Professor of Psychiatry, George Washington University

Assembly: Washington Psychiatric Society Representative and Past Speaker

Co-author, APPI book: Clinical Manual of Supportive Psychotherapy

Honorary Member: Washington/Baltimore Psychoanalytic Society

Past Trustee-at-Large, APA Board of Trustees

APA Administrative Psychiatry Award

Past Trustee, Group for Advancement of Psychiatry (twice)

Past President, American Association for Social Psychiatry

Past President, Federal Physicians Associations

Past President, American Association of Administrative Psychiatry

Past President, DC Chapter of the Washington Psychiatric Society

NAMI Exemplary Psychiatrist Award, 2000

Over the past decade, the proportion of the health care dollar in this country going to psychiatry has plunged. Over the past decade the proportion of psychiatrists wanting to belong to APA has plunged. To reverse these trends, APA must change.

Due to public policies, court decisions, and managed care, more psychiatrically ill are now in jails or prisons than in hospitals. Of those not incarcerated, many are on the streets. Of those neither incarcerated nor on the streets, managed care has left vast numbers only partially treated, still in pain, or still disabled. With too few exceptions, APA leadership has failed to express appropriate moral outrage—or to sustain an effective strategy for change.

A moral campaign for change should focus on the psychiatrically ill’s needs for three basic rights:

•First is the right of the psychiatrically ill to be free of their illness to the degree it can be achieved with today’s treatments. This requires access to the full array of treatments, under conditions of full confidentiality. Managed care bars this right in setting limited treatment goals.

•Second is the right to equality of opportunity for treatment and services. This requires cessation of discrimination against the psychiatrically ill. "Parity" that retains internal discriminations against the psychiatrically ill and psychiatrists must cease. An example: The back door, found nowhere else in medicine, through which the psychiatrically ill are thrown out of private treatment and dumped onto the public system, must be closed.

•Third is a right to live in this nation’s communities. Just as this nation has spent resources to allow the wheelchaired to be part of American communities by reconstructing sidewalks, so we must demand that this nation provide housing, sheltered work, and social supports so that the most disabled of the psychiatrically ill can become part of our communities.

Is such advocacy unrealistic? No! Rights for women, for minorities, for the disabled, were all achieved with moral, not economic, arguments. While it is valid to argue that psychiatric treatment ultimately saves money, such arguments should always remain within the shadow of our moral stance. APA leaders, who have made economic arguments independent of the moral issues, have mistakenly implied that rights are secondary to costs. That is unacceptable! If it costs 10 percent of the health care dollar to achieve these rights, we should say so. "Parity" associated with 2 percent of this nation’s health care dollar is shameful. And we should say so.

It debases our nation’s values to claim that a country that celebrates record annual car expenditures is incapable of celebrating fewer suicides and celebrating fewer psychiatrically ill in jails or on the streets.

Many major psychiatric organizations in this country are gaining membership. Some have gained 50 percent over the last five years. Not APA, which is losing 3 percent to 4 percent a year. In this year, 2000, APA may see the worst membership plunge in its history. Yet American psychiatrists care deeply for the psychiatrically ill and are eager to support a voice that captures and conceptualizes their patients’ needs. Membership will climb when the members believe that APA is making a difference in the fate of the psychiatrically ill. Only then will our colleagues feel the restoration of pride so essential to a strong and vibrant organization.

APA members from Area 3 have often been the initiators of demanding that APA challenge those who are depriving the psychiatrically ill of the treatment and care that the psychiatrically ill need. I would like your support in returning APA to the reason it was created 156 years ago: to explicate and champion the needs of the psychiatrically ill.

Work: 95%—Clinical treatment and teaching in a university setting

5%—Clinical and agency consultation

Income: 85%—University salary

15%—Consultations