Dr. Appelbaum's Homepage

APA Vice President, 1999- , and Secretary, 1997-99

Professor and Chair of Psychiatry, University of Massachusetts Medical School, 1992-

President, Massachusetts Psychiatric Society, 1992-93

President, American Academy of Psychiatry and the Law, 1995-96

Chair, APA Commission on Judicial Action, 1984-90

Chair, APA Ethics Appeals Board, 1997-99

Board of Directors, Community HealthLink, Worcester, Mass. (Regional Community Mental Health Center), 1992-

Teacher and Researcher on Legal and Ethical Aspects of Psychiatric Practice, 1980-

Practice of General and Forensic Psychiatry, 1980-

The time to act is now. We psychiatrists face unprecedented threats to our abilities to treat our patients and to sustain our profession. But there’s no reason for despair. If we work together, these are fights we can win. We will only be successful, though, if APA leads the way.

A winning advocacy agenda for APA requires us to set priorities and stick to them. Spread our resources thin and we’ll accomplish nothing. Stay focused and we can help our patients and ourselves. Here is where I would target our efforts as APA president:

The systematic defunding of psychiatric care must be stopped. Managed care has cut expenditures on psychiatric services by more than half. Public sector and VA services laboriously built over decades are being allowed to crumble. Children’s services in many states are at crisis stage. We need a multipronged strategy.

• Legislation can stop some of managed care’s most outrageous practices. New federal laws should require external review of payment decisions, limits on managed care access to patients’ records, prompt payment of physicians’ fees, an end to physician harassment, and HMO liability for their decisions.

• Litigation needs to be carefully targeted at illegal practices, including deceptive advertising by insurers and contractual promises of care that are undercut by artificial "medical necessity" criteria.

• Public education and alliance building must continue. Our successes in this area have led to the passage of parity laws in many states. But we need real parity—not rendered meaningless by discriminatory review—and we need it on the national level. We must persuade employers who purchase most health insurance of the critical importance of providing coverage for psychiatric illness, including substance abuse.

The idea that psychologists can prescribe medications is a dangerous farce.

APA must continue to assist district branches in this struggle, with resources and successful lobbying strategies. But psychiatry is about more than just prescribing drugs. Our uniqueness rests on our ability to combine psychotherapeutic and biological techniques. We need to promote the advantages of the integrated care that psychiatrists alone provide and work with training programs to ensure that a new generation of psychiatrists will learn this complete array of skills. Without strong protection for patients’ confidentiality, all psychiatric treatment is in jeopardy; we must continue our fight for confidentiality in Congress, in the states, and in the courts.

Reallocating funding from governance to advocacy has freed millions of dollars a year. Continuing that process, and holding dues stable while we increase our value to members, is critical to our success. We also must:

• Reach out to residents and early career psychiatrists with programs that meet their needs. The recent dues reduction in the initial years of membership, which I strongly supported, is a step in the right direction.

• Listen to our members’ concerns about the user-unfriendly aspects of APA and the growing pharmaceutical presence at our meetings.

• Fight discrimination against our members who trained in other countries and support the unique needs of our minority and underrepresented colleagues.

• Bring more young psychiatrists, women, IMGs, and minority group members into active involvement with our components and governance, including the Assembly and Board.

• As secretary and vice president, I have led the fight for patient confidentiality, testifying in Congress, lobbying in Washington, and in countless media interviews.

• I have helped shape our litigation and advocacy strategy, for six years chairing the Commission on Judicial Action.

• I cochaired the task force that developed the plan to share APA revenues with the district branches, so we can support their many needs.

• I have lobbied Congress for funding for psychiatric research, helped develop APA’s new conflict-of-interest rules, and chaired our Ethics Appeals Board. You have seen me defend psychiatry on "60 Minutes," on NPR, and in the press.

I know how this organization works and how to get things done. My goal is to bring people together by emphasizing our commonalities, rather than our differences. I would be deeply honored to be your choice for President-elect of APA.

As professor and chair of psychiatry at the University of Massachusetts Medical School, I do administration, research, teaching, and patient care. This accounts for more than 90% of my income, with the remainder from forensic work and honoraria.