xxAACP Newsletter, Volume 11,
Number 1, Winter 1997
APA Presidental Candidates Respond to AACP Concerns
As in the past, Community Psychiatrist contacted the candidates for President-Elect in the upcoming APA elections and asked them to respond briefly to three questions which reflect AACP concerns. Over the past year, several poliltical issues have arisen which have had, or will potentially have, a significant impact on community psychiatry and community psychiatrists. This year's questions are related to these issues.
William H. Ayres, MD -- He has been in private practice for more than 30 years, working with a multidisciplinary group. he has a long history of service to the APA which includes serving as district branch president and Assembly representative. He has also served as a member of APA components and committees. He is the immediate past President of the AACAP has been its delegate to the AMA House of Delegates.
Rodrigo A. Muñoz, MD -- Dr. Muñoz, MD has been in private practice for more than 25 years. He has served in several capacities over these years, including: APA Vice President, APA Board of Trustees, President of the American Academy of Clinical Psychiatrists and as President and Representative to the IMH Caucus of the APA Assembly. He is also a Clinical Professor of Psychiatry at the University of California, San Diego.
- The publication of
Psychiatric Services, the Psychiatric Services
Resource Center, and the organization of the annual Institute
for Psychiatric Services has been the APA's most important link
to community psychiatry.How do you see their future?
Dr. Ayres
Community psychiatry has not reveived the attention that it should have from the APA. However, attendance at the Institute for Psychiatric Services has exceeded 2,000 this past year and it should continue to grow with vigorous support from the APA. With the expansion of managed care into Medicaid and other state and federal community programs, it may be more feasible politically for the APA to monitor the quality of the services provided than to monitor state operated programs. I started in community psychiatry in the Sixties, then in practive for over thirty years I have consistently treated Medicaid patients, performed court evaluations, and lobbied the state legislature to fight against cutting funds for community programs. I can provide the aggressive energy but will need your advice and help to create an effective initiative to help the patients served by community psychiatry.
Dr. Muñoz,
I see a bright future for the AACP. Our patients, and the public in general, are realizing that managed care programs have been a failure, that employers are reducing coverage and programs for their employees, and that the outlays for mental health coming out of private funds are increasing. At the same time, close to 60 percent of mental health is provided with tax dollars. This being the case, the opportunity is here for community leaders, for psychiatrists, and for mental health programs to advance ideas that restore responsibility to the community and create new ideas that better represent the current situation. Working with the poor, the chronically ill, and the homeless, I feel encouraged that my community here in San Diego is coming to realize that new programs are required.
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Great concern has been generated by the passage of the new
welfare restrictions. What do you see as the mental health
implications of these changes and what is the proper role for
the APA in addressing them?
Dr. Ayres
The APA, as a medical specialty society, should approach the political realities of the changes in the welfare system with a scientific approach of evaluating the outcomes. As psychiatrists, we certainly believe in helping our patients work against dependency on the government and toward employability and self sufficiency. However, collection of data that would ecamine the access to adequate child and elder care and the effects on family members with chronic psychiatric disorders would also be essential to allow us to draw conclusions on the overall effects of the law as well. Our APA should approach the DMH's of all 50 states, the District of Columbia and Puerto Rico to gather comparable data. With that data, our APA should aggressively push for refinements or substantive changes throught the state and federal executive or legislative processes. This will require more attention to the state level in supporting district branch and area activities and would parallel the attention given to Medicaid changes and health care reform legistlation.
Dr. Muñoz,
This is related to the first item. Being a Hispanic working in a community that has a large population of legal migrants who are not citizens, I am dealing with a crisis. My colleagues and I have rallied to the help of those who are going to be left without protection by insisting on the creation of culturally competent community clinics that integrate psychiatry in a number of medical services without direct government intervention. We have to remember that more than $250 billion in health care comes from private funds, often from the pockets of those who have the least.
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In light of recent attacks on affirmative action around the country,
how should the APA work to increase diversity in its membership and
leadership?
Dr. Ayres
Our APA should remain committed to diversity in the membership and leadership and zero tolerate for any discrimination. However committed the APA has been, the truth is that we have problems. The leadership, looking at the Board of Trustees, the Assembly, the Councils and Committees, and the District Branch Councils, are disproportionately comprised of older white males. The reason for this is that it reflects those who volunteer to serve on those components. Minorities and women, at times, feel awkward and uncertain in being aggressive in seeking leadership positions. They also may not have the mentors pushing, encouraging and nominating them to serve at the next level. We need senior minority leaders to serve as mentors for younder minority members. We also need older white males in leadership roles specifically willing to serve as mentors for minority members and women. If we acknowledge that there is a problem in underrepresentation of minorities in leadership positions and deliberatelly address the problem by looking for minority members and women to promote to leadership positions, from residency training to district branch to committees and the Assembly, we can make a difference. The same process should occur in the academic programs, hospital staffs, medical societies and the administration of medical organizations, whether a department of mental health or a managed care organization. We have another related problem in the training of culturaly competence in our training programs and continuing education programs for our membership. Unfortunately, those who are not culturally competent are frequently unaware of their insensitivity toward minority patients. I would work to educate our membership to improve their clinical skills in this area by having a regular column in Psychiatric News devoted to discussing clinical vignettes demonstrating problems of cultural competency.
Dr. Muñoz,
This question also representes the main issues faced by people with whom I am in daily contact. More than 70,000 children are going to suffer in San Diego because of the attacks on affirmative action. The problems faced by many sectors of the community may not be addressed until those caring for the poor are more assertive in the provision of programs. This has been the case with at least one of the clinics with which I am closely affiliated, which is expanding services in a moment of need.