Claiming APA and Psychiatry’s Role in the Future of Mental Health

As my presidential term begins to wind down, I am delighted to share the culmination of the work of my Presidential Workgroup on a Roadmap for the Future of Psychiatry. The workgroup presented its report to the Board of Trustees at its March meeting, and the Board approved it for implementation. I am indebted to Bob Trestman, Ph.D., M.D., for his visionary leadership, strategic conceptualization, and tireless efforts to bring this initiative forward in less than nine months and to the APA administration and Board for their enthusiasm and support in rolling up our sleeves on behalf of APA and our profession.

Representing roughly 6% of the mental health workforce in the United States, psychiatrists are in the minority, yet we bring essential knowledge, skills, and training to mental health teams and institutions, in addition to the care we provide to individual patients. Beginning in May 2022, the workgroup, under Dr. Trestman’s leadership, brainstormed critical elements to populate a landscape of possibility around the ways that psychiatrists can most effectively deliver both individual and systems-based care. This work evolved into an iterative partnership between the workgroup and the Board.

Starting at its July 2022 meeting, the Board began a series of learning and visioning sessions to frame and imagine what a strategic roadmap for the future might encompass. The work kicked off with background stage-setting presentations prepared by APA Chief of Policy, Programs, and Partnerships Kristin Kroeger and Senior Manager Agathe Farrage. This was followed by APA Ethics Committee Chair Charles Dike, M.D., M.P.H., who inspired and challenged members of the Board to consider psychiatrists’ ethical responsibilities in advancing access and equity for all psychiatric patients.

Against this backdrop, Dr. Trestman framed two questions for the Board as the driver of the workgroup’s task ahead: What should the practice of psychiatry look like in the future, and what should APA do to support that future?

Through interactive and team-building sessions, the Board began to envision the critical elements of a plan. This work continued in a special learning session of the Board at its October meeting with Board guest Robert Phillips, M.D., M.S.P.H., the executive director of the Center for Professionalism and Value in Health Care of the American Board of Family Medicine. He shared expertise and insight learned from registry-based data sets and physician practice on the importance of outcomes data and on work done to reduce low-value practice.

Dr. Trestman also updated the Board in October and December on the workgroup’s progress and engaged the Board to provide input on critical decision steps as the workgroup developed iterative versions of its recommendations. The roadmap’s journey culminated at the March meeting a few weeks ago, when the Board accepted the workgroup’s report and voted to direct the APA administration to develop implementation plans.

Why all this background and lead up to the ultimate plan? The work to the finish line itself required collaboration, data, learning teams, and innovation—all hallmarks of the Roadmap for the Future of Psychiatry. The ambitious six-part plan adopted by the Board sets actionable goals for APA in both the short term and the next decade to lead as the thought, evidence-based knowledge, and practice leader in quality diagnosis and treatment of mental disorders. It also positions APA as the leading voice in advocating for quality patient care.

The workgroup divided the roadmap into six categories: the future of DSM and diagnosis, clinical practice guidelines, the PsychPRO Registry, quality measures and standards of care, education, and policy development and advocacy. The first five areas will support APA’s policy and advocacy work.

First, the recommendations specifically draw on APA’s strengths in DSM with an eye toward expanding the evidence base of diagnosis as well as innovation to expand point-of-care access and applicability. Second, expanding clinical practice guidelines will both improve quality of care and address scope of practice and safe prescribing by giving primary care clinicians, nurse practitioners, and physician assistants the tools they need to deliver care, while also setting forth clear indicators for psychiatric referral. Quality metrics and data collection through the PsychPRO registry will further inform practice into the future and lead to new initiatives for care delivery and modeling. Finally, innovation and education for future practice and leadership round out the pillars of the foundation on which APA’s advocacy and policy stand. Without a doubt, this bold leadership from the workgroup and Board will shape the future of psychiatry for the next generation.

Next month, I bring you my final column as president as we look forward to seeing each other at the Annual Meeting in San Francisco. Until then, please keep in touch, as always, and follow me on Twitter @Pres_APA.” ■