One of the many privileges of being part of the leadership of the American Association of Community Psychiatrists (AACP) is my ability to attend meetings representing our organization. In the last several months I have attended five such meetings: the annual meeting of the National Alliance for the Mentally Ill (NAMI); the Carter Conference on Reducing Disparities: Ethnic Minorities and Mental Health; APA/Allied Organizations Leadership meeting, Primary Care and Psychiatry, and the Mental Health/Criminal Justice Consensus project (the last for which I am not officially attending representing AACP, but rest assured, they are aware of our many stances on this topic). Like the old story of a group of blind men trying to describe an elephant by palpating one body part, each project focuses on their own salient "body part".

The meeting with NAMI was extraordinary, a reminder of the daily barriers consumers and family members must surmount, and their capacity to channel terrible challenges into tranformative action. The APA/Allied organization meeting, of which I have written before, also spoke to issues of survival, but more to the survival of a large organization; the importance, I suppose, being that if our organizations can all work better together, the ultimate products can aid those who are consumers of our services (I’m taking the high road here). The Carter conference was awe inspiring, with speaker after speaker informing and educating us on the blatant disregard for, lack of representation of, and limited mental health services for minorities: people of color, ethnicity, and culture; children and adolescents; women; and veterans. 

The Surgeon General’s report on reducing disparities is a must-read document. A project on the interface between primary care and psychiatry is being led by Annelle Primm (our AACP vice president) with support from Pfizer, to develop a consortium of people interested in identifying models of care whereby mental health services can be facilitated or provided by primary care health professionals. The Mental Health/Criminal Justice Consensus Project is being coordinated by the Council on State Governments and involved participants in four tracks (law enforcement, corrections, judiciary, and mental health). The potential product is a report replete with system recommendations and concrete suggestions for education, training, and treatment of those with mental illness whose lives are at the interface between mental health and the criminal justice system.

These organizations and projects examine only parts of the proverbial elephant. Each has their view of mental illness and the barriers that exist. I must admit that I have worried that each group will become so focused on their issues, that they will succumb to the very human belief that they are describing the whole elephant, or what they believe are the most important parts of the elephant. What we must always realize is that while our projects are imperative, so are the others.

While there are obviously considerable differences between the projects noted above, there are also enormous parallels: identification of the paramount importance and sequelae of mental health and mental illness that cuts across all populations; the variety of clinical settings where providers, consumers, and family members struggle with stigma, circumscribed resources, and limited training to maximize diagnosis, treatment, rehabilitation, reintegration, and recovery of those burdened with mental illness; and the enormous numbers of organizations and people committed to improving mental health systems of care. These are the backbone, the skeleton of the elephant, you might say. I view part of the job of the board of the AACP to be one of integration: maintaining our individual passionate pursuits, while keeping our eye on the whole elephant, assuring that we continue to pursue those overarching themes. I hope that we can strive for balanced support and advocacy.