APA Must Lead the Way to End Stigma, Improve Care, Says Incoming APA President

Bruce Schwartz, M.D., who began his tenure as APA’s 146th president at the end of APA’s 2019 Annual Meeting in San Francisco, vowed during his Opening Session address to focus on three crucial areas: increasing access to care, improving quality of care, and continuing the fight against the stigma and discrimination attached to mental illness.

David Hathcox

“We are in the midst of two public health crises,” Schwartz said. “Over 70,000 Americans died in 2017 of opioid overdoses. Suicide, as a cause of mortality in the U.S., rose 17% between 2004 and 2014. It is now the second-leading cause of death for young adults. We are one of the only countries in the world with an increasing suicide rate.

“At the same time, 1 in 5 of us will suffer from mental illness or addiction at some point during our lifetime, and up to 27% of our children will have to deal with mental illness or addiction. I believe we have a moral and ethical obligation to do everything we can to facilitate the care of people who have significant mental health or substance use problems.”

Schwartz is a professor in the Department of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine and deputy chair and clinical director of psychiatry and behavioral sciences at Montefiore Medical Center, both in New York. Past APA President Steven Sharfstein, M.D., introduced Schwartz to meeting attendees at the Opening Session.

Citing a dire shortage of psychiatrists, Schwartz said the solutions need to be “systems based,” including use of telepsychiatry and collaboration with other health care professionals.

Improving access, however, will not make enough of a difference if the profession is not also committed to continually improving quality of care, Schwartz stressed.

“This is an opportunity for APA to lead the way,” he said. “While the medical boards set the standards for licensure and insurers set reimbursement rates, they shouldn’t be the ones determining what high-quality care really looks like. … It is our job as professionals to lead with thoughtfulness and with recommendations based on empirical evidence.”

Schwartz cited two APA initiatives as particularly important to this effort, both of which strategically integrate psychiatric expertise and technology. “The first, a three-year grant from the Centers for Medicare and Medicaid Services, will help to develop and test quality measures that are clinically relevant and capture the value of mental health treatments,” he said. “APA is working with our mental health registry, PsychPRO, to begin to test these quality measures, which will help reduce the burden of data collection and provide tools to measure clinical outcomes. This is important because measurement that is not burdensome can facilitate quality care.”

The second critical initiative, the Clinical Support System for Serious Mental Illness, is funded by a five-year grant from the Substance Abuse and Mental Health Services Administration. “This will help doctors and other health care providers treat patients with serious mental illness through consultation and education that can be accessed in real time,” Schwartz said.

Schwartz next addressed the persistent societal stigma around mental illness and resultant discrimination. “We see it when state medical boards ask about history of psychiatric disorders or when life insurance companies come looking for treatment records,” he said. “It’s frightening to think that seeking treatment for an illness might compromise your livelihood or insurability. This is prejudicial and discriminatory and must be stopped.”

He called for continued and enhanced monitoring of compliance with the federal mental health parity law. And he drew attention to the recent ruling in Wit v. United Behavioral Health by the U.S. District Court for the Northern District of California, which held that the country’s largest managed behavioral health care organization illegally denied coverage for mental and substance use disorders based on flawed medical necessity criteria.

Finally, he reminded attendees that success in these areas hinges on sufficient research funding. “NIH research funding for lung diseases exceeds the total research funding for schizophrenia, bipolar disorders, depression, autism, anxiety disorders, and suicide despite the death and disability associated with these mental illnesses,” he said. “Policymakers need to hear, ‘You are seriously underfunding mental health research, and our people are the worse for it.’”

In his closing, Schwartz predicted an eventful year ahead. “I know that APA will accomplish great things in this historic 175th year,” he said. “We’ll work together to collaborate with other health care professionals to build access, we’ll keep using technology in a way that helps us provide the highest quality of care for all patients, and we’ll continue to turn the tide on the stigma and discrimination against mental illness.” ■