membership, because it’s a plan that will belong to every member and more broadly to patients and families and our field.

Our strategic planning group was steadfastly committed to involving members in this process. In November 2014, we conducted the largest and most extensive all-member survey in APA’s recent history—one that drew over 2,200 responses. Not only did we have a robust response to a lengthy survey, but those who responded mirrored closely the makeup of APA as a whole, and many took the time to add extensive and passionate comments. And because APA’s road map has considerable influence over the destination of our entire profession, we surveyed nonmembers as well. It’s not a small point: we take our role as the voice of American psychiatry very seriously.

Here’s some of what we learned:

• Respondents clearly recognized a shift toward a transformed health care system.

• Importantly, they powerfully identified a need for psychiatry to find its place in this transformed system. A number of respondents said APA can and must do better in charting these waters. And APA must do a much better job of supporting our members through this complex transition.

• They told us we can’t go it alone: they very strongly believe that collaboration with other medical organizations is especially critical.

• With less intensity, they believe collaboration with mental health groups is also important, although not as central as our work in the house of medicine.

• They see a more diverse psychiatric workforce, in all its dimensions, in the future, as well as a more diverse patient population.

• They definitively recognized the importance of evidence-based care and its connection to quality of care. Many want APA to play an active role in developing quality measures and providing usable technological support for our work.

• They prioritized APA’s focus on advocacy, communication, and education.

• They believe that APA needs to go “where the patients are,” engaging them in the fight for mental health parity, for example. They see psychiatrists focusing on more complex cases in the future. Younger members especially hold this view. Many respondents said that APA must help in this transition, whether or not particular members choose to change practice settings.

Psychiatrists across the spectra of age, practice setting, geography, and subspecialty gave their time and thoughts to help guide the work group’s important decisions. Armed with this input, the work group came to consensus that there are four major areas of focus for APA: advancing the integration of psychiatry in a transformed health care system, research, education, and diversity. And cross-cutting and essential to these efforts are advocacy and communications.

In advocacy, the work group’s recommended strategic plan underscored the importance of integrating psychiatry in the evolving health care delivery system, advocacy for the central role of psychiatry in all care settings, and parity implementation and enforcement. As the environment changes and new technologies emerge, APA needs to assist members in those transitions.

In the research arena, the work group recommended that APA advocate for enhanced funding to achieve the fundamental understandings of psychiatric illness that will transform clinical care and reduce the burden of mental illness for our patients and society. Quality measures will help, as will best practices and expertise in APA on what the practice of psychiatry really looks like across the United States.

Education has two components: one is supporting lifelong learning—from medical school and residency training throughout our members’ careers; the other is educating patients, families, the public, and other practitioners about mental disorders and evidence-based treatment options. None of this can happen without advocacy for residency training and building the psychiatric workforce.

Finally, with respect to diversity, the work group advocated for APA to support and increase diversity throughout the Association, while also helping members care for diverse and underserved patient populations. Working to end disparities in mental health care is a crucial component of this work.

The work group was acutely aware that we cannot achieve these ends on our own and that we need to be mindful of changes in our environment. It also made the strategic plan flexible: “APA is a learning organization, and we are prepared to update our structure and governance to meet the needs of our profession, members, and society in a changing environment,” it wrote.

I want to thank several people, especially work group members, who volunteered generously over the past year to bring this plan to life: APA President-elect Renȳe Binder, M.D., Assembly Speaker Jenny Boyer, M.D., Ph.D., J.D., CEO and Medical Director Saul Levin, M.D., M.P.A., Speaker-elect Glenn Martin, M.D., Immediate Past President Jeffrey Lieberman, M.D., Past President Alan Schatzberg, M.D., Altha Stewart, M.D., Treasurer Frank Brown, M.D., Secretary Maria Oquendo, M.D., and Steven Starks, M.D. The APA staff was invested heavily in this effort and we would not have achieved our ends without their efforts. Lastly, our partner in facilitating this effort was the Center for Applied Research (CFAR) team: Barry Dornfeld, Tom Gilmore, and McWelling Todman.

The Strategic Planning Work Group contributed much thought and effort to arrive at its recommendations. It is now up to the Board to complete this work and put it into action. We are in a moment of high change in our health care system and great opportunity in science. We have a long history of being the trusted voice for our patients, their families, and our field. I believe this work will help us ensure a bright future for APA and for psychiatry, and in turn for our members and patients. We owe them no less. ■