March 5, 1999

A major AMA reorganization has resulted in the elimination of an independent AMA Department of Mental Health, which will now be subsumed as a program under the new unit of Science and Public Health Advocacy and Programs.

The reorganization was announced December 17, one week after the AMA's interim meeting. Eight long-standing departments, including mental health, alcohol and other drugs, adolescent health, HIV, and geriatric health, were eliminated, with those interests now subsumed under three new, overarching units. As a consequence of a dispute over the reorganization, the AMA fired psychiatrist Larry Goldman, M.D., on January 12. Goldman was director of the Department of Mental Health at the time of the reorganization.

APA President Rodrigo Muņoz, M.D., and APA's delegates to the AMA House of Delegates (all former presidents), Joseph T. English, M.D., Jerry Wiener, M.D., and John McIntyre, M.D., spoke with Psychiatric News about the reorganization, as did AMA Senior Vice President for Professional Standards Reed Tuckson, M.D.

AMA leaders, including Tuckson and Executive Vice President E. Ratcliffe Anderson Jr., have an early March meeting with the APA leadership, including Medical Director Steven Mirin, M.D., at which the reorganization and other issues will be discussed.

In an interview with Psychiatric News, Tuckson vowed to find a psychiatrist to replace Goldman and said that mental health would continue to be a high priority for the AMA.

"We intend to do more, not less, both with APA as well as with the issues of mental health," said Tuckson. "This reorganization was designed to help us to better coordinate and integrate these concerns into the life of what we are doing with our programs."

Despite these reassurances, APA leaders expressed concern about the way in which the reorganization was handled. They also hoped that the strength of the relationship between the AMA and APA would continue to grow.

English, one of APA's three delegates, noted that a major reorganization was expected when Anderson assumed the leadership of the AMA.

"It was clear that Dr. Anderson was expected to reorganize substantially the staff of the AMA," said English. "We regret that there was not some consultation with APA about the position that has been abolished because of how many years we worked with the AMA to correct deficiencies related to that position."

McIntyre, another delegate, observed that "obviously the reorganization is a major issue for psychiatry." APA has "worked mightily over the last several years to improve the relationship between APA and the AMA and to be an effective and responsive part of the house of medicine. The position of having a psychiatrist as head of the mental health office of the AMA was obviously a crucial issue for us."

Wiener, the third delegate, articulated why he is concerned about the reorganization.

"When AMA had a director of the Department of Mental Health, we knew what the position was and we knew what the responsibilities were," said Wiener. "I think that what the AMA is proposing now is relatively uncertain."

According to the AMA, the new employee will be the "program director for mental health" and will report to Thomas Houston, M.D., the director of the unit of Science and Public Health Advocacy and Programs.

A major reason that the reorganization struck such a raw nerve among APA's delegates to the AMA is that APA officers spent years fighting to have the former Department of Mental Health headed by a psychiatrist at a time when it was headed by a psychologist, explained Wiener. This explanation was echoed by all three APA delegates to the House of Delegates.

"Several APA leaders will visit Chicago soon," observed APA president Muņoz. "We expect to visit with [AMA Executive Vice President Anderson] and others who may give us the best understanding of the situation and may help us define more appropriately our reaction to the AMA transformation."

Mirin, APA's medical director, commented that APA will be working closely with the leadership of the AMA and the leadership of the new division to ensure that activities of the division are consistent with the goals shared by APA and the AMA on the care of the mentally ill and the role of psychiatrists in providing that care.