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By Rodrigo Muņoz, M.D.
APA President
Last month I attended the annual convention of the National Alliance on Mental Illness in Washington, D.C. I was impressed by the enthusiasm of the audience members who eagerly focused their attention on speakers in various sessions. Among the inspiring speakers in the plenary session was former APA president Herbert Pardes, M.D., who was a particularly apt choice for this group. During his APA presidency Dr. Pardes invested much time and effort in building a strong relationship between APA and mental health consumer and advocacy groups.
That same morning APA Medical Director Steve Mirin, M.D., also discussed with style and eloquence the progress that has been made in developing clinical performance indicators, communications with relevant federal agencies, and new proposals for effective care that will transform the practice of psychiatry.
Steven Hyman, M.D., director of the National Institute of Mental Health, further encouraged a close interaction between the research community and those who need the best from treatment centers. Dr. Hyman has made much progress in creating research principles that are bringing new discoveries in diagnosis and treatment directly into clinical services.
The presentations of Drs. Pardes, Mirin, and Hyman demonstrated their appreciation of the intelligent, well-informed, and plugged-in audience who listened intently to their words. It was clear to me that this group has a deep understanding of psychiatry, particularly in the areas of psychiatric disorders and treatment, and the realities that block access to care. As psychiatrists, we must not only acknowledge but be thankful that consumerism has arrived. That our patients and their families want some degree of mastery over the problems they face is of enormous import to our field and provides them with some sense of control over their situation.
During my term as APA president, I will give particular attention to NAMI, the National Alliance for Research on Schizophrenia and Depression (NARSAD), the National Depressive and Manic-Depressive Association (NDMDA), the Mental Health America (NMHA), and other similar groups. I also am encouraging all APA members to be active in these organizations and make every effort at assuring their success. Doing so helps us avoid paternalism, keeps us in touch with the concerns and difficulties experienced by our patients and their loved ones, and shows that we recognize them as our most effective allies in trying to win over Congress and state legislatures on mental health issues, such as parity and access to high-quality care.
These ideas are not new. They go back to the early years of psychiatric care and are represented in the efforts of many who helped bring about the transformation of systems they considered oppressive. One outstanding example was the revolution in inpatient care instigated during World War II by conscientious objectors who chose to serve in mental hospitals and rebelled against the conditions they found. Their actions led to the modernization of institutions as they progressed from providing only minimal custodial care to therapeutic care.
One of the most recent voices for a new covenant between physicians and patients came from a lay professional. In her 1997 book Market-Driven Health Care: Who Wins, Who Loses in the Transformation of America's Largest Service Industry, Professor Regina E. Herzlinger of the Harvard Business School advocates a consumer-controlled health care system. One of the best chapters in her book is titled, "Give Me Death: The New Health Care Activist." Her idea, which is predicated upon consumers' acquisition of power in making their own health care decisions, is in line with recommendations in a report recently adopted by the AMA (Psychiatric News, July 3 and August 7). The AMA believes that individuals should have the opportunity to select and own their health insurance policies. Under such a system, according to the report, consumers will become more responsible, market forces will control cost and quality, and lack of portability will cease to be an issue.
A case can be made for the proposition that an educated public is the best defense against abuse. This certainly seems to be demonstrated by the public outcry, now joined by many politicians seeking election and reelection, against current practices in HMOs and other types of managed care.
NAMI, NARSAD, NDMDA, NMHA, and other similar organizations have created a powerful consumer movement for our patients. Let's work with them in providing the best we can give.