Psychiatry in the Decade of the Brain is facing major challenges. From within, the field is challenged to integrate the hard-won knowledge and experience of 100 years of dynamic psychiatry with knowledge from the newly emerging neurosciences, while preserving the fundamentals of compassionate, humanistic, ethical practice with its cornerstone, the doctor-patient relationship. From without, managed care, an ever expanding army of non-medical psychotherapists, government regulation, a restrictive, discriminatory insurance system that excludes or severely limits psychiatric benefits and the realities of years of economic recession have ravaged the public psychiatric sector and left millions uninsured with no access to care.

Such challenges must be responded to with vision, innovation and the activation of our biggest asset: our members. APA has a proud tradition of openness and participatory democracy. But most of our members are uninformed and uninvolved, the cost of maintaining the current APA structure is very high and the need for organized coordinated psychiatric response on the local, state and national level is urgent and ever expanding. The APA is as good as its ability to be a reliable responsive vehicle fostering and facilitating the participation of its members who need to address the challenges confronting psychiatry, psychiatrists and psychiatric patients. It took six years to develop the current structure in the 1960's. The current structure served us well through years of steady increase in membership providing an accepting, containing function during decades of factionalism and brain/mind polarization. Each and every piece of the mosaic of psychiatry found a place in APA.

But the picture has now become blurred. Many members feel their needs aren't being addressed and APA isn't helping their adaptation into new practice settings. Issues such as contract negotiations, relations with other professionals, prevention of malpractice suits and maintaining one's professional integrity in practice settings that foster substandard care because of improper working conditions or policies contribute to professional discontent The regulated world of Medicare and managed care has alienated many members. The issues are complex and the time has come to reexamine both the functions and structure of APA to prepare for the next century.

The new realities include the societal view of health care as a right and the recognition that medical and psychiatric knowledge are essential to survival and adaptation. Demand for psychiatric knowledge will expand. Psychiatry has to maintain its leadership by emphasizing its unique role in the generation of this knowledge by insuring funding for the neurosciences, research in psychiatric conditions and treatments (including psychotherapy), support for residency training programs and continuing education. Psychiatry must also continue its efforts in ethics education and maintenance of standards, work on practice guidelines, DSM-IV, sustaining the campaign against stigma and strengthening patient advocacy by fighting to ensure access to psychiatric care, non-discriminatory insurance coverage and a ban on pre-existing exclusions.

I am in favor of subspecialization in psychiatry. I do not feel that it will fragment the field. On the contrary, it will strengthen it by providing the necessary organizational structure for the generation of in-depth knowledge in special areas of psychiatry through research and training. While I understand that certification will figure in promotions and compensation, the policy of APA should be to advocate for reimbursement policies that differentiate between psychiatrists and non-medical practitioners and offer assistance to members for recertification or re-licensure.

The APA should encourage research into the psychiatric needs of minorities, domestic violence, racism and prevention of psychiatric illness, disability and dysfunction. A primer in psychiatric prevention should be developed for use in public education. The APA's legislative and public affairs efforts should be strengthened and coordinated to maximize efficiency and minimize cost I favor fund-raising by the American Psychiatric Foundation from outside our field according to specific guidelines and consistent with our ethical principles. These guidelines should be developed by the Foundation in consultation with APA.

I am deeply honored with this nomination. If elected, I'll serve you with enthusiasm and vigor and seek to foster two-way communication between us.