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2008 ANNUAL REPORT

SHAPING OUR FUTURE SCIENCE and SERVICE

A MERICAN P SYCHIATRIC A SSOCIATION


AMERICAN PSYCHIATRIC ASSOCIATION 35,619 MEMBERS 76 DISTRICT BRANCHES and STATE ASSOCIATIONS EXECUTIVE STAFF (2008) James H. Scully Jr., M.D., Medical Director and CEO, American Psychiatric Association William Bruce, Chief Information Officer, Information Technology Paul T. Burke, Executive Director, American Psychiatric Foundation Eugene D. Cassel, J.D., Special Counsel and Director, Division of Advocacy Margaret Cawley Dewar, Director, Association Governance Deborah Hales, M.D., Director, Division of Education Rosalind Keitt, M.A., Chief of Staff Ronald E. McMillen, Chief Executive Officer, American Psychiatric Publishing, Inc. Annelle B. Primm, M.D., M.P.H., Director, Office of Minority & National Affairs Darrel A. Regier, M.D., M.P.H., Director, Division of Research, and Executive Director, American Psychiatric Institute for Research and Education Therese Swetnam, Ph.D., C.P.A., Chief Financial Officer and Director, Division of Finance and Business Operations

TABLE OF CONTENTS 1

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Letter from the 2008-2009 President and Medical Director/ CEO

Shaping our Future Through SCIENCE Shaping our Future Through SERVICE

14 APA Affiliate Organizations 18 Finance & Operations

AMERICAN PSYCHIATRIC ASSOCIATION 1000 Wilson Blvd., Suite 1825, Arlington, Va. 22209 (703) 907-7300 or (888) 35-PSYCH E-mail: apa@psych.org | www.psych.org | www.HealthyMinds.org

Cover Photo Credits (clockwise from top left): Jeanne Hatch, Medioimages/Photodisc, Andrea Morini, Jochen Sands Text Photo Credits: David Hathcox, Maureen Keating, Ellen Dallager Photography, Psychiatric News Design: www.GroffCreative.com


2008 ANNUAL REPORT

LETTER

AMERICAN PSYCHIATRIC ASSOCIATION

FROM THE 2008-2009 PRESIDENT AND THE MEDICAL DIRECTOR/CEO Dear Colleague: The year 2008 will be remembered as one of historic change for our members, patients and the field of psychiatry. For more than a decade, the APA has fought tirelessly to end insurance discrimination. The passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 brings the promise of non-discriminatory mental health coverage to millions. Through this annual report, we reflect on our successes in 2008 and look ahead to future endeavors. Involvement of our dedicated membership and the work our members do on behalf of patients, psychiatry and the APA made these accomplishments possible: ■ The Medicare Improvements for Patients and Providers Act, which overhauls key features in Medicare

coverage of treatment for mental health, was passed. This bill will allow patients easier access to psychiatrists and treatments that can relieve suffering, and will help patients live more fulfilling and productive lives. ■ The APA’s Diagnostic and Statistical Manual of Mental Disorders Task Force and Work Group members

began reviewing scientific advances and research-based information to develop the fifth edition of the manual. The goal is to develop a DSM that is useful in clinical practice as well as in research. ■ The APA and local district branches and state associations blocked psychologists’ efforts to secure prescribing

privileges in California, Hawaii, Mississippi, Missouri and Tennessee. ■ The APA’s Institute on Psychiatric Services meeting in Chicago saw its first public forum, which included

discussions by leading psychiatrists on mental health policy, depression in minority populations, and facts about schizophrenia, alcohol and drug abuse and personality disorders. ■ The APA continued its proactive approach to maintaining certification through the demonstration of life-

long learning with eFOCUS, an innovative electronic clinical survey. ■ The APA demonstrated leadership in the medical community in requiring transparency and addressing

relationships with industry. In early 2008, the APA established a work group to develop guidelines for interactions between the APA, individual psychiatrists and medical industries. Patient care has been and always will be the focus of the psychiatric profession, and the practice of psychiatry continues to save lives and alleviate suffering for millions of people. Thank you for shaping the future for our patients and profession. Sincerely,

Nada L. Stotland, M.D., M.P.H. President

James H. Scully Jr., M.D. Medical Director and CEO

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SCIENCE SHAPING OUR FUTURE THROUGH

The APA shaped the future of psychiatry in 2008 as it continued development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, promoted research, updated treatment guidelines and expanded educational opportunities for psychiatrists and other medical professionals.

Reviewing the Data. The DSM-V Task Force and Work Groups began meeting to review scientific advances and research-based information to develop the fifth edition of APA’s Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The work group members include more than 150 world-renowned scientific researchers and clinicians with expertise in neuroscience, biology, genetics, statistics, epidemiology, public health, nursing, pediatrics and social work.

Advancing Psychiatry. “Our Voice in Action: Advancing Science, Care, and the Profession” was the theme of the 161st Annual Meeting of the APA in Washington DC. Highlights included the William C. Menninger Memorial Convocation Lecture by neurologist and best-selling author Oliver Sacks, M.D., and sessions by the National Institute of Mental

Health and the National Institute on Drug Abuse. Learning Online. The top sessions from the APA Annual Meeting continue to provide learning opportunities long after the meeting ends. Thirty-seven of the best lectures and symposia from the 2008 meeting were recorded and turned into state-of-the-art audio/slide presentations. The material is available for


2008 ANNUAL REPORT

AMERICAN PSYCHIATRIC ASSOCIATION

FACING PAGE, LEFT: Participants in the symposium, “Conceptual Considerations for Revising DSM and ICD Diagnoses” at the 2008 World Congress on Psychiatry in Prague. From left: Darrel Regier, M.D., M.P.H.; Dilip Jeste, M.D.; Kim Yonkers, M.D., Eric Taylor, M.D.; Stephan Heckers, M.D.; and Jan Fawcett, M.D. FACING PAGE, RIGHT: Meeting

attendees flock to monitors to check the availability of open CME courses, which sell out quickly. These courses are the most popular learning format at the annual meeting, offering a small group learning environment with ample time for direct exchanges with skilled course directors.

continuing medical education credit on DVD and at psych.org. Encouraging Residents. The 100% Club continued to grow with more than 30 residency programs qualifying in 2008. Psychiatry training programs with 100 percent membership in the APA receive a major textbook of their choice from APPI and have their program featured in Psychiatric News with a photo, plus a free online subscription to FOCUS.

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BELOW, LEFT: Outgoing APA President

Carolyn B. Robinowitz, M.D., passed the presidential medallion to incoming APA President Nada L. Stotland, M.D., M.P.H., in a time-honored tradition during the board meeting at the annual meeting. BELOW, RIGHT: Robert E. Drake, M.D., Ph.D. (center), was presented the Alexander Gralnick Award for research in schizophrenia at the lecture he delivered at the APA’s Institute on Psychiatric Services in Chicago. Also pictured are Anthony Lehman, M.D. (left), and Howard Goldman, M.D. (right), editor of the Psychiatric Services Journal.

Promoting Research. The first edition of the redesigned Psychiatric Research Report was published in summer of 2008. The publication provides psychiatric researchers and young investigators with a comprehensive picture of current research activities.

2008 Institute on Psychiatric Services in Chicago. The program included 11 invited lecturers and seven award lectures. “Practical Pearls” was a new format that provided concrete, practical, user-friendly information on clinical topics relevant to psychiatric practices.

Transforming Psychiatric Practice. “From Patient to Partner: Transforming Systems of Care” was the theme of the

Expanding Educational Opportunities. The APA is expanding its “lifelong learning” approach to continuing


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SCIENCE medical education as it prepares members for a new paradigm that will require physicians to measure clinical performance against evidence-based guidelines. The second clinical eFOCUS, a case of treatment-resistant depression, provided an online clinical decision-making exercise for APA members and FOCUS subscribers. Competing for Knowledge. More than 400 annual meeting attendees watched the University of Texas at Houston team win MindGames, a national competition for residents. The game show, hosted by APA’s own Glen Gabbard, M.D., covers medical knowledge and patient care, along with challenging but entertaining questions about psychiatry and APA history. Focusing on CME. The journal FOCUS: Journal of Lifelong Learning in Psychiatry grew to more than 2,500 subscribers, covering topics like major depression and suicide, schizophrenia, child and adolescent psychiatry, and panic and social phobia. FOCUS provides up to 20 category one CME credits a year.

Guiding Treatment. The APA continues to provide evidence-based recommendations for the treatment of psychiatric disorders through its practice guidelines. A second edition practice guideline on panic disorder was approved and finalized for publication in early 2009. Draft third edition practice guidelines on major depressive disorder and bipolar disorder were made available for general review and work began on a second edition practice guideline on HIV/AIDS. ABOVE: Attendees browse the American

Training Physicians. APA members and other physicians across the country received training on the use of buprenorphine through the APA in cooperation with district branches. Eleven regional courses were provided, enabling physicians to complete training required to participate in a federal program to treat opioid-dependent patients in an office-based setting.

Psychiatric Publishing Inc. bookstore which consistently offers cutting-edge psychiatric research and educational materials to advance the science and practice of psychiatry. TOP: Tanya Krolls, M.D., Peter Ly, M.D., and Magdalena Peixoto, M.D., psychiatry residents at the University of Texas-Houston, celebrate following their victory in the second annual MindGames competition at the APA annual meeting in Washington, DC.


2008 ANNUAL REPORT

AMERICAN PSYCHIATRIC ASSOCIATION

SHAPING THE FUTURE OF THE

DSM

t may seem strange to say this after a more than 30-year career in academic psychiatry, but I have only recently begun to truly understand the importance of diagnosis. This has driven my growing interest in the Diagnostic and Statistical Manual of Mental Disorders (DSM). When I completed my psychiatric training and began to pursue further experiences in clinical research in sleep and mood disorders, I appreciated the necessity of defining whom we were studying, their diagnostic profile and how this might help increase our understanding of the relationship of biological psychiatry to clinical diagnosis and practice. I also realized that in communicating diagnoses and scientific findings with colleagues abroad, particularly in Europe, we encountered difficulties that were often based on the use of different diagnostic criteria. As I became busy with research and clinical administration, the importance of diagnosis, and of the DSM and the International Statistical Classification of Diseases and Related Health Problems (ICD) systems became even more evident. This understanding, in turn, led to my involvement in the APA and my activities as chair of the Committee on Psychiatric Diagnosis and Assessment. Groundwork for the DSM-V began in 1999 when the APA, the National Institute of Mental Health and other groups met to talk about how to integrate new research in genetics, neuroscience, and behavioral science into our diagnostic system. This led to a succession of planning sessions, conferences, and white papers culminating in a

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BY DAVID J. KUPFER, M.D. Chair, DSM-V Task Force University of Pittsburgh School of Medicine, Pittsburgh

series of 13 conferences between 2004 and 2008 under the guidance of an international steering committee. These exciting interactions with our peers around the globe will have a major influence on the final DSM-V product. Our work with our international colleagues to harmonize the DSM and the ICD prompted us to prioritize important cross-cutting themes that represent worldwide needs — including the adoption of a lifespan developmental approach to psychiatric diagnosis, improved understanding of the interrelationships between psychiatric and medical conditions, and the development of instruments to measure functioning and to assess a number of other important dimensions. Current communication tools allow for unprecedented interaction among the geographically and professionally diverse DSM-V Task Force and Work Group members as they incorporate appropriate new knowledge to develop a DSM-V that will serve the profession and our patients well. I have been impressed by the quality of the scientific debates, the passion of clinicians for patients and their families, and the overall spirit of collaboration required to succeed in such a large venture. I never expected development of the DSM-V to be dull, but I have been amazed by the enthusiasm and commitment of everyone involved.


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BY GEOFFREY M. GABRIEL, M.D. Greenville Hospital System, South Carolina, University Medical Group Department of Psychiatry and Behavioral Medicine

FOCUS

ON LIFELONG LEARNING

he APA provides a lifelong learning tool that fits my lifestyle and my learning style. FOCUS, The Journal of Lifelong Learning in Psychiatry, brings me a nice mix of clinical articles, reviews and research. In addition, I can use it to earn up to 40 hours of continuing medical education (CME) a year. I can put it in my briefcase, and it’s available when and where I have time. FOCUS helps me stay current on issues I face as a hospital psychiatrist and provides me with tools for my own professional growth as well as for teaching medical students. It also allows continual self assessment and development. Ethics, Professionalism and End of Life Care was a recent issue of FOCUS that I found especially relevant. As a geriatric psychiatrist, I deal daily with ethical issues related to end-of-life and palliative care. This issue of FOCUS provided new information and even prompted me to delve more deeply into the topic by ordering a book from APPI. FOCUS is also helpful with issues outside my daily scope of practice. I am trained in geriatric psychiatry and left child and adolescent issues behind in residency. The spring 2008 issue, Child and Adolescent Psychiatry, provided enough current and in-depth information to enable me to provide competent consults on adolescent issues.

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I also find FOCUS valuable when teaching medical students. The winter 2008 issue, Major Depressive Disorder and Suicide, was particularly helpful recently in my interactions with a student. The articles provided detailed case studies that served as a starting point for useful discussions. In addition, I often use the Patient Management Exercises with medical students and share review articles. Students readily understand the articles and enjoy them. It speaks highly of FOCUS that it appeals to a wide range of individuals with different interests and backgrounds. FOCUS is a well-written journal that represents our specialty and our association well.


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BY APRIL MORCIGLIO, M.D., PGY-4 University of South Carolina, Palmetto Health Alliance

100% CLUB:

RESIDENTS EXPLORING OPPORTUNITIES

eing part of the APA during my psychiatric residency has provided me with a wealth of opportunities to see the profession from different vantage points and to do meaningful work for the profession and for our patients. I am a fourthyear resident at the University of South Carolina, which is proud to be part of the APA 100% Club, which means all 23 psychiatry residents are APA members. Two events stand out in my mind in the last year that would not have happened if I had not been part of the APA. As a member of the APA Committee on Women, I was a co-chair of a workshop on novel careers in psychiatry at the APA Annual Meeting. This experience allowed me to interact with women like Melva Green, M.D., who expands the reach of her psychiatric practice to underserved communities in Baltimore through her weekly radio program, and Colonel Elspeth Cameron Ritchie, M.D., a psychiatrist in the U.S. Army who coordinated the Pentagon’s mental health response in the weeks after the 9/11 terrorist attacks and has worked to address the special needs of women who are deployed to a war zone.

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My heart now is with public psychiatry, and I think I will begin my career in a state psychiatric hospital or a community mental health center. But my experience with the APA has shown me the range of opportunities in psychiatry. These women are a great inspiration to me and to other psychiatrists-in-training who participated in the workshop. My most memorable experience in the last year was the role I was able to play in the successful fight for federal parity legislation. During the Fall Component Meetings in Washington, DC, fellows were asked to schedule meetings with their representatives. I met with staffers for South Carolina Senators Lindsey Graham and Jim DeMint. This marked the first time I was able to advocate for our patients in this manner. When I got word parity legislation had passed, I was overwhelmed with joy. Mental health patients should not face inequitable co-pays and be forced to choose between needed visits to a doctor and other necessities. It was very gratifying to have been a part of the process that will help to eliminate some of those difficult decisions.


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SERVICE SHAPING OUR FUTURE THROUGH

By successfully fighting for parity for mental health coverage, educating the public about mental illnesses, working to reduce stigma, and providing learning opportunities at every stage of the physician’s career, the APA continued in 2008 to shape the future of the profession through service.

Gaining Parity for Mental Healthcare. More than a decade of work by APA staff and members culminated with the enactment of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. The legislation marks a huge step toward the end of inequity in health insurance benefits for mental health disorders, including substance use disorders. The law, which applies to certain employer-sponsored group health plans, brings the promise of non-discriminatory mental health coverage to 113 million people across the country.

Supporting Mothers. The APA actively supported and worked for passage of the Melanie Blocker-Stokes MOTHERS Act, which would provide education about postpartum depression for expectant mothers and inform them about available services. Protecting Patients. The APA worked with District Branches and State Associations to block efforts to secure prescribing privileges for psychologists in California, Hawaii, Mississippi, Missouri and Tennessee. Joining forces with the American Medical Association and other medical

societies, the APA addressed the issue of non-physician providers expanding their scope of practice. Promoting Awareness. “Seeking help is a sign of strength” was a focus of the APA initiative for Mental Illness Awareness Week in October. The APA distributed a series of radio public service announcements on mental health and mental illness and arranged interviews with APA members across the country. At least 60 radio stations and networks in 26 states ran the announcements.


2008 ANNUAL REPORT

AMERICAN PSYCHIATRIC ASSOCIATION

FACING PAGE, LEFT: Sen. Pete Domenici (R-N.M.) speaks at an impromptu press conference on Capitol Hill in 1996 to rally support for mental health parity after parity legislation was overwhelmingly passed by the Senate a few days earlier. The passage of the 1996 legislation set the stage for the Paul Wellstone & Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. FACING PAGE, RIGHT: R. Dale Walker, M.D., chair

of the Council on Advocacy and Public Policy, (left) presented the President’s Special Recognition Award to Jeffrey Akaka, M.D., for his legislative efforts on scope-of-practice issues in Hawaii. Also pictured is Lori Murayama, M.D., secretary-treasurer of the Hawaii Psychiatric Medical Association.

Fighting for Military Mental Health. The mental health of military service members and their families was the focus of the APA’s Mental Health Month campaign. The APA sponsored a survey of military families and a survey of APA members on experience with TRICARE, the U.S. government’s health insurance program. The Mental Health Month campaign — part of the ongoing “Healthy Minds. Healthy Lives.” campaign — opened with a national press conference and included

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BELOW, LEFT: James Peake, M.D., secretary of the

Department of Veterans Affairs, tells Advocacy Day attendees about federal efforts to improve the mental health care provided to veterans and members of the military. BELOW, MIDDLE: OMNA on Tour gathered mental health experts in Los Angeles, for its fifth and largest gathering, to strategize on reducing health care disparities and co-occurring disorders. Seated, from left: Dan Dickerson, D.O.; Carl Bell, M.D.; Roderick Shaner, M.D.; Keris Myrick, M.B.A., Ph.D. Standing, from left: Donald R. Vereen, M.D.; M.P.H.; Marcia Goin, M.D.; Altha Stewart, M.D.; Nancy Carter of NAMI; Annelle Primm, M.D., M.P.H.; and Rev. Ronald Wright. BELOW, RIGHT: The APA’s Office of Minority and

National Affairs, in collaboration with the Minority Affairs Consortium of the American Medical Association, coordinated a Doctors Back to School event at the Steinmetz Academic Center in Chicago where psychiatrists oriented high school students to the field of psychiatry. The event is meant to inspire young people to consider a career in mental health.

a radio media tour and several public service announcements. Improving Medicare. The APA worked to ensure that the Medicare Improvements for Patients and Providers Act of 2008 includes protections for the six classes of clinical concern, as well as the elimination of the discriminatory 50 percent co-pay for mental health treatment. The co-pay will be phased out and eliminated by 2014.

Closing the Gap. OMNA on Tour continues to educate communities to close the gap of mental health disparities. The Office of Minority and National Affairs held a workshop in Los Angeles to focus on co-occurring disorders and the impact ethnic and racial disparities in access to mental healthcare have on community well-being. Working with Faith Leaders. The APA worked with the Center for the Integration of Spirituality and Mental Health to encourage faith leaders to


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SERVICE focus on providing support for individuals with mental illnesses and to promote mental health awareness. Improving Communication. In Living Color: Depression Treatment in Primary Care is a new program to help primary care physicians better recognize and treat depression in diverse patient populations. The APA collaborated with the National Alliance on Mental Illness to develop this program to improve doctor-consumer communications about depression. Informing Members. APA’s Headlines was expanded to reach nearly 20,000 members daily with summaries of mental health news. In a survey, readers indicated that the daily briefing helps expand the sources they read and helps them be aware of news patients may come across. Assisting Early Careers. The APA book Practice Management for Early Career Psychiatrists was updated, and revised chapters were posted on the psych.org Web site. A CD of the book was distributed as an APA member benefit. Reaching Out to Latino Patients. A bilingual public service DVD and companion guidebook entitled Mental Health: A Guide for Latino Patients and Families was developed for release in early 2009. The guidebook discusses mental illnesses, treatments and how to find mental health care.

Sharing Information. Resources to inform members about electronic health records were maintained on the psych.org Web site. The resource page provides easy access to information on health information technology, provides links to outside resources, and allows physicians to post and read reviews of health information technology products.

Growing the Profession. Medical students learned about careers in psychiatry at a mentor breakfast during the annual meeting of the Student National Medical Association in New York City. The event was part of the APA Minority Fellowship Program, which promotes careers in psychiatry through scholarships and mentoring.

Protecting Privacy. The APA, along with members of the Mental Health Liaison Group privacy subcommittee, delivered a letter to Senate leadership expressing concerns about patient privacy and security related to the proposed Wired for Health Care Quality Act.

Inspiring Students. Fellows and medical students visited high schools in Washington and Chicago as part of the APA’s Doctors Back to School program, established to inspire young students to consider attending medical school and pursuing careers in psychiatry.

Educating Consumers. New topics were added to the Let’s Talk Facts brochures series. New titles include Mental Health of Seniors, Substance Abuse & Addictions, Alzheimer’s Disease, Schizophrenia, Mental Health in the Hispanic/Latino Community (both in English and Spanish) and Mental Health in Asian Americans and Pacific Islanders. Helping States. The APA supported district branches in Pennsylvania, Wisconsin, Delaware, Oklahoma, Maryland, California and the District of Columbia on Medicaid legislative and regulatory issues related to access to medically necessary psychotropic medications.

Mentoring Network. Maryland, Pennsylvania and Tennessee developed minority mentoring programs in conjunction with the APA’s National Minority Mentors Network. The APA assists local and regional training programs, which serve as extensions of the network.


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AMERICAN PSYCHIATRIC ASSOCIATION

BY BARRY B. PERLMAN, M.D. Chair, APA Committee on Government Relations Director of Psychiatry, Saint Joseph’s Medical Center, Yonkers, N.Y.

WINNING THE FIGHT FOR

PARITY

sychiatrists know how important a sense of “mastery” is to one’s sense of well-being. In the 30-plus years since I completed my residency, the world in which we practice has radically changed. Today we practice in a highly politicized arena. Depending on our practice setting, we are increasingly subject to the rapidly expanding demands of state and federal regulatory agencies, accrediting organizations and health insurers. As individuals, our power to push back against the forces that impinge on our professional lives is limited, but as members of the APA our concerns are heard and our ability to fight for what we believe in is enhanced. The APA and its state associations are the voice of our profession and advocates for those we serve. Members embody the values and express the concerns of our profession. I have been deeply engaged with APA and the New York State Psychiatric Association for well over two decades. During that time I have been honored to serve as the president of NYSPA, as its representative, and as chair of the Committee on Government Relations. I have also had the pleasure of serving as chair of the New York State Mental Health Services Council and as a member of the New York State Hospital Review and Planning Council.

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I will remember year 2008 as the one when I saw the realization of state and federal mental health parity laws. Enactment of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 ensures equal coverage to millions of Americans who seek treatment for mental illnesses, which for me and many psychiatrists represents far more than equitable insurance coverage. We saw it as another important achievement of the “civil rights” movement, which has been and continues to be a central part of the progressive political agenda of America for the past half-century. As a result, I have experienced the wonderful sense of having had a positive impact on my practice environment, which in turn has greatly enhanced my professional well-being and satisfaction.


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AMERICAN PSYCHIATRIC ASSOCIATION

BY MICHELLE O. CLARK, M.D., DFAPA President, Golden State Medical Association

TAKING SERVICE ON THE

ROAD

any Americans in minority communities remain at a disadvantage in learning about and receiving mental health services, including substance abuse treatment, even as the nation becomes more aware of mental health concerns and effective treatments. OMNA on Tour is a traveling education program designed to inform communities around the nation about the significance and impact on community well-being of ethnic and racial disparities in mental health. The tour, conducted by the APA Office of Minority and National Affairs, aims to foster collaboration among a variety of stakeholders with the goal to develop local action plans to eliminate mental health disparities. I first became involved with OMNA on Tour during its inaugural conference held in concert with the American Association of Community Psychiatrists at Howard University School of Medicine in Washington, DC. In spite of an atypical snow storm that day, the conference was well attended and very stimulating. My next experience was in New Orleans, where OMNA partnered with the All Healers

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Mental Health Association and Black Psychiatrists of America, Inc. Survivors of the southern Louisiana hurricanes of 2005 attended and shared their personal experiences of trauma, recovery and heroism. My next and most recent experience with the program, OMNA on Tour: Co-Occurring DisordersNo Longer Double Jeopardy, occurred in my home city of Los Angeles. There I experienced a series of broad multicultural presentations that provided insights regarding cultural realities of the many ethnic subcultures and the unique mental health issues for each. In the ongoing effort to educate communities and close the gap of mental health disparities, mental health experts came together to improve mental health outcomes for underserved populations in the Los Angeles area. It was an excellent opportunity to expand awareness about minority mental health issues.


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AMERICAN PSYCHIATRIC ASSOCIATION

BY JACK CROUGHAN, M.D. President of Eastern Missouri Psychiatric Society (2006–2008)

THE BATTLE FOR

ACCESS

s president of the Eastern Missouri Psychiatric Society (EMPS), I was the chief spokesperson and point person “on the patrol” during the 2008 legislative session. I didn’t have to wait long to represent our members and patients. Though many states have been fighting psychologist prescribing legislation in recent years, Missouri was the first state to do battle on the issue in 2008. Armed with speaking points and facts that APA provided, I was ready to testify. I discovered that people don’t like to hear a steady diet of criticism, and that it’s important to focus on the positive when testifying. Emphasizing the positive aspects of being evaluated by a medically trained physician is more powerful than being critical of the psychologists for their lack of medical training and experience. Legislators like to vote positively. Another important thing I learned was to be flexible. You must be ready to jump ship on all of your pre-planned positions and notes if the other side brings up issues you had not anticipated. A canned speech may not do anything to refute important points made by the other side just a few minutes before.

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Two bills aimed at allowing non-medically trained psychologists to prescribe medications in the State of Missouri failed to pass during the 2008 legislative session. We had many soldiers in this fight and will reassemble when the battle lines are drawn again. The EMPS is also addressing the related issue of access to care, particularly in rural areas. We have proposed providing telephone consultations by psychiatrists to primary care physicians in rural areas. This gives primary care physicians access to a psychiatrist for consultation as well as handson training that, over time, improves the primary care providers’ ability to handle issues related to prescribing psychotropic medication. It also reduces reliance on less qualified mental health providers. EMPS is providing funding for a statewide toll-free phone line staffed by volunteer psychiatrists.


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AMERICAN PSYCHIATRIC ASSOCIATION — AFFILIATES

American Psychiatric Publishing, Inc. The First and Last Word in Psychiatry American Psychiatric Publishing, Inc. (APPI), the APA’s publishing subsidiary, had a strong year in 2008. APPI is the world’s premier publisher of books, journals, and multimedia on psychiatry and is the publisher of the Diagnostic and Statistical Manual of Mental Disorders and The American Journal of Psychiatry, the oldest continuously published medical specialty journal in the United States. More than 700 titles sell actively, and APPI published 33 new books in 2008, including textbooks, clinical manuals and monographs, and many titles are available as ebooks. APPI also publishes six journals, one newspaper, and self-assessments. The variety of psychiatric research, treatment, and educational materials APPI publishes every year helps the APA shape the future of psychiatry. ■ Journal Tops in the Field. The American Journal of Psychiatry has long been the leading publication in the field in terms of total citations of the articles it publishes, but this year the Journal also became the number one publication in psychiatry. The Immediacy Index, a Thomson Scientific measure of journals that are published in emerging areas of research, showed that The American Journal of Psychiatry holds the top spot. This performance metric represents the average number of times an article published in a specific year is cited over the course of that same year. The Journal also saw its Impact Factor rise almost a full point to 9.127, with a continued rise to over 10 expected next year, placing it in an elite tier. ■ Psychiatric News Preferred by Members. Psychiatric

News conducted a readership survey in 2008, and results show that the newspaper continues to be a valued — and valuable — member benefit. Among its major findings: 85 percent of respondents said that the quality of articles in Psychiatric News was excellent or good, 78 percent rated Psychiatric News as excellent or good in meeting their professional needs and 80 percent said that Psychiatric News was more valuable than other comparable trade publications. Psychiatric News was also the preferred publication for information on psychiatry and mental health issues and for employment opportunities within the field of psychiatry. ■ New Partners in Europe. APPI completed its first year with its new partners in Europe, resulting in a 100 percent increase in sales. APPI books are now more readily available to APA members and other customers in Europe, who can

order directly through nbninternational.com, local bookshops, amazon.co.uk, or bookdepository.co.uk. ■ PsychiatryOnline.com Expands. PsychiatryOnline continues to grow in number of subscribers and content. APPI offers site license sales to institutions, which provide unlimited access across college campuses and share APPI books and journals with more readers than ever before. A “mobile” version of PsychiatryOnline will soon launch to provide an optimal experience from handheld devices like smartphones and PDAs, further increasing the portability and clinical utility of PsychiatryOnline content. ■ Multimedia Textbooks. APPI successfully launched innovative web companions for its line of subspecialty textbooks. Buyers of the print textbook gain access to a custom Web site for that book supplementing the learning experience with full-text searchability, reference linking, slideshows, interactive study guides, and more. ■ Core Textbook Updated. American Psychiatric Publishing Textbook of Psychiatry, Fifth Edition, has been meticulously revised to maintain its preeminence as an accessible and authoritative educational reference and clinical compendium. More than 100 contributors — 65 new to this edition — summarize the latest developments in psychiatry. Each chapter ends with key points, recommended readings, and helpful Web sites for clinicians, patients, and family members.

Other noteworthy books published by APPI in 2008 include: Textbook of Psychotherapeutic Treatments, Mentalizing in Clinical Practice, Recovery From Disability: Manual of Psychiatric Rehabilitation, American Psychiatric Publishing Textbook of Substance Abuse Treatment, 4th Edition, Textbook of Hospital Psychiatry, Approach to the Psychiatric Patient: Case-Based Essays, and Cognitive-Behavior Therapy for Severe Mental Illness: An Illustrated Guide


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AMERICAN PSYCHIATRIC ASSOCIATION — AFFILIATES

American Psychiatric Foundation Advancing Public Understanding of Mental Illnesses The American Psychiatric Foundation is the philanthropic and educational arm of the APA. The foundation develops programs to advance public understanding that mental illnesses are real and treatable. These programs take many forms, including grants and specific educational campaigns designed to increase awareness of mental illnesses and improve access to treatment. The foundation continued to work toward these goals through several educational, informational and outreach grants and programs.

■ Community Connections: Let’s Talk Depression, was presented in Memphis and in Columbia, South Carolina. Community Connections is an educational program that combines a town hall meeting concept with depression education. It is an exciting program that allows depression education to be offered in settings tailored to the unique social economic and cultural needs of a community.

■ The Typical or Troubled?™ mental health education

program was expanded during the 2008 – 2009 school year. More than 12,000 teachers and other school personnel across the nation participated in the program, which has been implemented in 125 high schools, serving more than 180,000 students. ■ The foundation formed a partnership with the Give An Hour program to create a public education campaign to help generate awareness about the mental health issues that military service members and their families face. The purpose of the campaign is to develop a national network capable of responding to the needs of this group. ■ The Helping Hands Grant program awarded grants to medical schools for student-run community mental health service activities, particularly in underserved communities. ■ The Partnership for Workplace Mental Health continued to advance effective employer approaches to mental health. It expanded Employer Innovations Online, a Web-based, searchable database that profiles employers’ innovative programs and practices for addressing mental health in the workplace. Work also continued on the Disability and Return to Work Initiative, a project focused on improving the assessment and management of disability due to mental illness. A pilot project is in place to test the effectiveness of the tools developed by the initiative. ■ The foundation and six prominent physician, patient and civic organizations — collectively known as the Depression Is Real Coalition — in May 2008 launched “It Is Depression,” a groundbreaking series of public service announcements aimed at increasing awareness of depression. These PSAs comprise the Coalition’s second bilingual, multi-media campaign about the reality of living with depression and the seriousness of the disease.

■ Actress Patty Duke was the guest for the seventh annual Conversations event at the 2008 APA Annual Meeting in Washington, DC. In an interview with APF’s immediate past-president, Altha J. Stewart, M.D., Duke shared her story of having bipolar disorder and her struggle to understand and cope with her diagnosis. More than 900 people attended the event. Dr. Stewart also interviewed author Terrie Williams at the second Conversations held at the Institute on Psychiatric Services meeting in Chicago. In her book, Black Pain: It Just Looks Like We’re Not Hurting, Ms. Williams shares her story of being an African American with depression. ■ The foundation’s annual benefit event, “Windows on Washington” was held at Washington, DC’s Union Station in May. The evening also featured the presentation of the Awards for Advancing Minority Mental Health to the following individual and organizations: Francis G. Lu, M.D., Homes for the Brave, Housing Works, and Tristan’s Quest — Support for Kids of Incarcerated Parents. The awards recognized innovative efforts to raise awareness of minority mental health issues in underserved communities.


16 2008 ANNUAL REPORT

AMERICAN PSYCHIATRIC ASSOCIATION — AFFILIATES

APAPAC: Psychiatry’s Voice in Washington APAPAC is the political voice for the American Psychiatric Association. APA invigorates its patient and professional advocacy activities by establishing a political action committee that allows APA, at the national level, to educate and lobby members of the House and Senate of the U.S. Congress. The APAPAC Board of Directors continues its work to put psychiatrists’ PAC dollars to the best possible use. With dozens of new members and leadership in Congress, the Board remained focused on maintaining access to key Democrats and Republicans on the committees and subcommittees with jurisdiction over matters of concern to psychiatrists and patients. The PAC enjoyed back-to-back record breaking years in 2007 and 2008 with contributions from APA members and staff totaling over $594,000. APAPAC put those funds to use immediately, distributing over $447,500 to 138 candidates for Congress (representing 40 states) and other party-affiliated political committees. Sixty-four percent of the candidates and committees supported were Democrat and 36 percent were Republican, while 60 percent of the funds went to Republicans and 40 percent to Democrats. The PAC also hosted events for 103 Members of Congress who support APA’s legislative goals. Ninety-one percent (106 of 117) of APAPAC-supported candidates who were up for re-election this year were victorious on November 4th. (Outcomes of races involving two more supported candidates had not been decided at the time of this writing). Once again, the APAPAC Board of Directors was effective in balancing support for candidates from both political parties; TOP: John Wernert, M.D., APAPAC Chair (center), David Diaz, M.D., APAPAC Member (right), and Rep. Phil Gingrey, M.D. (R-Ga.) (left) talk during APA’s Advocacy Day. BOTTOM: Tiffany Farchione, APAPAC Board Member (center), with Rep.

Tim Murphy (R-Pa.) and Rep. Jason Altmire (D-Pa.) at APA’s Advocacy Day.

using its political power for access to key Republican and Democratic members who serve on the various committees and subcommittees of jurisdiction; and engaging allies and educating others on APA issues. In fact, these contributions allowed the PAC to play a crucial role during both the mental health parity and the Medicare legislative debates in Congress, helping both bills become law! The APAPAC Board of Directors remains dedicated to putting APA member funds to the best possible use for the profession and patients.


2008 ANNUAL REPORT 17

AMERICAN PSYCHIATRIC ASSOCIATION — AFFILIATES

American Psychiatric Institute for Research and Education: Advancing Psychiatric Practice Through Research and Education The American Psychiatric Institute for Research and Education (APIRE) contributes to the scientific base of psychiatric practice and policy by conducting and supporting projects that bridge the gap between research and practice. Among APIRE’s activities in 2008: ■ Medicaid Prescription Drug Policies and Psychopharmacologic Treatment Access and Continuity Studies. These studies examined the scope and consequences of medication access problems among Medicaid and Medicare psychiatric patients. Among the important findings coming from these studies are that all of the prescription drug utilization management policies and medication access problems studied were highly associated with significant adverse events such as emergency department visits, hospitalization, homelessness, or detention/incarceration in jail or prison. These findings are actively being used by the APA and other advocacy groups to help improve Medicare and Medicaid prescription drug policies. Given the policy relevance of these clinically detailed databases, funding for further analyses has been obtained from the Agency for Healthcare Research and Quality. ■ National Depression Management Leadership Initiative. In collaboration with the American Academy of Family Physicians and the American College of Physicians, APIRE completed a research demonstration project designed to assess the feasibility of implementing the nine-item Patient Health Questionnaire (PHQ-9) as a common metric for monitoring depression severity in primary care and psychiatric practices. At the conclusion of the project, both primary care and psychiatric practices had adopted the PHQ-9 as a routine part of depression care and reported use of the PHQ-9 for screening, assessing illness severity, and monitoring of treatment response. Study findings, which were recently published in the journal Psychiatric Services, suggest that adoption of measurement-based care is achievable in both primary care and psychiatric settings.

■ Treating the Invisible Wounds of War: Collaboration with the Department of Defense. APIRE received two awards from the Department of Defense for studies focused on mental health services for returning soldiers. The Walter Reed Army Institute for Research Survey of Routine Army Mental Health Care will characterize routine practice in Army behavioral health settings, including patient, clinician, and setting attributes, and assess the extent to which clinical practices conform with evidence-based treatment recommendations for posttraumatic stress disorder (PTSD), traumatic brain injury, substance use, depression, and suicidal ideation/ behavior. The information will be used to construct a clinically detailed data base that will provide a first-ever, in-depth understanding of patterns of diagnosis and treatment in Army military treatment facilities, identify key service delivery factors that facilitate or impede the delivery of evidence-based assessment and treatments, and improve quality of care provided. The Comprehensive Approach to Disseminate Evidence-Based Care for PTSD is developing and pilot testing a concentrated continuing medical education course for training military clinicians in evidence-based screening, diagnosing, monitoring, and treatment of PTSD and depression. As a result of this work, military health care systems will have a workable model for implementation and dissemination of evidence-based care for PTSD and other psychiatric disorders. ■ “The Future of Psychiatric Diagnosis: Refining the Research Agenda” was a series of 13 research planning conferences, organized and administered by APIRE in collaboration with the World Health Organization and the National Institutes of Health, which funded the series. The initiative was successfully completed in 2008 with a conference on autism and other pervasive developmental disorders. A summary of each of the conferences can be viewed at www.psych.org/dsmv. Four “Research Agenda for DSM-V” monographs have been published, with eight titles in press or production. Approximately 90 journal publications have resulted from this conference series, and its related documents are now serving as a fundamental resource for the DSM-V Task Force and Work Groups.


18 2008 ANNUAL REPORT

AMERICAN PSYCHIATRIC ASSOCIATION

A STRONG ASSOCIATION APA FINANCE, OPERATIONS and ADMINISTRATION

Membership The total number of members continued to increase throughout the year due to significant recruitment activity in 2008, and reached a high of 37,584 in September. However, the new dues payment deadline of October 31 had an effect on the membership total and the year ended with 35,619 members. Membership Recruitment and Retention Approximately 120 members referred a colleague for membership through the Member-Get-a-Member Campaign which will be extended into 2009. Nearly 50 members joined the APA through the Annual Meeting Rebate Program and 13 members joined through the joint membership campaign with the American Association for Geriatric Psychiatry. Targeted mailings were sent to nonmember psychiatrists throughout the year, including residents, psychiatrists insured through the APA-endorsed program, and Annual Meeting registrants. APA exhibited at several psychiatry meetings to promote membership, including the Canadian Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, the American Association for Geriatric Psychiatry, and the U.S. Psychiatric and Mental Health Congress. A series of four promotional postcards was developed in 2008 highlighting important APA activities and benefits. The postcards are centered on the APA tagline “Member driven. Science based. Patient focused.” and were mailed to targeted membership groups on a quarterly basis beginning in the summer. The postcard mailings will continue into 2009. Member Benefits Several new affinity programs were added to the list of member benefits in 2008, including financial and retirement planning through Merrill Lynch, the HealthCare Notification Network (HCNN), a service that delivers FDA-mandated drug Alerts instantly online, discounts on Penny-Wise office products, discounts on Fed-Ex shipping services, and PsychSites, a Web site that is an online therapist referral

directory where APA members receive a free three-year trial of a personal page with biography, photo and links through the Web site. Branded Merchandise Membership operated an APA Store at the annual meeting offering a selection of merchandise with the APA name and/or seal. Popular items included baseball hats, polo shirts, jackets, and executive fountain pens.

Information Technology

The year 2008 resulted in many technological accomplishments and challenges with respect to the continued implementation and live use of the APA’s association management system, TMA Resources Integrated Member Services Solution (TIMSS). The team continued efforts to resolve outstanding issues with implementing the new finance system. They also worked on planning stages of bringing APPI into the association management system fold. Initial efforts focus on a business needs discovery to provide documentation of the current systems in place. IT has nearly completed the development of the new District Branch and State Association Web site system, which will provide participating district branches with a Web site and contact management system. The completion of the sites will be finalized and district branches notified of the availability of this service in 2009.

Financial Outlook

Association operating funds come from three main funding sources: membership dues, publications, and the annual meeting. Total association operating revenues and grants for fiscal year 2008 were $65 million. Net assets were $64 million, down from $77 million in 2007, most of which was due to the decline in the investment market. Several years ago, the association eliminated its reliance on investment income to support current operations. As a result, we were


2008 ANNUAL REPORT 19

AMERICAN PSYCHIATRIC ASSOCIATION

not forced to precipitously cut activities as a result of the downturn in the market. Last year, we reported that uncertainty in the economic environment was likely to affect our revenue and cost streams; and indeed 2008 was a challenging year. Although revenues from membership and the meetings were generally on target, there are declines in advertising receipts. The association has a

long-standing contingency plan to address anticipated shortfalls, and took steps early in the year. As a result, on a consolidated basis, the association ended the year with a surplus, though smaller than what was budgeted. APA members can find more detailed financial data in the Members Corner section of the APA Web site, www.psych.org.

3%

17% 6%

8%

38%

5%

27%

22%

6%

4% 31%

5% 4%

2% 22%

2008 Operating Revenues* ■ ■ ■ ■ ■ ■

Membership Publishing Federal Awards, Research & OMNA Continuing Medical Education Foundation & Other Private Award Revenue

Total Revenue

11.1 25.7 2.4 20.1 2.3 3.7 65.3

2008 Operating Expenses* ■ ■ ■ ■ ■ ■ ■ ■ ■

Membership External Affairs Publishing Federal Awards, Research & OMNA Continuing Medical Education Foundation Private Award Expenses Business Operations Governance & Components

Total Central Office Expenses *Dollar amounts are expressed in millions.

1.7 5.3 16.5 4.0 14.3 1.0 3.2 14.1 3.4 63.5


20 2008 ANNUAL REPORT

AMERICAN PSYCHIATRIC ASSOCIATION

APA BOARD OF TRUSTEES (2008–2009) BOARD OF TRUSTEES (2008-2009) Officers Nada L. Stotland, M.D., M.P.H. President Alan F. Schatzberg, M.D. President-Elect Carol Ann Bernstein, M.D. Vice President David Fassler, M.D. Secretary-Treasurer Voting Past Presidents Carolyn B. Robinowitz, M.D. Pedro Ruiz, M.D. Steven. S. Sharfstein, M.D.

Trustees Amy M. Ursano, M.D. Jeffrey L. Geller, M.D., M.P.H. Dilip V. Jeste, M.D. John C. Urbaitis, M.D. Sidney H. Weissman, M.D. Mary Helen Davis, M.D. Thomas K. Ciesla, M.D. William M. Womack, M.D. Lauren M. Sitzer, M.D. Roger Peele, M.D. James E. Nininger, M.D. Melinda G. Fierros, M.D.

ASSEMBLY (2008–2009) Officers Ronald M. Burd, M.D. Speaker Gary S. Weinstein, M.D. Speaker-Elect Bruce A. Hershfield, M.D. Recorder James H. Scully Jr., M.D. Medical Director and Chief Executive Officer


2008 ANNUAL REPORT 21

AMERICAN PSYCHIATRIC ASSOCIATION

2009 MEETINGS:

SAVE THE DATE

163rd APA Annual Meeting May 22–27, 2010 New Orleans

ALAN F. SCHATZBERG, M.D. PRESIDENT JULIO LICINIO, M.D. CHAIR, SCIENTIFIC PROGRAM COMMITTEE

62nd Institute on Psychiatric Services October 14–17, 2010 Boston CAROL BERNSTEIN, M.D. PRESIDENT-ELECT ANITA SMITH EVERETT, M.D. CHAIR, SCIENTIFIC PROGRAM COMMITTEE


American Psychiatric Association 1000 Wilson Blvd., Suite 1825 Arlington, VA 22209 (703) 907-7300 or (888) 35-PSYCH

E-mail: apa@psych.org www.psych.org www.HealthyMinds.org


SHAPING OUR FUTURE, SCIENCE and SERVICE  

American Psychiatric Association 2008 Annual Report

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