Enhancing Coordination and Effectiveness of APA Is First Priority By Steven M. Mirin, M.D. APA Medical Director

I very much appreciate Dr. Rod Muņoz's invitation to discuss one of the sides of his "Pentagon"-the APA central office and its staff. Clearly, one of my key roles as director is to align the functions of the APA staff to best meet the needs of the members and help us accomplish our strategic goals. Accordingly, we are working to enhance the coordination among the APA's various departments, provide more stringent oversight of our publishing and other business activities, and, most importantly, enhance the effectiveness of our organization in advocating on behalf of our members and their patients. The following are some of the changes we have made thus far:

Office of Psychiatric Services (OPS)

Over the past six months, the OPS has developed an expanded array of activities and a new name, the Office of Quality Improvement and Psychiatric Services. It is my firm belief that, by virtue of training, scope of knowledge, and experience, psychiatry is in the best position to take the lead role in setting the standards of care. Moreover, if we do not assume this responsibility, others will set the standards for us. For this reason, OPS has been increasingly involved in the development of not only practice guidelines, but also additional tools to guide both clinical decision making and enhance the quality of care our patients receive. Other important goals for this office include taking a leadership role in translating data from clinical and health services research into advances in clinical care and a proactive stance in defining the appropriate role for psychiatrists in organized care systems.

Office of District Branch and State Society Relations

Now, and in the future, many of the important legislative, regulatory, and economic issues that concern APA members will be engaged not by the central office in Washington, D.C., but by the state societies and district branches. As the Congress and the Executive Branch cede more authority to the states for allocating public sector funds for mental health care, it is imperative that the communication between the central APA and the DB's improve. We must also assist the DB's in communicating with each other. The new APA Office of District Branch and State Society Relations will serve as a clearinghouse for identifying DB/state concerns and for responding to their requests for information and support. Office staff will work closely with the Task Force on the DB/APA Partnership and with an APA committee that will oversee the distribution of funds to support DB/state initiatives of national significance.

Economic Affairs

It is clear that, as cost-containment pressures intensify, it is essential that APA provide up-to-date, credible data to support our positions on key clinical and economic issues including the affordability of parity; the cost-effectiveness of integrated, rather than fragmented, care; the efficacy and effectiveness of psychosocial, as well as somatic treatment; and the medical cost offsets of timely and appropriate care for mental health and substance abuse care.

We need to take a leadership role in shaping national policy on the financing and delivery of mental health care and it is my expectation that the newly configured Office of Healthcare Systems and Financing will be an important source of information and support to you as you confront the economic issues that now pervade the mental health care market place.

This office will also develop educational programs on issues related to health insurance coverage and reimbursement, managed care and practice management, as well as products and services to aid psychiatrists who choose to participate in organized systems of care. Finally, the revitalized office will work to establish new links with organized health care systems, trade groups, managed care organizations, and the purchasing alliances and agencies that fund mental health care in the public and private sector.

Government Relations

A more informed process for policy development is only the first step in our efforts to fix what is broken in the American health care system. The Joint Commission on Government Relations, the Joint Commission on Public Affairs, and the offices that support their activities can be viewed as the efferent arms of a neural circuit that helps translate APA policy into action. This year the effectiveness of those arms was evident in a number of areas including:

1. Successfully opposing any delay in implementation and/or proposed loopholes that would allow employers to opt out of the parity requirement.



2. Working with other advocacy groups commissioning a report on child mental health benefits in 16 states, covering 63 percent of the nation's eligible uninsured children, to help state policymakers and patient advocates discern which options to choose under the $24 billion Children's Health Insurance Program.



3. Voicing our concerns about encroachment into the confidentiality of medical records to Health and Human Services Secretary Donna Shalala and supporting the introduction of federal legislation, based largely on APA principles that would assure a patients' right to exercise informed consent before the release of their medical record, encourage the segregation of more sensitive parts of the record, place strong limits on the information that insurance and managed care companies can require for claims processing, and require due process before law enforcement and regulatory agencies could seek access to a patient's record.



4. Ending the Department of Defense Psychologist Prescribing Program and helping the DB's oppose similar state legislative initiatives that erode the quality of care for our patients.

Public Affairs

To devise better ways of reaching the hearts and minds of legislators, employers, and the public, APA's Division of Public Affairs is reexamining its priorities and approach to the media and to the public, and we are working toward a closer integration between public affairs and government relations especially on key issues like parity and confidentiality.

Office of Education

Meeting the educational needs of our members and training the next generation of clinicians, teachers, and researchers, is a key element of APA's mission. This year, the Office of Education has been reaching out to the academic community in a number of important ways, including participating in a consortium of organizations concerned with psychiatric training, meeting with medical school deans who are psychiatrists, and reviewing the activities of the Residency Review Committee, which is now revising the special requirements that define the training of psychiatric residents.

This office has also been working to improve the process for annual meeting CME activities, developing a number of innovative ideas on how to best provide CME to our members, and assisting the state societies/DB's in both formulating and funding CME activities and helping shape the criteria by which psychiatrists are certified and recertified.

Looking to the future, I believe we must also play a key role in defining the workforce needs for psychiatry lest others, including the MCO's and the federal government, do it for us.

Office of Research

Over the last decade, total funding for psychiatric research has increased by more than 400 percent, and, across the nation's academic medical centers, psychiatry is second only to internal medicine in the amount of grant funds received from NIH.

The impressive growth of federal funding for NIMH, NIDA, and NIAAA bespeaks the recognition on the part of the Congress that supporting research on the causes and treatment of mental illness, including substance use disorders, is a good investment. But this progress, along with the proposed doubling of the NIH budget over the next five years, does not happen in a vacuum. The diligence and persuasiveness of advocacy groups, working with the APA and the APA-sponsored academic consortium, in generating Congressional and public support for research in our field is a key ingredient in our success.

At the same time, it is fair to say that our progress has been uneven. We still need a major investment in research on the efficacy and cost-effectiveness of psychosocial treatments, including psychotherapy, as well as other clinical care issues. Thus, support of health services research must remain a priority for NIH and for the centers that comprise the Substance Abuse and Mental Health Services Administration.

New knowledge derived from research and clinical experience is essential to improving the care of our patients. Moreover, if we are be credible participants in the health policy debates that will dominate the next decade, we need to become a national center for the coordination of health services research, continue to develop APA's research network, and serve as a training ground for health care leaders of tomorrow. I believe that an affiliated but distinct APA Institute for Research and Education is the best vehicle for realizing this goal and in the months to come will be exploring the feasibility of establishing such an institute.

Strategic Planning

A clear enunciation of APA's mission, vision, goals, and strategic priorities is essential if we are to be an efficient and effective organization. At the same time, we must examine and prioritize our current and future commitments and focus our finite resources on those issues that are of most concern to our members, our profession, and our patients.

The Strategic Planning Task Force, along with the APA leadership and staff, will shortly complete the first phase of this process. It is my hope that by year end we will have a set of strategic priorities and associated action plans for each of the areas reviewed in this column, as well as member recruitment and retention and the APA governance process. We are working to enhance APA's operational effectiveness, its responsiveness to the needs of our members, and its ability to advocate for patients. You can be proud of your Association, its past and its future, and it is my privilege to serve as your medical director during this exciting time.