AACP Newsletter, Volume 10,
Number 3, Summer 1996
President’s Column:
Changing of the Guard
Dr. Silver’s last President’s Column in which he reflected on his tenure as President and the history of the AACP, offers me a great starting point for my turn at writing this column. We are very fortunate to have had Dr. Silver’s superb stewardship of the AACP these past four years. He has ably guided the AACP through its own transitions and he has led us all through the amazing, sometimes frightening, changes in the systems of care in which we work. I have come to dearly love and respect all those who have offered their time and energy to serve on the Board. The remarkable thing about the AACP for me is that our leadership seems to reflect so well the membership; we are the trench working psychiatrists in community mental health systems. We are the ones who are with the case managers, in the shelters, on the streets and with the patients regardless of our titles, academic roles, fame or fortune. All of you I have come to know seem to revel in discussing the difficult, complex clinical issues that surround our patients. I am always amazed at the interest and energy we have in improving the systems of care we serve in. More than any other group of psychiatrists we seem share a profound respect for our patients and their families. On average the psychiatrists I have come to know in the AACP seem more joyful in their work and have more fun professionally. With all the strange and unsettling forces afoot in our world, community psychiatrists seem to be more optimistic and proactive in searching for solutions to problems.
Let me share with you some of my personal history as a way of introducing myself to you as the new AACP President and as a case example of AACP leadership. I was one of those who participated in the tumultuous days in the ‘60’s in street clinics and drug abuse flying squads, talking down hippies on bad trips. As I moved through my residency I found a more responsible outlet for my idealism, and my need to understand hard and damaged lives, by working for a community mental health center. I became a child and adolescent psychiatrist: my passion is in working with teenagers. I split my time between a CMHC and child-oriented social service agencies and a private practice. I am one who strongly believes that, an orientation as a community psychiatrist profoundly shapes ones private practice, particularly one devoted to working with kids. In my 20 years at the mental health center, I worked in most of the programs serving adults and older adults. I started in day treatment programs that evolved to clubhouse programs and intensive case management teams. I found that working with the elderly was particularly rewarding for a child psychiatrist. I also served for many years in the CMHC's child and family programs. I was the psychiatrist who went into the schools with a school-based mental health service team. I consulted to our therapeutic preschool and I supervised the resident serving in a children’s intensive case management program practicing the art of wraparound services to the most difficult kids. I have consulted to social service, residential programs for kids and I am still a team member in a program that offers help to runaway and disaffected teens through foster care and family reconciliation. Of late I have become a therapist on a research team at the University of Washington studying a behavioral treatment for suicidal borderline women.
Recently I have made a career move which I hope doesn’t prove the Peter Principle. I have joined the staff at our county’s mental health division as a part time medical director for child and adolescent programs. We are launched on the brave and frightening adventure of bringing managed mental health care to our county's Medicaid population under a waiver from HCFA. Our county has formed a non-risk baring contract with US Behavioral Health who contracts with our provider agencies and authorizes and monitors the care of our clientele. I have taken my passion for improving service systems into this new job. Through the borderline research program at the UW and my private practice I remain profoundly grounded in clinical work. But I must admit that I find myself talking about financial and administrative issues in the most wonkish terms. I hope that my own entree into the strange and daunting world of mental health administration will be a position from which I can establish a dialogue with you who read this column. I am convinced that old warhorse clinicians like myself must be in that world, dealing with managed care and the ravages of funding limitations.
I hope that many of you will respond to the articles you read in the Community Psychiatrist, especially now that we are moving into the more interactive medium of the World Wide Web. I know that many of you have stories parallel to mine and others of you are just launching on such adventures. By sharing your stories, your successes and frustrations, you can help me in the awesome task of leading this wonderful organization towards the next millennium.
Charles Huffine, MD
President
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