Currently, APA is facing dual adaptational challenges. First, APA needs to re-structure. Second, it needs to respond constructively to the external environment of rapid change. From within, APA has to reorganize both its home office organization and its governance structure. Change has already started on both, but the actual blueprint cannot be finalized or implemented until the arrival of the new APA Medical Director. The next two years are going to be crucial. Leadership at the APA Board, at this historic time, is essential. I know change intimately, its hazards and rewards. I understand the need to ask the tough questions and the courage to take the painful actions that real structural change demands. Half measures will not do if the goal of ensuring quality survival for psychiatry and psychiatrists into the next millennium is to be achieved. The decisions that your APA Board will make, in close working relationship with our new Medical Director, will shape the face of American Psychiatry in the next millennium. I believe I am the most qualified for this challenge and here is why. I have a track record of demonstrating my capacity to take on tough, controversial, potentially explosive areas of concern to our integrity and work constructively within and without our organization to implement solutions in addressing the areas of concern. Starting in 1977, I pioneered the first model of due process ethics hearings in the APA. At the same time I started ethics education for our members. I based my efforts on my firm belief that real knowledge is acquired through close study of our failures and mistakes. Our successes need to be highlighted as the fruits of our knowledge while the study of failures generates new knowledge. My skills in asking what works and what doesn't, my capacity to innovate in the midst of mistakes and chaos have been acquired through real life experiences, not books. For over 25 years I have been successful in raising three sons with my husband of 33 years while maintaining a thriving, full-time, solo, private practice in the highly competitive, turbulent practice environment of Southern California. I know what it takes to survive with integrity.
The task of restructuring APA goes hand in hand with the need to sell APA to its members. APA is a voluntary member organization, dedicated to quality psychiatric care for our patients and their families. Members will stay or drop based on APA's ability to demonstrate that it offers members increased opportunities to apply what they know creatively/competitively and keep expanding their knowledge base. In a world of massive technological advances and, at a time of exploding knowledge in neurosciences, genetics and psychopharmacology, instead of celebrating, we are confused, demoralized and at risk of yet another round of fragmentation and polarization. The reason is that, as highly trained professionals, we psychiatrists are part of the health care industry. In the U.S., the land where the corporation was born in this century, up until the 1970's medical care was a cottage industry based on millennia old patterns of practice, teaching and research. While many of us saw corporatization coming, none of us was ready for it. But No More!
What we need is PSYCHIATRIC INNOVATION across the board. We are the owners of psychiatric knowledge. We just never thought we had to participate in applying this knowledge outside the traditional patterns of clinical practice, research and teaching. Now we are challenged to do just that. We have to innovate and manage new systems of care that best meet our patients' needs. No one can do this without us. We are indispensable. The issue is not that managed care is here to stay. It is that change is here to stay and we are not used to that. APA cannot advocate for or against any one emerging system of care nor for any one specific treatment modality or therapy. APA has to advocate, not only for basic research in neuroscience but also in psychotherapy and especially in treatment outcomes and effectiveness of various theories in actual clinical practice. We are not a religious order or a guild. We are the only integrative medical specialty dedicated to bridging the gap of brain/mind and soul/soma through scientific, empirical knowledge. APA has to continue to expose, identify and work to eliminate abusive, corrupt systems of care by all means necessary: legal, legislative, research and, above all, education of the public, the media, the legislators, the patients, their families and our fellow members. Additionally, we must employ strategic alliances with individuals and with other organizations who share our concern for quality patient care.
Not only do we have "to sell" the APA to our members, we must "sell" psychiatry to the rest of Medicine. Our survival depends on our success. We can only do that by providing care that is ethical, efficient and effective. Results sell. Competition is here to stay. No non-medical mental health professional can take away the hard earned knowledge each psychiatrist has acquired. This is our capital resource. It belongs to each of us. Each of us has earned it and owns it. What we now need to learn is that it is OK to apply this knowledge in ways that fit the needs of our patients, whether or not this pleases or displeases teachers, our supervisors, our administrators or our pocketbooks. The test is does this advance quality patient care. Our practice guidelines are based on clinical experience. They are not orders for conformity. They are the vital information to guide our practices. We know far more than we actually use and apply. This has to change. We have to focus on creative imaginative innovation for quality care.
APA has to energize its members to innovate and it must reward and recognize those members who do. APA has to continue to advocate for universal coverage; for real, full parity; for national standards of care which insure a continuum of care, the preservation of the doctor-patient relationship, the privacy/confidentiality of patients, the freedom of patients to contract outside any system of care with the psychiatrist of their choice, for changes in ERISA, and for accountability by all corporate care systems as to the quality of care they provide and full disclosure of their profits.
It is my conviction that stigma will be erased only when ethical psychiatric treatment becomes highly efficient, effective and affordable.
Psychiatry has yet to see its full maturity. If we keep innovating
and expanding our knowledge the millennium will be ours!