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Presidential Papers   |    
Response to the Presidential Address
Pedro Ruiz, M.D.
Am J Psychiatry 2006;163:1716-1718. doi:10.1176/appi.ajp.163.10.1716
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APA President, Dr. Steven S. Sharfstein; Assembly Speaker, Dr. Joseph Rubin; APA Medical Director, Dr. James H. Scully; past presidents and officers of APA; fellow psychiatrists; colleagues; friends; ladies and gentlemen. I feel privileged and honored to be here, today, as your incoming President of APA.

Before I proceed to make my official remarks, I would like to take a moment to introduce my family members who have joined me for this special occasion.

First of all, my daughter, Angela Maria, who is here with her husband, Omar; Angela Maria is a pediatric social worker who works at Ben Taub General Hospital, a public county facility affiliated with Baylor College of Medicine in Houston, Texas. Her husband, Omar, is a teacher in the Houston, Texas, Independent School District.

With me tonight is also my son, Pedro Pablo, who is here with his wife Julie. Pedro Pablo is an attorney and, currently, a judge presiding in the State District Court of Fort Bend County, Texas. His wife, Julie, is a teacher in a private school in Fort Bend County, Texas.

Additionally, here with me are my three grandchildren: Francisco Antonio and Pedro Pablo, Jr., from my son’s family, and Omar Josef, from my daughter’s family. As you might remember, my three grandchildren were my campaign managers during my recent APA elections. Francisco Antonio handled the East Coast; Pedro Pablo, Jr., managed the West Coast; and Omar Josef took care of the Midwest. I am sure that you will agree with me in that with them on my side, I could not have lost any APA election.

Finally, here with me tonight is the person who deserves all the credit for my professional achievements; the person who has made it possible for my professional career to be fulfilling and gratifying; the person whose continuous guidance and support have made my personal life very worthwhile; she has been my friend and partner for more than four decades. Please join me in recognizing my wife: Angela Ruiz.

Let me now focus on my official comments for this occasion. First of all, I should underline that it will be very difficult for me to fill the shoes of our APA President, Dr. Steven S. Sharfstein. During his tenure as APA President, Dr. Sharfstein has made major contributions to our profession and our field. His theme “From Science to Public Policy: Advocacy for Patients and the Profession” has been well received by all of us. His leadership has led us to work hard to achieve his goals and objectives for our organization and profession. Dr. Sharfstein has been an outstanding President. I look forward to his guidance and counsel during my tenure as President of APA. Steve: thanks for a job well done.

Dr. Sharfstein’s APA theme and priorities offered a good link to my own APA theme and priorities, as well as to my plans and strategies in addressing the current challenges faced by our profession and field. My theme is “Addressing Patient Needs: Access, Parity, and Humane Care.” Today, my remarks will primarily focus on the conceptual framework of my plans, strategies, and vision for APA.

In recent decades, the mental health care system of the United States, our profession, and the field of psychiatry at large have confronted challenges that have never been faced before. We have all witnessed the consistent decline of organized medicine. We have all observed the systematic defunding of the mental health care system, particularly in the public sector. On a daily basis, our image as physicians and psychiatrists has been tarnished and diminished. External circumstances have seriously interfered with the doctor-patient relationship. The relevance of patient confidentiality has been ignored and often dismissed by insurance companies and governmental agencies. These unfortunate situations and dilemmas have shaken the core values of our profession and our field.

As your incoming APA President, I want to reassure all of you that we do not intend to retreat, pull back, or do nothing with respect to these challenges. Quite the contrary, we will provide the required leadership to boldly and courageously confront them; we intend to implement the right strategies to resolve them; we will seek to improve the public confidence in our profession; we will try to regain the professional stature that the members of APA and our profession deserve; and we look forward to seeing our image, as physicians and psychiatrists, shine bright once more.

I am very much aware that we will need the support of every APA member to achieve these goals and objectives. We are absolutely sure, however, that we can count on your full confidence and support in implementing these strategies and plans. Together, we can do it, and we will do it.

We all know quite well the requirements and qualifications of our profession. Our profession requires awareness and sensitivity, caring and empathy, dedication and commitment, and, above all, will and courage.

My fellow psychiatrists, I know that we have these necessary professional and personal qualities; therefore, I am sure that we will succeed in our professional and organizational quests. Nevertheless, in order to accomplish these strategies and plans, we must all put the needs and well-being of our patients first. My theme, “Addressing Patient Needs: Access, Parity, and Humane Care,” embraces these goals.

When addressing patient needs for access to health and mental health care, certain factors must be taken into consideration. For instance, nearly 46 million Americans currently lack medical insurance, and this number continues to rise. Additionally, many other millions of Americans are underinsured. The uninsured and underinsured population encompasses all sectors of society: one-third belong to the poor and disadvantaged sector; many are from ethnic and minority groups; about 17% are persons working full time; about 24% are persons working part-time; and about 10 million are children and adolescents. The majority of the uninsured and underinsured persons have one thing in common: they lack access to health and mental health services.

My fellow psychiatrists, we cannot sit back and ignore this national disgrace; we must advocate; we must join forces with patient-oriented groups; and, above all, we must put the needs of our patients first. Together, we must take the necessary actions, because we must regain and maintain the dignity and well-being of our patients. I am fully confident that in accomplishing this objective, we will once again be able to secure and maintain the professional image and the respect that we deserve as members of the healing arts and as psychiatrists.

My fellow psychiatrists, I am certain that we can achieve this noble goal, but in order to achieve it, we must attain universal access to health and mental health services; and I am sure that we will do it because we, psychiatrists, have the dedication and commitment, the strength and vision, as well as the will and courage to do it.

Parity, between health and mental health services, is the second component of my Presidential theme. For centuries, mentally ill patients have been denied parity of psychiatric services. In this respect, state governments, for the most part, have been very insensitive. Additionally and unfortunately, many sectors of society continue to be negatively affected by stigma and lack of education vis-à-vis the rights and clinical needs of mental patients; particularly the chronically mentally ill patients and the mentally ill patients from the public sector.

Despite recent advances in the neurosciences and psychosocial sciences, which have clearly proven that psychiatric disorders are real medical illnesses that can be effectively treated, managed care companies as well as the federal and state governments continue to deny mentally ill patients the opportunity to be comprehensively treated, healed, and rehabilitated, as well as to engage and enjoy a normal life in our communities. Likewise, psychiatrists continue to be deprived of the opportunity to heal and to care for the mentally ill because these patients are denied full parity of psychiatric services.

Carve-outs, high deductibles, high copayments, limitations in the numbers of psychiatric outpatient visits, disapproval of psychotherapy treatment rendered by psychiatrists, and reduction in the length of inpatient stays—they all are factors that have negatively affected mentally ill patients.

My fellow psychiatrists, we must address these discriminatory policies and disparities that currently exist in our mental health care system. We must strive to remove the stigma against mentally ill patients once and for all, and not just from the United States, but from all the regions of the world as well.

My fellow psychiatrists, we can achieve our goal of attaining full and comprehensive parity of psychiatric services; I know that we can, because we, psychiatrists, have the commitment and dedication; because we have the strength and vision; and because we have the will and the courage to do it.

Humane care is the third component of my APA theme and priorities. For me, achieving the goal of humane care is central to my Presidential plans and vision. I know what inhumane care is all about. On many occasions, I have been an eyewitness to inhumane care. I have seen inhumane care with my own eyes during my psychiatric training in Florida, during my professional years in New York, and, also, during my years of practice in Texas.

I have seen, repeatedly, poor and disadvantaged persons deprived of preventive health and mental health care. I have seen countless persons denied proper access to mental health services. I have seen a vast number of persons stripped of full and comprehensive parity of psychiatric care. I have seen a large number of persons devoid of quality mental health services. I have also seen too many mentally ill patients from ethnic minority groups divested of culturally competent mental health services. I have seen mentally ill children and adolescents, women, and older adults refused and disallowed humane care. I have, additionally, seen mentally ill homeless persons sleeping under highways and bridges and, thus, being disowned from humane care. I have seen, again and again, mentally ill patients unfairly and unnecessarily sent to jails and prisons and, therefore, being diverted from humane care. I have not only seen but have also felt inhumane care countless times during my psychiatric career.

My fellow psychiatrists, how much inhumane care do we have to see and feel in our daily psychiatric practices and in society at large before we say, Enough is enough.

My fellow psychiatrists, as a public sector psychiatrist, dealing with the poor and disadvantaged on a daily basis, I will never give up in my efforts to eliminate the inhumane conditions that mentally ill patients are exposed to on an ongoing basis. For instance, on Sept. 1, 2001, in Texas thousands of children and adolescents were dropped from the Medicaid program when the government of the state of Texas faced a $10 billion budget deficit and placed a higher priority on non-health-related programs rather than on providing humane health and mental health care to these disadvantaged children and adolescents.

Nowadays, the federal government has also shown a higher priority for spending billions of dollars abroad, rather than providing health and mental health insurance coverage for the nearly 46 million Americans who lack this coverage, as well as for the many other millions who are underinsured. This situation is obviously clear in Louisiana. In Louisiana thousands of poor and disadvantaged Americans, most of whom are African Americans, were and still are deprived of their basic human needs, as well as of their health and mental health care needs, after they were stricken by Hurricane Katrina.

Likewise, dozen of homeless mentally ill patients, on a daily basis, are beaten, sometimes to death, in our cities and across the nation. It has happened in Fort Lauderdale, Florida; in Lawrence, Kansas; in Little Rock, Arkansas; in Atlanta, Georgia; in Las Vegas, Nevada; in Dallas, Texas; in Santa Monica, California; in Chicago, Illinois; and all over urban America.

Similarly, many Medicare beneficiaries who are mentally ill have been recently denied their psychopharmacological medications under the new Medicare benefit plan installed on Jan. 1, 2006, which has led to their decompensation, relapse, and unnecessary rehospitalization. To me, all of these previously cited examples denote inhumane care at its worse.

My fellow psychiatrists, as physicians and psychiatrists, we must fulfill our responsibilities with respect to the patients who are denied health and mental health care or are exposed to inhumane care. When we became physicians, our oath was to avoid suffering, to heal, and to sustain life in a humane environment. I am certain that we are not going to retreat from these principles. I am certain that we are not going to sit back and do nothing about these inhumane conditions. Quite the contrary, I am certain that we are going to individually and collectively do everything that it takes to offer our patients universal access to health and mental health care, full parity of psychiatric services, and above all, humane care.

My fellow psychiatrists, when I ran for election to become your APA President I promised you that I was going to work very hard on behalf of APA, on behalf of our profession, and on behalf of our field at large. Today, I want to reaffirm to you that I am ready to do so, and that I will do my very best to achieve the goals and objectives that I have delineated for you today. I must admit, however, that I cannot do it alone. I need all of you in this journey. I need your hard work; I need your commitment and dedication; I need your will and determination; and, above all, I need your courage.

In closing, I would like to quote one of my heroes. A person who was not afraid of dreaming and who tried very hard to convert his dreams into reality. A person who was forthright in differentiating right from wrong and also in addressing both.

The person that I am referring to is the late Dr. Martin Luther King, Jr. In one of his numerous addresses to the Southern Christian Leadership Conference, Dr. Martin Luther King, Jr., was discussing the importance of taking the right positions in life, and in this regard he said,

On some positions, Cowardice asks the question, “Is it safe?” Expediency asks the question, “Is it politic?” And Vanity comes along and asks the question, “Is it popular?” But Conscience asks the question, “Is it right?” And there comes a time when one must take a position that is neither safe, nor politic, nor popular, but he must do it because conscience tells him it is right.

My fellow psychiatrists, tonight, I wish that all of you, together with your families, would join me in yet another dream; this dream is that organized medicine, under the leadership of APA and in full partnership with advocacy and patient-oriented groups, secures for our patients universal access to psychiatric care, comprehensive parity of mental health services, and, above all, humane care, not only in the United States but in all corners of the world as well.

My fellow psychiatrists, let us convert this dream into reality because it is the right thing to do. Together, we can do it. Let us be united in securing these goals and objectives, because APA needs it, our profession needs it, our field needs it, and, above all, our patients need it even more.

Many thanks for listening, and best wishes to you all.

+Presented at the 159th Annual Meeting of the American Psychiatric Association, Toronto, May 20–25, 2006. Dr. Ruiz, 133rd President of the American Psychiatric Association, is Professor and Vice Chair, Department of Psychiatry and Behavioral Sciences, University of Texas Medical School at Houston. Address correspondence and reprint requests to Dr. Ruiz, 1300 Moursund St., Houston, TX 77030-3406; pedro.ruiz@uth.tmc.edu (e-mail).

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