1 Boring Old Man

The new APA president cites astonishing advances in psychiatric research and a broad acceptance of the importance of mental health as reasons to be optimistic.

Lieberman Says it’s ‘Our Time’ for Equity and Fairness in Mental Health

Psychiatric News

by Mark Moran
June 13, 2013

The new APA president cites astonishing advances in psychiatric research and a broad acceptance of the importance of mental health as reasons to be optimistic. This is “our time,” said incoming APA President Jeffrey Lieberman, M.D. — time for psychiatry to seize on its advantages and realize a long-deferred dream of equity and recovery for people with mental illness.

Speaking at the Opening Session of APA’s 2013 annual meeting in San Francisco last month, Lieberman said he was angry about the continued stigma associated with mental illness and disparagement of psychiatry in some quarters. Quoting the 1976 movie “Network,” he said he was “mad as hell and not going to take it” anymore. “Although I saw this movie 37 years ago, I have recently thought about that scene in ‘Network’ because as I view what is happening to the field of psychiatry and all of mental health care, I feel ‘mad as hell, and I don’t want to take it anymore.’ The truth be told, that is why I ran for APA president—because I felt mad and wanted to use all of the power and influence of APA to speak up and stick up for our profession and our patients.

“Throughout my career, I have been acutely sensitive to the stigma associated with mental illness, the disparities in mental health care, and the lack of respect toward psychiatry as a medical specialty,” Lieberman said. “I suppose there might have been a time when psychiatry wasn’t as scientifically based as it should have been. But that was then, and now is now. For such attitudes and practices to persist in the 21st century is nothing short of discriminatory and prejudicial.” But persist they do, he said. Lieberman noted that the mental health parity law was signed in 2008, yet no final rule on its implementation has been issued. He added that the recession of 2008 has gutted public mental health systems and encouraged private and voluntary hospitals to cut psychiatric services, as at Cedars Sinai Hospital in Los Angeles, which closed its psychiatry department.

“The pharmaceutical industry has all but abandoned the development of novel psychotropic drugs,” he said. “And DSM-5 has become a lightning rod for self-styled critics and the antipsychiatry movement. Mental illness is alternatively feared too much or not taken seriously enough, and psychiatry continues to be a punch line for jokes”…

My recollection is that the famous rant in that movie was in part directed at an industry that pursued profit above all else.

… we can not move forward until we acknowledge the role psychiatrists, including leading academic psychiatrists, have played in distorting the evidence base that we so proudly promote.

But in the spirit of listening for what Dr. Lieberman has to say that’s right, his kick-ass-and-take-names approach is actually appropriate on a couple of fronts. "Lieberman noted that the mental health parity law was signed in 2008, yet no final rule on its implementation has been issued. He added that the recession of 2008 has gutted public mental health systems and encouraged private and voluntary hospitals to cut psychiatric services." Third Party Carriers have painted psychiatrists into an impossible situation – doing brief med checks without a thorough evaluation and little chance for comprehensive follow-up. They’ve made voluntary hospital treatment of the severe mental illnesses virtually impossible, yet provided no real support for an intensive community based alternative. Mental Health Parity is actually a vital piece of internal psychiatric reform. We can’t be expected to do it right, when the whole system is organized around supporting us only when we do it wrong.

And the fate of the chronic mental patient in the public system is tragic. We live in a much more accepting world now than in earlier times. One thing we learned during "deinstitutionalization" is that society is much more tolerant of having the severely mentally ill living among us. But watching the Community Mental Health Act expire also taught us that without the needed services, that doesn’t go very well. America’s abandonment of those patients is a shameful tragedy, and they are in no position to mount their own campaigns. Unlike every other social democracy, we just left them to their own devices, which too often means prison – the ultimate form of involuntary treatment. And besides failing to insist on adequate services for these patients, modern psychiatry fuels their mistreatment with it’s cry of "astonishing advances in psychiatric research." With polio, we didn’t just sit around waiting for the vaccine that mercifully came, we took good care of the afflicted. Even with the AIDS epidemic with its stigma, we’ve come to provide care in lieu of waiting for a cure. But with the long known chronic psychoses, we’re waiting for the silver bullet instead of caring for the sick. Dr. Lieberman is an expert on Schizophrenia and that may be the one place where he’s right about stigma. So in my book, he can rant about our failure to address the problems of the severely mentally ill as long as he wants to and kick-ass-and-take-names to his hearts content. We could use some softer, gentler medications, sure enough. But until they come along, let’s use the ones we have much more judiciously, and focus on championing adequate community care for a second "deinstitutionalization" [in the tradition of Phillipe Pinel].