Response to the Presidential Address

As I sat down to write this speech, I thought about all the things I aspire to do in my year as your President.

What can I contribute or organize that will inspire, engage, and excite my colleagues, my patients, and my profession about the promise and practice of psychiatry over the next 12 months? What are the barriers that keep us from doing our best? What are the opportunities coming our way?

We are all here today because of something we aspire to do as physicians and leaders in psychiatry. Everyone in this room is here because of a relationship they have to psychiatry. Most of us are psychiatrists, some are family and/or friends of our profession. Our hopes and goals brought us to this meeting and to this room. They will also guide how we will spend the next year of lives—and beyond!

I want to take a few minutes of your time tonight to talk about the aspirations of our profession and of us as individual attendees at this meeting, and as members of the best and the biggest organization of psychiatrists in the world.

Many of us became psychiatrists because of an aspiration to help others. We can—and do—make a tremendous difference in people's lives. Often, we don't fully know the impact we have had.

One of my first experiences with psychosis was as a medical student on a psychiatric unit in the VA. This was a different era in VA medicine. Patients stayed on big open wards for weeks, just to get on the surgery schedule for a hernia repair, for instance. They smoked, played cards, and told stories on the ward. The psychiatric unit at this hospital was an outbuilding in a grove of trees on the VA campus, and it was not unusual for patients to stay there for months at a time. I had not had experience with being exposed to psychosis in my childhood.

Being in the midst of people with delusions and hallucinations was a new and fascinating experience for me. During my rotation, there had been three patients with religious delusions. One patient, I'll call him Frank, was younger than the rest and seemed to be new to the experience of hospitals and such. At the recommendation of my attending, I spent a lot of time talking with Frank. It was amazing to me how firmly delusional he was. He would talk of the special mission he had on earth and how he had to work out his “theology” so that he could get his people to the promised land. I learned that he had lost his job as a shoe store manager, and his wife had kicked him out recently because of arguments over the “theology.” Frank also told me that his mother had spent time in a state psychiatric hospital. With lithium and the therapeutic community on the unit, he was less focused on the theology and much more able to talk about the things he needed to do in his earthly life by the end of my rotation.

Three months later, I was in the middle of the mall on a rare shopping trip, when someone came running down the concourse yelling, “Hey, Dr. Everett! Hey, Dr. Everett!” Initially I was flummoxed in this novel situation. What should I do? Here I am not yet a doctor in a very public place with a patient breaching his own privacy. I had been schooled to avoid revealing the identity of patients in a public place; however, this was him tracking me down. As he got closer, I could see that it was Frank. He caught his breath and said, “Hey, I just wanted to thank you. The hospital and all those talks we had really helped; I know you are just a student, but all that stuff really helped. Look at me now! I got a job in the same store, and my wife is thinking about letting me move back in!”

To help people like Frank, one of our aspirations must be better access to our profession. It's no secret to anyone in this room that there are not enough psychiatrists to treat every American with a mental health or substance use condition. Through innovation, we can aspire to reach more people with effective treatment.

Telepsychiatry allows us to use technology in innovative ways to reach people who wouldn't otherwise have access to a psychiatrist. Telepsychiatry can mitigate geographic distances, but it currently is predominantly a one-at-a-time model.

New collaborative care models help us consult and work with colleagues in primary care so that patients get the treatment they need. Collaborative care enables tiering of patients so that one psychiatrist, coupled with a case manager, can consult on many patients.

We don't even know yet how other e-therapists, group therapy, and technologies might help us incorporate technology as a way to improve access to effective treatment so that patients receive the right treatment at the right time and with the right level of intervention.

We can also aspire, as individuals and as a profession, to offer the best possible care to each of our patients.

There have been so many wonderful advances in mental health treatment over the past few years. I am optimistic that these changes will help us deliver better treatment to more of our patients. In the last 5 years, we've seen advances in diagnosis, from the DSM-5 to innovative technologies, that help us understand and diagnose mental illness.

There have also been major innovations in treatment, including myriad evidence that demonstrates the ways that psychotherapy works. Research is helping us know which interventions, combinations, and sequencing of interventions are best for which conditions.

We've witnessed exciting new developments with medication, particularly for depression, mood disorders, and bipolar disorders. We now have more effective pharmacologic treatments with fewer side effects. This is especially true of the new-generation antipsychotics, which support the recovery of individuals with more serious illnesses. We've also advanced our range of neuro-stimulation techniques to treat major depression and other disorders.

As a community psychiatrist, one services innovation that I am particularly excited about is the expansion of team-based programs for the treatment of first episode of psychosis. At Johns Hopkins community psychiatry, I had the privilege of facilitating the startup of an early intervention and first-episode psychosis program. Narrowing the gap between that first episode and the start of treatment is critical for improving outcomes. Right now, that gap, also known as the duration of untreated psychosis, averages 8 years. That's far too long! We can and must do better.

First-episode psychosis programs are team-based treatment that includes psychotherapy, pharmacotherapy, and supported education, which is a model that provides close monitoring and coaching that is designed to support performance at school. Team-based models that provide treatment early to young adults will help us shorten the time between symptom onset and treatment. The promise here is the opportunity to keep kids on or near the life trajectory they would have had.

In my year as President, I plan to work with our Council on Children, Adolescents, and Their Families to identify gaps for psychiatry that our organization, the APA, can address so that adult and child psychiatrists are equipped to provide the best evidence-based care to patients at this critical juncture.

In order to organize and advise our APA Board of Trustees on innovations and aspirations, I have started the formation of a workgroup on Access to Treatment Through Innovation, and the work of this group will go on throughout the year. Thank you to Dr. John Santopietro for taking this on; we are all looking forward to the work of this group, which will build upon and contribute to the standing council and committee work that is happening within our APA. John is a community psychiatrist. I have appointed many leaders in community and public psychiatry to positions throughout our APA. Good community psychiatrists are systems thinkers and gravitate toward working in team-based settings to address the circumstances, treatment, and recovery support of our most seriously ill.

All of these advances give me great hope that we can improve access to mental health care and provide more effective care to the people to come to see us.

I also aspire to improve your mental health and well-being. Physician wellness and resilience are issues that matter deeply to me. Earlier today I hosted a town hall meeting about physician wellness and burnout. More than half of physicians in the United States report feeling at least one symptom of burnout, with emotional exhaustion topping the list. Most of us right here in this room have felt, at the very least, some degree of compassion fatigue and at most have experienced deep and pervasive episodes of burnout in our careers as psychiatrists. We know that excessive productivity quotas and limits on the time we can spend with each patient are major sources of dissatisfaction for doctors.

Many psychiatrists choose to practice “off the grid” in cash-only practices because the rules and regulations that are required to practice in mainstream health care are so cumbersome. We need to assure that employed physicians, and especially those in community mental health centers, have jobs that are generative, meaningful, and valued. When physicians work in settings that support collegiality, respect, and autonomy, they feel more satisfied with their work.

Physician profession burnout is of growing concern to many professional organizations. Earlier this year, I had the opportunity to represent the APA at a meeting convened by the American Board of Psychiatry and Neurology. There I learned that the American Academy of Neurology has had an ongoing effort to address the professional burnout of their members. Likewise, the American Medical Association, now led by a psychiatrist and APA member, Dr. Patrice Harris, also has a prominent campaign to address physician well-being and burnout. For me, professional meetings like the Annual Meeting help to refuel and refurbish my passion for our profession.

I love meeting up with my fellow psychiatrists, sharing stories and reconnecting with mentors and friends. I learn a lot about how my APA friends practice, what kinds of vacations they take, what kinds of hobbies they have, and what issues have meaning to them. Our Annual Meeting app is a great way to jump start those connections. I highly encourage you to make use of this tool during your stay here. You can create a profile and join a virtual conversation with your peers about what you are seeing and doing and learning here in San Diego.

Our work on these issues certainly won't end with the Annual Meeting. I've created a work group, Chaired by Dr. Rick Summers, to address well-being and burnout throughout the next year. The work group will be looking at strategies that promote physician wellness and interventions that can help both our specialty and our colleagues in other branches of medicine. By the end of the year, we hope to have tools and resources to share with all of you on this important issue.

Another of my aspirations for the next year is to make sure all our members know more about what APA does for its members. Although I've been involved with the APA for more than 30 years, serving as President-Elect over the past year has given me a wider and deeper perspective on what the APA is doing for all of us in psychiatry. For example, one of the duties of President-Elect is to chair the Joint Reference Committee, also known as the JRC. As JRC chair, I received regular reports from the 13 councils working on everything from addiction to ethics to quality care. Our councils publish products, create guidelines, write position statements, deliberate critical issues in detail, prepare educational materials, and communicate that to members. I'd like to take a moment now to thank all of the members who participate in and guide our councils, committees, and caucuses throughout the year.

As President-Elect, I also had a front row seat to the work of our Assembly. Their role is to represent you within the APA. To give one example of what the Assembly has accomplished in the past year, they introduced and championed a new position statement on the impact of climate change on mental health, which the APA adopted in March. Let's thank them now.

If you've visited psychiatry.org lately, you probably noticed the new website and learning management system. Going forward, you will be able to use one login for all your interactions with APA.

Psychiatric News also got a fresh look, which you are seeing for the first time right here at the Annual Meeting.

On the practice side, APA is developing a guide to working with transgender and gender-nonconforming patients, which will be published soon. This is an important step in addressing the mental health of the transgender population, which has disproportionately high rates of depression, suicide, and addiction. This product aims to be a valuable resource for our members.

APA also launched PsychPRO earlier this year. PsychPRO is a mental health registry that will be of benefit to both psychiatrists and ultimately also to our patients. It is designed to meet Medicare quality reporting requirements to assure that participating practices are able to demonstrate quality in their work. PsychPRO is currently in a testing and development phase, but I'm pleased to share that it is progressing well ahead of schedule. I want to take a moment to thank Dr. Saul Levin, APA's CEO and Medical Director, and the APA staff, particularly Dr. Phil Wang, for the hard work in launching the registry. It is truly a great accomplishment. The latest good news about APA's PsychPRO registry is a discussion with the NNDC, or National Network of Depression Centers, to consider a partnership. The NNDC is a network of over 20 academic and community clinic settings that aims to collect, aggregate and share outcomes the treatment course of mood disorders nationally. Our community psychiatry clinic at Johns Hopkins in Baltimore was one of the original sites for the NNDC, so I know the level of commitment, thought, and coordination that has gone into this significant project. I encourage you to visit APA Central in the exhibit hall to learn more about the registry while you are here. More information about PsychPRO and how to participate will come out in the next several months.

I hope you are as impressed as I have been with everything the APA administration is doing to advance psychiatry and help all of us with our professional needs. Knowing how many wonderful things are happening at APA, it's no surprise to me that our current membership is the highest it has been in 14 years! We now have over 37,000 members! And I hope we will continue to grow in the years to come. I'm particularly encouraged by the growth we are seeing in younger psychiatrists, who represent the future of our profession. Membership among early-career psychiatrists grew nearly 2% over the past year.

Already I have visited several district branches. In Virginia, every psychiatry resident across all four training programs, except one person, is an APA member. In Brooklyn, house staff across four programs taught me about the benefits of being in a training program that has platinum status. Platinum happens when programs have had 100% house staff membership for 5 years.

As your President, I aspire to make the APA the “go to” place for every psychiatrist in America. All of these projects and accomplishments only matter if you are involved and engaged with APA's work. My interactions with APA over more than 30 years as a member have kept me energized and motivated. I aspire to give each of you the same opportunity.

As we kick off this year's Annual Meeting, I encourage each of you to take just one more step to deepen your involvement with the APA. It could be as simple as following APA's accounts on social media, or taking one of the free member courses available each month.

Keep the engagement going! Don't drop the connections you make at the Annual Meeting. You could get more involved with your district branch, or sign up to join the next phase of the PsychPRO registry.

If you aren't already a member of APA, your next step could be stopping in the exhibit hall this week to learn about the benefits of membership. Take advantage of this amazing organization that is here to help you reach your goals throughout your career!

Stay tuned! Look for those results from our innovations work group, from the psychiatrist well-being and burnout group, and on the area of first-episode psychosis.

Make the APA your “go to” place for professional development and support.

Throughout my career, I've kept a “thank you” file of people who let me know that I helped them in some way. It's not usually as dramatic as Frank chasing me down in a crowded shopping mall, but it is always rewarding to hear from someone who feels that psychiatric treatment has facilitated a happier, healthier life.

Think about your own aspiration story. Become what you aspired to be.

You can make a difference, and I hope that in my term as President I can initiate a few things that enhance your professional lives, too.

Thank you again for the honor of serving as your President for the next year.

This is an exciting time for psychiatry, and I can't wait to see what we can accomplish together.