Pedro Ruiz, M.D., of Houston, Texas, was chosen president-elect of the American Psychiatric Association in 2005 balloting by APA members. Dr. Ruiz will assume the APA presidency in May 2006. The current president-elect, Steven Sharfstein, M.D., of Baltimore, will become APA president in May. He will succeed Michelle Riba, M.D., of Ann Arbor, Michigan.
Dr. Ruiz, who is serving a two-year term as APA vice-president, won 74 percent of the vote in a race against Sidney Weissman, M.D., of Chicago. Dr. Ruiz is professor and vice-chair of the department of psychiatry at the University of Texas Medical School at Houston and a past president of the American Board of Psychiatry and Neurology. He has been a member of the editorial board of Psychiatric Services since 2001.
Succeeding Dr. Ruiz as vice-president is Nada L. Stotland, M.D., M.P.H., who is currently APA secretary. She received 62 percent of the vote against Patricia R. Recupero, M.D., J.D., of Providence, Rhode Island. Dr. Stotland is professor of psychiatry at Rush Medical College in Chicago.
Winning a second term as APA trustee-at-large was David Fassler, M.D., of Burlington, Vermont, who defeated Charles Bensonhaver, M.D., of Johns Island, South Carolina, with 62 percent of the vote. Two area trustee positions were up for election this year. Incumbent Ann Marie T. Sullivan, M.D., of New York City, won 60 percent of the vote in a race against Jack Drescher, M.D., also of New York City. In the race for area 5 trustee, Mary Helen Davis, M.D., of Louisville, Kentucky, received 53 percent of the vote to defeat Dudley M. Stewart, Jr., M.D., of New Orleans.
In a three-way race, Lysiane Ribeiro, M.D., M.P.H., of New York City was elected member-in-training trustee-elect, defeating Chanley M. Martin, M.D., J.D., of Louisville, Kentucky, and Robert Kelly, M.D., of New York City.
About a third (34 percent) of the 30,546 eligible voting members cast ballots in the 2005 election. Of the 10,424 ballots, 2,458, or 24 percent, were submitted on-line.
New officers and trustees will take office at the conclusion of the 2005 APA annual meeting in Atlanta, when Carolyn Robinowitz, M.D., who is currently treasurer, will become secretary-treasurer, in accord with 2003 changes made by members to downsize the board of trustees by combining the treasurer and secretary posts. Also, David Mamah, M.D., currently member-in-training trustee-elect, will become member-in-training trustee.
Current efforts to transform the mental health care system focus primarily on the public sector, even though the President's charge to the New Freedom Commission specifically included the private sector and the commission found fragmentation and poor-quality care in both sectors. A new report from the Bazelon Center for Mental Health Law presents recommendations for improving the integration of primary care and behavioral health care in the context of private health insurance. The report cites increasing evidence that integrated care is more cost-effective, leads to better outcomes, and is more satisfying for patients and providers.
The report lists dozens of detailed recommendations for five groups—primary care providers, health plans, employer-purchasers of care, academic institutions and professional societies, and state and federal policy makers—and summarizes the panel's discussion of key topics. The ten-member panel included health care leaders with expertise in primary care, mental health and substance abuse services, and policy making, purchasing, and administration in public- and private-sector health plans. The panel met for two days in Washington, D.C., in September 2004.
The panel set the stage for discussion by noting that fiscal issues drive the context of all discourse about changes in health care. Rising costs have led most purchasers of care to limit their financial liability by requiring consumers to pay more. In this environment, proposals for reform will be measured against their potential to either improve or worsen the current fiscal realities, the report notes.
The general consensus of the panel was that integrated primary and behavioral health care should be the standard of care. The panel identified common characteristics of successful integrated practices: a team approach, strong clinical and practice-management leadership, informal knowledge exchange, effective use of midlevel practitioners, a loyal base of consumers, and the ability to serve patients with complicated problems and diverse cultural and socioeconomic backgrounds. Staff members in such practices are selected—and self-select—on the basis of a commitment to working as part of an integrated team that views behavioral health as inseparable from health. Over time, because of differences in philosophy and orientation, practices with an integrated approach attract clients who value integration, and enduring provider-patient relationships are formed, the panel noted.
Parity in coverage is critical to integrated care, and carve-outs should be eliminated because they discourage integration, the panel concluded. Managed care plans should reconsider their use of exclusive provider panels because of disruptions in continuity of care when employers change insurers, which not only is disheartening to consumers but also is associated with significant costs. The need to change reimbursement practices was strongly emphasized by the panel, which noted that current practices, such as higher reimbursement for two 15-minute visits than for one 30-minute visit, establish "perverse disincentives" to integrated care.
Screening for behavioral health disorders in primary care received the panel's strong support. The biggest payoff in measurements of quality and cost savings will come from targeted screening of at-risk populations, and efforts should begin with these groups. Primary care practitioners should keep in mind that simple behavioral health screening tools, such as the CAGE questionnaire for substance use problems, can be effective, and that self-assessments and Internet tools work only for relatively sophisticated consumers. The panel recognized that resistance to screening in primary care is a reasonable response when practitioners are not experienced in talking with patients about behavioral health issues and do not believe that they can make timely and appropriate referrals for patients who are identified in screening efforts. The panel cited the development of screening toolkits by professional societies and some health plans as well as comprehensive efforts to change practice, such as the Bright Futures initiative of the American Academy of Pediatrics, as effective ways to provide decision support to primary care practitioners.
Several of the panel's recommendations focus on how best to engage consumers in treatment and disease management. The panel pointed out that although models of co-location of primary care and behavioral health practitioners are currently more the exception than the rule, practitioners who continue to believe that virtually all behavioral health treatment belongs in the domain of mental health professionals are ignoring current patterns of care. The New Freedom Commission underlined the fact that about half of all care for common mental disorders is delivered in general medical settings.
Integration of Primary Care and Behavioral Health is available at www. bazelon.org. It is a companion document to Get It Together: How to Integrate Physical and Mental Health Care for People With Serious Mental Disorders, a report on integration of health and behavioral health care in the public sector, released in June 2004 and also available on the Web site.
Mental Health Transformation Trends: The premier issue of Mental Health Transformation Trends has been published by the Substance Abuse and Mental Health Services Administration (SAMHSA). The publication is a periodic report on emerging issues, practices, and trends at the federal, state, and local levels in the process of transforming the mental health care system as recommended by the President's New Freedom Commission on Mental Health. The first issue profiles New Mexico's initiative to bring together all state agencies and jointly plan for system change. A monthly feature—"Federal Partner Spotlight"—describes internal initiatives in the Department of Labor to increase work opportunities for people with psychiatric disabilities, including ex-offenders and adolescents. The premier issue also describes SAMHSA's Mental Health Transformation State Incentive Grants (MHT SIGs). The new publication is available on the Web at www.samhsa.gov/matrix/mhst.
New program for prescription assistance: A national partnership of pharmaceutical companies, physicians, nurses, pharmacists, other health professionals, patient advocates, and community leaders has been formed to help patients who lack prescription coverage obtain medications. The Partnership for Prescription Assistance is an unprecedented program that offers a single point of access to more than 275 public and private patient assistance programs, including more than 150 programs offered by pharmaceutical companies. Information is also provided on government programs for which patients may qualify. More than 50 national organizations have joined the partnership, including the American Psychiatric Association, the Academy of Family Physicians, the National Alliance for the Mentally Ill, the National Association of Chain Drug Stores, the National Urban League, and the United Way. The user-friendly Web site (www.pparx. org) has portals through which patients, caregivers, and prescribers can determine eligibility for prescription assistance programs. Eligibility information is also available via a toll-free number (888-4PPA-NOW). Trained specialists provide application assistance in English, Spanish, and more than 150 other languages.
Guide on the legal rights of people in recovery: SAMHSA's Center for Substance Abuse Treatment has developed a brochure—"Are You in Recovery From Alcohol or Drug Problems? Know Your Rights"—that provides information about federal laws that protect against discrimination in employment and job training, housing, health care, education, and government services and programs. Written in partnership with the Legal Action Center, "Know Your Rights" is available in both English and Spanish. The brochure can be obtained from the National Clearinghouse for Alcohol and Drug Information, either on the Web (www.ncadi.samhsa.gov) or by telephone (800-729-6686).