Borenstein Looks Back on Presidential-Year Achievements

APA has been working extremely hard for its members and patients this past year.

That was the message that outgoing APA President Daniel Borenstein, M.D., brought to the approximately 2,000 people at the Opening Session of APA’s 2001 annual meeting in New Orleans last month.

At a time when psychiatrists throughout the country are feeling pounded by managed care and other economic forces undermining access to care, they should know that, under Borenstein’s leadership, their Association has refocused or expanded many of its professional and patient advocacy activities to strengthen its position to carry out APA’s mission.

Perhaps the most important activity that APA undertook this past year was to transition from a 501(c)(3) nonprofit charitable organization to a 501(c)(6) nonprofit business organization. As president during the transfer of members from the old APA to the new, Borenstein noted that “the shift permits APA to provide more financial assistance to district branches and state associations [DBs and SAs] and to commit more of its resources to legislative and public-relations activities, including a new political action committee.”

The impact of this change has been felt already, said Borenstein. So far APA has provided $700,000 in revenue-sharing funds to DBs and SAs; also, $150,000 was made available to lower the dues of early career psychiatrists, and $20,000 was provided for amicus briefs in support of lawsuits in California and New York. Moreover, he said, in its first year, APA’s Commission on Public Policy, Litigation, and Advocacy evaluated numerous requests from DBs and SAs for assistance with issues important in their local areas. To date, the distribution of more than $300,000 has been approved for assistance with scope-of-practice issues.

“I am pleased to report that 32 states have enacted some form of parity legislation, that a proactive plan to deal with the efforts of psychologists to obtain prescribing privileges is well under way, and we have begun building a sizable fund to support advocacy and education,” said Borenstein.

Another important project was launched in the second half of 2000, the APA Business Relations Initiative, said Borenstein. It is through this program that APA is talking to business in the language it knows best—financial—with the message that providing mental health benefits to employees has a positive impact on the bottom line. Among the major companies with which APA has met to date are Union Pacific Railroad, Hughes Electronics, Delta Airlines, Pacific Business Group on Health, Constellation Energy, and GTE, which is now Verizon. Additional discussions occurred with representatives from Bank One, Sears, General Electric, American Airlines, AT&T, Dow Corning, Anheuser-Busch, Texaco, Conoco, and Pacific Gas and Electric. In June, he announced, APA is holding an invitational forum in partnership with the Carter Center for corporate health care decision makers.

Closer to home, APA is working hard to resolve remaining problems with its membership database and electronic communications system, said Borenstein. The new director of APA’s Information Systems, Mahamoud Jibrell, is working with members, DBs and SAs, and staff to respond to their computer and database needs. He announced that a plan for a comprehensive and integrated communications system will be presented at the June meeting of the Board of Trustees. In the meantime, he said, members have access to a new “Members Only” feature on APA’s Web site where they can access directories for members, staff, and components and update their membership information.

With research at the heart of psychiatry’s future in terms of the prevention, diagnosis, and treatment of mental illness, Borenstein was also pleased to announce that APA has received research grants totaling $3.6 million for 2001. One of the research projects under way is an evaluation of the costs and quality of psychiatric care in the Federal Employees Health Benefits Program, under which parity is mandated and care is managed. Another major project, he continued, is the start of work on DSM-V—a milestone edition because it is hoped to lead to a uniform diagnostic nomenclature on an international basis.

Among other initiatives that were undertaken under Borenstein’s tenure are these:

• A “leadership summit meeting” in which the leaders of the 14 allied groups in the APA Assembly participated. Similar meetings with representatives of minority and ethnic organizations are also planned.

• The appointment of APA’s first Committee on the Prevention of Psychiatric Disorders and the Promotion of Mental Health.

• Appointment of a committee charged with developing guidelines for APA’s interactions with the pharmaceutical industry.

APA’s Future

The profession of psychiatry must be a player on Capitol Hill and in state legislatures if psychiatric patients ultimately are going to gain the equanimity, compassion, protection, and fairness to which they are entitled. These are among the significant legislative areas in which Borenstein said that APA must be involved in the 107th Congress:

• Repeal of the discriminatory 50-percent copayment for outpatient psychotherapy in the Medicare program.

• Reconsideration of the discriminatory 190-day Medicare lifetime limit on inpatient treatment in a psychiatric hospital.

• A prescription drug benefit under Medicare.

• A patients’ bill of rights.

• Renewal and expansion of the Mental Health Parity Act.

At the same time that APA is pursuing all these vital tasks, however, it can’t lose sight of the very people who are the Association—its members, he said.

“The American Marketing Association reports that ‘65% of business comes from existing, satisfied customers and that customer acquisition costs six times the amount of customer retention.’ The same principles apply to organizations whose existence depends upon maintaining a satisfied membership. We must redouble our efforts to provide our members with what they need and to give them the service they deserve.”

Psychiatry’s future is bright, Borenstein concluded.

“Your American Psychiatric Association is here to represent your interests in research, education, and clinical advances, which together safeguard our work with patients in need. My year as president ends at the close of the 2001 APA annual meeting. I offer Richard Harding, our incoming president, and Paul Appelbaum, our new president-elect, my best wishes and support in furthering APA’s goals. APA is in good hands. I am honored to have served as your president. It was a great year.” ▪