Join Me in My ‘Roadmap’ for APA’s Future

The joy of being together in person at the New Orleans Annual Meeting in May kicked off my year as president by reinforcing the gifts of connection, community, and our profession and their relevance to my presidential theme of “A Roadmap for the Future.” As we find ourselves now faced with a twin mental health pandemic, how can we apply these gifts to the challenge at hand—ensuring that every American has access to effective, high-quality mental health care?

As you may have heard or read in the report on my speech, to do this work we must focus internally on supporting psychiatrists, developing our workforce, and fighting structural stigma that reimburses psychiatrists less than our medical colleagues. These are the reciprocal responsibilities that we accept in recognition of the gift of profession and collegiality. We need to develop and advance policy and structure to advance our goals and fight systems and business practices that prioritize profits over patients, and we must advocate for the communities we serve. Finally, we will have to build critical connections for public engagement to advance health, including mental health. We must connect and stay connected. (Speaking of which, I encourage you to follow me on Twitter through the APA president’s official Twitter account at @Pres_APA.)

This month, on July 16, the new nationwide 988 mental health crisis number goes live (see 988 is Coming, But Most Localities Still Not Prepared). With 988, suicide prevention and mental health crisis response will be accessible by a three-digit number, just like the 911 number for medical emergencies that preceded it by half a century. The 988 line will patch into the existing federal national suicide prevention lifeline, which consists of over 200 crisis centers from coast to coast, though many calls are not answered locally. The existing hotline number (1-800-273-TALK [8255]) will also stay live, continuing to field the nearly 2.5 million calls it receives annually from Americans experiencing mental health crisis and suicidality. With rising suicide rates in the United States, record drug overdoses, and Americans increasingly concerned about mental health, any measure to reduce barriers to an emergency mental health response, particularly a simplified three-digit number, is welcomed. But the potential impact of 988 is even greater.

The 988 rollout has the potential to reduce the stigma associated with mental illness. In the current system, 911 responses all too often include dispatching law enforcement personnel to intervene in mental health crises, especially, but not limited to, those involving behavioral dysregulation. A law enforcement response reinforces an association between crime and mental illness—a false, stigmatizing, and damaging narrative that has played out in harmful ways from erecting barriers to care to false but often persuasive public narratives about mental illness as the etiology of acts of mass violence. APA has joined with other organizations in challenging this narrative especially in light of recent mass shootings. In addition, law enforcement involvement is more likely to result in inequitable rates of legal system entry for Black and other racialized and minoritized individuals compared with other Americans.

There is no question that safety is important and that we can provide training to law enforcement personnel to improve the efficacy and de-escalate mental health crisis interventions when they do respond. However, effective mental health crisis response requires more trained responders, community resources, and connections to care. 988 has the potential to go beyond connection to community with funding to support local mental health crisis response services and treatment and to integrate with the existing 911 emergency medical response system.

Imagining, designing, and envisioning this constellation of services from crisis to ongoing care along with the integration of medical and mental health care can set a roadmap for the future imbued with connection, community, and visionary psychiatric leadership.

Want to be part of the solution? We encourage you to learn more about 988 and what you can do to support 988 implementation in your community (again, see article on page 12 and especially its ending). Finally, thanks to those of you who have volunteered your ideas for the future of psychiatry. I encourage you to keep them coming at [email protected]. Until next month! ■