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Appelbaum addresses crisis in mental health. (APA Chief Offers Six-Point Plan).

CHIGAGO -- The nation's mental health system is in crisis, and the psychiatric community needs to engage in an unprecedented campaign of activism to stanch the bleeding, Dr. Paul S. Appelbaum told the American Psychiatric Association's Institute of Psychiatric Services.

"We can no longer be quiet about the impending decline of the mental health system," said Dr. Appelbaum, president of the APA.

"Unless we as a society are willing to pay the costs of adequate mental health care, facilities will continue to close," he added.

In his speech opening the 54th annual Institute for Psychiatric Services, devoted mainly to community and public sector psychiatrists, Dr. Appelbaum cited more than a dozen examples of rapid and severe degradation of what remains of the mental health safety net for the nation's poor.

He also put forth evidence that the problems with mental health funding and onerous policies of private mental health managed care companies are beginning to affect the middle class as well.

And Dr. Appelbaum outlined a sixpoint plan designed to spur the psychiatric community to action. Among his suggestions to make policy makers sit up and take notice:

* Gather data on the inadequacy of mental health care from sources such as state mental health agencies and the National Alliance for the Mentally Ill (NAMI).

* Alert the media. Dr. Appelbaum said that local weekly papers are far more influential to most people than the New York Times or CNN, and that's where the media push should be.

* Prioritize which areas of mental health care are most dire and focus on those.

* Work with allies such as NAMI, local mental health associations, and state chapters of other medical societies and disease specialty groups.

* Meet with legislators and business leaders--the ones paying the health care bills--and convince them their money is being spent poorly

* If all that takes up time that people do not have, they should go home and write a letter to the governor and send copies to state legislators.

Among Dr. Appelbaum's examples of the crisis is what he called the wholesale abdication of responsibility by the government of his native Massachusetts to fund mental health care, and an e-mail from a Vermont mother whose severely mentally ill son lives on the streets without care--even though he has insurance and a steady monthly income.

Dr. Appelbaum talked about mental health care workers in Boston who are leaving their jobs in favor of higher salaries at Burger King.

In Minnesota, he said, many community health clinics are stretched so thin that they have waiting lists as long as 6 months just for an appointment.

"Can you imagine being plagued by an anxiety disorder or being seriously depressed, taking weeks or months to work up the courage to call for help, and being told you have to wait 6 months to get an appointment?" Dr. Appelbaum asked.

"This is not acceptable," Dr. Appelbaum said. "We and our patients have had enough."

When Dr. Appelbaum sought the presidency, he vowed to focus attention on what he called the "systematic defunding" of psychiatric services.

Currently, Dr. Appelbaum serves as chair of psychiatry at the University of Masschusetts in Worcester.

In addition, Dr. Appelbaum has been on the APA's board of trustees since 1997 and has served as chairman of both the Commission on Judicial Action and the Council on Psychiatry and the Law.
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Author:Perlstein, Steve
Publication:Clinical Psychiatry News
Date:Nov 1, 2002
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