Spring 1997 - Public Psychiatry and the APA

xxAACP Newsletter, Volume 11, Number 2, Spring 1997

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Public Psychiatry and the APA

During Mental Health Awareness Week in October '87, I participated in a series of panel discussions with Dr. Michael Ford, the then Executive Director of Manhattan Psychiatric Center, Professor Krin Gabbard, co-author with Glen Gabbard, MD of Psychiatry and the Cinema, on the topic: "Psychiatry in Film and Real Life - The Image of the State Hospital and the State Hospital Psychiatrist." The recently published Gabbard book surveyed typical stereotypes of psychiatrists in the movies. Our discussions started with the portrayal of psychiatrists in such popular films as One Flew Over the Cuckoo's Nest and King of Hearts. These discussions were well attended with the lay audiences eager to ask questions of the panelists. They often became quite sophisticated, spurred by questions from concerned families of patients in state hosptials. In the process, the audience not only received up to date information about developments in psychopharmacology as well as other recent advances in psychiatry. They also heard, in practical and understandable terms, what the Governor's budget and funding for the Office of Mental Health actually meant for patients and staff at the local state hospital. All this occurred in the context of a lively and entertaining survey of portrayals of psychiatrists and psychiatric hospitals in the movies.

More importantly, these audiences had an opportunity to see and hear two "real" (as opposed to "reel") psychiatrists addressing questions and issues of concern to patients and families in an open manner quite different from the stereotype presented in most American films.

I wrote up this experience for my district branch newsletter in an article entitled: Stigma, Stereotypes and State Hospitals" and received a positive response from colleagues in other state hospitals who were now encouraged to consider the open meeting, panel format to help combat sterotypes and stigma in their own facilities and to improve family/staff relationships. Not long after, the APA's Committee on State Hospital Systems presented a similar panel: "Psychiatry in Film: The State Hospital Image" as a component workshop at the Annual Meeting in Montreal with Dr. Glen Gabbard as the chairperson. Around that same time the Committee also proposed that we put out a public psychiatry newsletter to share experiences such as these two successful film programs. A newsletter would foster increased communitcation among psychiatrists in the public sector, to stimulate new approaches to commmon problems, exchange information and experiences about what works and recognize the efforts of those working in the meagerly financed and under funded public care system. It was also seen as a way to encourage and inspire psychiatrists to join in the challenge of working in the public sector, while simultaneously attempting to recruit psychiatrists to join the APA.

Publishing yet another APA newsletter at a time when APA expenses outstripped income was not an easy sell. Why not just print these articles in the Psychiatric News? There was not objection to having articles published in Psychiatric News, but the consensus of the committee was that there should be a special publication devoted to the ideas, interests, and specific concerns of psychiatrists working in the public sector. Their unique concerns, such as managing to take care of patients despite shrinking state budgets, make working in the pubic psychiatry setting different from other settings. Most of all, it was clear that there was a need to bolster the morale and boost the self-image of psychiatrists working in the public sector. Creating a public psychiatry newsletter would help boost the sagging spirits of those who often work in underfunded systems, ususally providing care for difficult patient populations who are often unresponsive to the standard psychotropic treatments. Learning more about colleagues and how they cope by reading their articles and their comments on their own work, as well as their views of our professional organization, is probably the best way I know of, to dispel stereotypes and prejudices that we may harbor about our colleagues just as we dispel negative stereotypes by exposing the public to "real" psychiatrists.

These points led the committee to an overwhelming support for the idea of a public psychiatry newsletter. There then followed a flood of new and exciting ideas about what should appear in our "newly created newsletter," and it became necessary to suspend acceptance of many enthusiastically offered ccontent contributions until we settled some critical operational questions, like: "Who is this newsletter for?" "How will they get copies of this newsletter?" "How many copies will we need to print?" "Who will pay for the printing? "... for the mailing?" "Who will edit it?" "Who will be the Editor?" "... the Editorial Board?" "How much APA staff time will be spent on this operation?"

A lot has transpired sine that time. The APA approved the newsletter but could not fund new initiatives because of the shortage of resources. The Committee on State Hospital Systems became the Committee on State and Community Psychiatry Systems. The Assembly Committee on Public Psychiatry voiced its support for the newsletter and got Assembly approval as well. The Council on Psychiatric Services began a reorganization which discontinued all of its components, including the Committee on State and Community Psychiatry Systems, the "parent" of the newsletter, in favor of several Consortia focusing on issues such as funding, special settings and treatments. The Assembly Committee on Public Psychiatry in its meetings with the Assembly Committee on Community Psychiatry sought ways of speeding implementation of the newsletter. In that process, we became aware that the AACP was publishing a newsletter, Community Psychiatrist, which had been in existence for several years. It was evident from our discussions with the AACP leadership that the aims and objectives of the Public Psychiatry Newsletter and Community Psychiatrist are similar and at times overlapping, and we saw potential for an ongoing relationship which could be complimentary rather than competitive. The committee accepted a gracious offer of a guest column in the AACP Newsletter from the AACP Board of Directors. We believe that this is a good partnership and a good place to get started.

In this column, we will focus on issues concerning psychiatrists in many different public settings such as state hospitals, VA hospitals, county and municipal hospitals and psychiatrists in the military and in jails and prisons. All share certain experiences in common and have many similar challenges pursuing professional activities related to their public sector setting. We hope that this will be a vehicle for discussion of mutual frustrations and/or satisfactions. The AACP has welcomed this opportunity to bolster their efforts in this regard.

We are very appreciative of the opportunity to have this guest article published in your newsletter, and are anxious to hear what you think about this column and the eventual realization of the Public Psychiatry Newsletter. Please respond c/o Wes Sowers, MD, Editor.

Sy Gers, MD

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