by Bruce A. Hershfield, M.D.
[Spring/Summer 1998; Vol. 25 No. 1]
Steven Mirin, M.D., the new medical director of the APA, addressed the annual business meeting in Baltimore on May 14, 1998. He began by emphasizing that the relationship between the APA and district branches is becoming closer. He pointed out that our patients continue to need a high level of care, even though that issue is tempered by societyµs debate about how much care is enough. He pointed out that we have made very significant progress in destigmatizing our patients..."We have come a remarkably long way...in the care of our patient population." However, access to care is restricted. Due to continuing shifts in the financing of health care, about 65 percent of insured Americans currently have some form of managed behavioral health care. We need to engage with managed care organizations about the care of our patients. Managed care organizations are consolidating, so that four or five companies will probably be relevant by the year 2000. Managed care is now reducing its presence in the private sector, with twenty-five states now including managed care in their public programs. This is likely to go on to forty such states by the year 2000. Additionally, by the year 2000, Medicare will be more involved with managed care organizations. He discussed the detrimental effect of carve-outs and the need for psychiatrists to insist on psychiatric service as part of an integrated system of care.
He continued by advocating parity for mental health. This would include services for substance abuse. He emphasized the need for more research to further develop standards of care. Research gives credibility to our requests for additional funding. He described predicted work force needs for psychiatrists. Where there is a lack of services, people seek other practitioners instead of psychiatrists. The largest "mental health facility" in the country, he pointed out, is the LA County Jail.
In the last part of his speech, Dr. Mirin talked about confidentiality -- "the cornerstone of what we do." He pointed out that it is "threatened on every front." Dr. Richard Harding of the APA cast the only dissenting vote on the presidential commission addressing confidentiality. We need to convince bureaucrats that we can effectively help their constituents. Finally, Dr. Mirin told the audience that the success rate for treatment of depression is now almost 90 percent -- significantly better than the success rate for angioplasty with a success rate of only 50 percent. A lively question and answer session concluded the evening.