NIMH Director Expresses Hope For Future Of Psychiatry

Back to table of contents Next article Association NewsFull AccessNIMH Director Expresses Hope For Future Of PsychiatryKen HausmanKen HausmanPublished Online:4 Apr 2003https://doi.org/10.1176/pn.38.7.0001aThe director of the world's largest mental health research program is sounding an alarm about the rapidly decreasing number of psychiatrists pursuing research careers.Thomas Insel, M.D., discusses the factors that have coalesced to make psychiatric researchers a rapidly diminishing resource.Thomas Insel, M.D., director of the National Institute of Mental Health (NIMH), emphasized at last month's APA Board of Trustees meeting that rising student debt loads (the mean medical school debt is $95,000), shrinking financial resources, lack of appropriate mentorship, and the failure of medical school psychiatry instruction "to connect clinical psychiatry with relevant science" have combined to produce a serious shortage of psychiatrist investigators.This has developed even though about half of the students entering medical school have majored in science and have research backgrounds, he noted.With psychiatry's being one of the less-popular specialty choices for medical school graduates in recent years, and decreasing numbers of psychiatrists opting for research careers, a troubling future is facing the field "at a time when the chance to make breakthroughs is unprecedented," Insel said.Citing statistics to reinforce his concern, he pointed out that the number of psychiatry programs with M.D. or M.D./Ph.D. research fellows dropped from 143 in 1992 to 104 in 2001, a 27 percent decline. The number of physician or M.D./Ph.D. research fellows in these programs decreased from 342 in 1992 to 210 in 2001, a decline of about 39 percent.Insel also indicated what NIMH's priorities will be in the next few years in addition to trying to increase the population of physician scientists. The agency will target research in depression, suicide, schizophrenia, and autism, he said, along with a newly heightened interest in bioterrorism and behaviors linked to HIV infection. He noted that "obesity is also becoming a growing area of interest" for NIMH.The agency also plans to increase its collaborations with other institutes within the National Institutes of Health, the federal Substance Abuse and Mental Health Services Administration, and APA's American Psychiatric Institute for Research and Education, Insel said.The Board also heard former APA president Joseph T. English, M.D., and Karen Heller, executive director of the Health Economics and Outcomes Research Institute, describe progress that APA and the institute are making in jointly developing a Medicare prospective payment system (PPS) for inpatient psychiatric care. Units and facilities providing such care have for 20 years been exempt from the PPS that governs payment for other types of inpatient medical care.The Centers for Medicare and Medicaid Services (CMS) was expected to report to Congress at press time on the approach it favors to bringing psychiatric care into the Medicare PPS system. English indicated that CMS appeared to be looking favorably on the system APA and the institute developed.Friend-of-Court BriefsThe Board also was informed of amicus briefs that the Executive Committee agreed to support during conference calls between this and the previous Board meeting.One case, Sell v. United States, centers on the issue of whether a defendant with a mental disorder can be forcibly medicated to be competent to stand trial (Psychiatric News, March 7). The judiciary is looking for APA's expertise in this potentially precedent-setting case.In Garner v. Texas, another case in which APA will file a friend-of-the-court brief, it is registering its opposition to Texas's law that criminalizes sex between people of the same gender as "deviate sexual intercourse." APA is participating at the request of the American Psychological Association.APA will also be signing onto an amicus brief by the Association of American Medical Colleges supporting the University of Michigan's affirmative action admission policy. The case, which is before the U.S. Supreme Court, is Grutter v. University of Michigan.Other ActionsDuring its two-day meeting at APA's new Arlington, Va., headquarters, the Board voted to• accept "in principle" the report of the Task Force for a Vision for the Mental Health System. Chaired by APA Vice President Steven Sharfstein, M.D., the task force was formed last year by APA President Paul Appelbaum, M.D., and charged with articulating a vision of a comprehensive mental health care system that would be broader than the one expected to be issued later this month by the Bush administration's New Freedom Commission on Mental Health.Steven Sharfstein, M.D., discusses the report of APA's Task Force for a Vision for the Mental Health System as Michelle Riba, M.D., listens.The report describes 12 principles that must be part of the mental health care system. Among the issues on which the principles focus are the right to quality psychiatric care, the need for nondiscriminatory payment and patient-centered cost-containment principles, the needs of patients with serious and persistent mental illnesses, and a system of comprehensive care for children, adolescents, and their families.With the Board's endorsement, the task force will make minor changes to the report, and the Executive Committee will give it official Association approval in the next few weeks.• endorse the recommendations in an APA task force report on principles of care for persons with serious and persistent mental illness and charge the Committee on Government Relations with developing strategies for getting federal and state governments to pass legislation to codify these principles.• adopt an Assembly action paper calling on APA leaders to "recognize and draw attention to the needs of people who are seriously and persistently mentally ill. . .and to advocate on their behalf." It also directs appropriate APA components to develop an advocacy strategy and find sources of funding for the effort.• have the Council on Medical Education and Lifelong Learning implement a program to assist APA members who are preparing for the ABPN board and recertification examinations.• insist that states be viewed as the psychiatric safety net when APA advocates at all government levels for improved mental health care.• back dues relief for Canadian APA members (Psychiatric News, December 6, 2002). Because the Canadian dollar's (CDN) value is at about $0.64 of the U.S. dollar and Canadian members are not eligible for all the benefits their American colleagues receive, the Board agreed with an Assembly action to lower Canadian members' dues beginning with the 2004 dues year. Dues will be lowered from $526 CDN to $450 CDN. This will cost APA approximately $50,400 a year, but the Board hoped it would convince some of the 1,500 or so Canadian psychiatrists who are not APA members to join their 1,200 colleagues who are.• approve the appointment of an APA representative to the World Psychiatric Association's Task Force on Escalation of Violence in the Middle East.• approve wording for amendments to the APA Bylaws that, if passed, would designate the president-elect rather than the senior vice president to become president if an APA president cannot complete his or her term. In such an eventuality, the president-elect would not be held to a one-year term limit as president.• refer to the Assembly for its input on proposals to lower the required voting percentage for Bylaws changes from 33 1/3 percent to either 30 percent or 25 percent. The Assembly will discuss the issue at its May meeting so the Board can vote on it in June. The proposals are also going to the seven Area councils.A summary of the Board's actions is posted in the Members Corner section of the APA Web site at www.psych.org under the link for the Board of Trustees. ▪ ISSUES NewArchived

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