April 2, 1999

APA is about to launch a referral project that will make it far easier for people to connect with a psychiatrist in their local community.

This new Psychiatric Referral Service was endorsed by the APA Board of Trustees at its March 13-14 meeting in Chicago. The Board also voted to appoint a small Board oversight group to assist the Division of Public Affairs in implementing the project.

The new service will allow individuals in the U.S. and Canada to call a toll-free telephone number to receive the names of three APA-member psychiatrists who share the same ZIP code as the caller. If there are fewer than two participants in a ZIP code area, the system will then search the nearest ZIP code and supply the telephone number for the district branch that includes the caller's community or for APA if the district branch is not participating in the service. When there are more than three participating psychiatrists in a ZIP code, the system's computer will automatically rotate among the names listed to ensure that all participants have the same number of referral opportunities.

Members will be listed only if they inform APA that they want to participate in the referral network.

"APA has been enormously successful in attacking stigma and other barriers to psychiatric care. Now we have to help patients and families find us," said Nada Stotland, M.D., chair of APA's Joint Commission on Public Affairs.

Once a caller telephones the toll-free number, only the psychiatrist's name and telephone number will be provided. The psychiatrist's address, specialty areas, and insurance plan participation will not be revealed as part of the referral system. APA will not sell this list of participating psychiatrists to any third party.

The system will also alert each caller to the need to contact their closest emergency room if they perceive the problem to be an emergency. In addition, they will hear an advisory cautioning them that a psychiatrist's choice to be listed in the referral database does not imply an APA endorsement.

The new national system is designed to link with-not replace-referral systems already in place in district branches and state societies. When district branches or state psychiatric societies already have a referral system operating, APA's new system will eventually be able to link callers to those systems if the district branch agrees to participate. These links between local and national referral systems also might lead to reduced expenditures by district branches to run their systems independently.

APA began a pilot test of the referral service on March 29 that listed only the telephone numbers of participating district branches. (By early March, before APA had publicized the new benefit, 105 members had signed up.) By May 1 APA hopes to inaugurate the system that integrates individual psychiatrists' telephone numbers.

Lilly Pharmaceuticals is funding the project's initial phase through an unrestricted educational grant and plans to accompany the launch with a series of public service television spots aimed at increasing the public's awareness of depression symptoms and treatments. The company has agreed that these announcements will not mention Prozac, but will instead encourage people to call a toll-free number to obtain more information about depression. Information brochures Lilly sends to callers will cite the toll-free number for the APA referral service.

Several Trustees voiced concerns about the possibility that lines separating Lilly and APA in the referral service could be blurred. Trustee-at-Large Marcia Goin, M.D., expressed the view of many of her colleagues when she said that she "hopes there will be a steel wall" between APA and Lilly with respect to the relationship between the referral service and the endorsement of any pharmaceutical product.

The flier included in the packet of information Lilly sends out will contain a disclaimer stating that APA "does not endorse any one medication for the treatment of clinical depression or other mental illness. Your physician and you are the best qualified to determine together the course of your medical treatment, including medication, psychotherapy, and combinations of medication and psychotherapy best suited for you."

The disclaimer also will note that a listing in the database does not imply endorsement by APA and will advise readers of the possibility that the psychiatrist they call may not take their particular insurance.

The Trustees were satisfied that the disclaimer would demarcate APA's role from that of the pharmaceutical company.

In the future, APA may invite other pharmaceutical firms to link their public information campaigns to the referral network. Advocacy and allied professional organizations will also be invited to link to the system.

Another concern expressed by Board members centered around the experience of several district branch referral services in which a large majority of callers have been uninsured or had insurance that psychiatrists to whom they were referred did not accept. Harold Eist, M.D., a former APA president, emphasized that APA needs to publicize the referral network as "a public service of APA" and educate members as to this aspect. Otherwise, he noted, the Association could find itself facing a serious public relations problem when participating psychiatrists turn down an indigent caller or one covered by a policy that the psychiatrist could not accept

In response to the insurance concerns, APA is developing an enrollment packet that will discuss this issue and advise psychiatrists on how to address insurance questions.

APA's goal is to enroll 10,000 members-about 25 percent of its membership-in the referral system by 2000.

In urging APA members to join the Psychiatric Referral Service, Stotland emphasized that it is "an opportunity for you to let potential patients know who you are and what you do. This is our own service; be a part of it."