ATLANTA – American psychiatry is facing a “crisis of credibility,” said Steven S. Sharfstein, M.D., the new president of the American Psychiatric Association.
Dr. Sharfstein vowed at the APA's annual meeting to restore that credibility by advocating for patients and creating and enforcing ethical standards.
“Our profession is seen, by many, as an interest group, a trade association. And too often we have behaved like one,” said Dr. Sharfstein, who has served as president and chief executive officer of the Sheppard Pratt Health System, a nonprofit psychiatric hospital system in Baltimore, since 1992.
Psychiatrists are failing to lead when it comes to problems such as lack of access, high costs, and unmeasured quality in health care. The problem, he said, is not a lack of sound policy proposals, but the profession's lack of credibility and leverage.
“When we speak, too few listen,” he said. “And to a large extent, we have only ourselves to blame.”
Dr. Sharfstein pointed to an erratic and inconsistent system of self-discipline, an unacceptable rate of medical errors, and gross disparities in health care. As a profession, psychiatry has frequently allowed itself to be corrupted by industry and has compromised the core value of patient confidentiality in an effort to guarantee payment and stay on managed care contracts.
“We must earn back our moral authority,” said Dr. Sharfstein, who succeeds Michelle B. Riba, M.D., in the 1-year presidential term. “We must regain the public's trust.”
The first step is to recommit the profession to advocating for patients. Patients with mental illness still face stigma, and they are often ignored and mistreated. Psychiatrists should advocate for better care with insurers and policymakers, Dr. Sharfstein said. He also encouraged psychiatrists to form “creative alliances” with groups such as the National Alliance for the Mentally Ill and the National Mental Health Association.
In addition, he urged psychiatrists to push for the restoration of funding recently cut from the federal portion of the Medicaid program. And that advocacy should also extend beyond the boundaries of the doctor-patient relationship to broader issues of public health.
For example, thousands of young people are incarcerated unnecessarily each night because community mental health services are not available. And adults with mental illness are shot and killed by police who have little or no training to deal with such situations. “This, too, must be psychiatry's concern,” he said.
Next, psychiatry needs to create and enforce ethical standards. Dr. Sharfstein singled out the need to address the relationship between psychiatry and the pharmaceutical industry.
“It is my view that these relationships have been rife with the appearance of conflict of interest and frankly, with conflict of interest itself,” he commented.
Finally, Dr. Sharfstein said psychiatrists can help earn back their credibility by defending their core professional values, including confidentiality, academic inquiry, and scientific integrity.
Although it isn't proper in an age of terrorism to insist on total confidentiality of records, it's appalling that the Patriot Act allows the government to not only view patient records but to prevent psychiatrists from telling patients of such breaches. “Speaking up for confidentiality, even if we have a lone voice, is absolutely essential to our credibility and our professionalism,” Dr. Sharfstein said.
Academic inquiry is another area that must be defended. That means refusing to let drug companies withhold clinically important information from physicians and patients. The APA has made progress in obtaining access to data, and the group will continue to push for federal legislation aimed at establishing a registry of all clinical trials, he noted.
Psychiatrists also need to work to protect the scientific integrity of the field from attacks, including those from government officials. Dr. Sharfstein cited comments made by Rep. Ron Paul (R-Tex.), who is opposed to psychiatric care for children. Rep. Paul, an ob.gyn., has said that psychiatric diagnosis is inherently subjective and that mental health screening in schools has “no place in a free and decent society.”
Dr. Sharfstein fired back, calling Rep. Paul's comments “ignorant attacks.”
Dr. Sharfstein warned that threats to scientific integrity have also come from government agencies. For example, Bush administration officials recently instructed researchers presenting a study on suicidality among gay, lesbian, bisexual, and transgender individuals to not use the words gay, lesbian, bisexual, and transgender.
Telling researchers to delete those words is an insult to science and human rights, Dr. Sharfstein said, and psychiatrists cannot sit back and let that happen.
“If we abandon our core principles, then we lose our moral and professional authority–which is the light we must use to lead,” he said.