Despite our successes in the Decade of the Brain, the survival of our field is at stake. To meet adaptational challenges, leadership and innovation at the APA Board are a must. We need wisdom, courage and vision to survive. The arrival of the new APA Medical Director will accelerate changes and focus on the restructuring of APA, both internally and in its governance. Half measures will not do. Your choices in this election can ensure dynamic leadership. The decisions that your APA Board will make during the next two years will shape the face of American Psychiatry in the next millennium. I believe I am the best candidate for this challenge and here is why. As a foreign born, U.S. educated physician, I know change intimately, its hazards and rewards. I can ask the tough questions and have demonstrated the courage to take the painful actions that real structural change demands. I have a track record of decades in clinical practice, education and constructive activism. I am known for taking on controversial, potentially explosive areas of concern to our integrity and working constructively within and beyond our organization to implement solutions. Starting in 1977, I pioneered the first model of due process ethics hearings in APA, started ethics education for our members, worked with other professionals and the public on legislation and public education in psychiatry. By having me as your APA Secretary, not only will the ethics appeal process continue effectively and fairly, but I'll see to it that the APA re-structuring incorporates ethical issues. We have to rethink how best to ensure the integrity of our profession in the evolving systems of care through ethical principles as well as practice guidelines and treatment outcomes.

The task of restructuring APA goes hand-in-hand with the need to make APA member-friendly. APA is a voluntary member organization. Members will stay or drop based on APA's ability to continue to influence the external world of economics-driven care towards ethical, competent, scientifically based patient care. APA has to stand for universal coverage; for real, full parity; for national standards of care which ensure a continuum of care, the preservation of the doctor-patient relationship, the privacy/confidentiality of patients, the freedom of patients to contract outside any system of care with the psychiatrist of their choice, for an outside appeals process in cases of denial of care, for changes in ERISA, for accountability by all corporate care systems as to the quality of care they provide, along with full disclosure of their profits, improved reimbursement certification and demonstrable clinical competence as well as advocacy for research into psychiatric illness, disability and dysfunction.

APA has to energize its members to innovate across the board. We are an integrative medical specialty, bridging brain/mind and soul/soma through scientific empirical knowledge derived from medicine, neuroscience, psychotherapy and other fields. We need to lead and actively participate in the re-structuring of traditional patterns of clinical practice, research and teaching with the needs of patients and families as primary. When we let them do it for us, THEY DO IT TO US and patient care suffers and our integrity is compromised. No one can do this without us. While we uncompromisingly should expose and work to eliminate abusive, corrupt systems of care, by all means necessary (litigation, legislation, advocacy, coalition-building and public education), our main focus must be to advocate for scientifically-based ethical standards of psychiatric care regardless of the type of delivery of care.

Not only do we have to inspire our APA members; we must demonstrate psychiatry's value to the rest of Medicine. Our survival depends on our success. We can only do that if a) we preserve APA as the unifying voice of our multispecialty field; b) we collaborate with our medical colleagues in meeting patient needs. Results sell. Competition is here to stay. We have to focus on creative imaginative innovation for quality psychiatric care.

It is my conviction that stigma will be erased only when ethical psychiatric treatment becomes highly efficient, effective and affordable. Psychiatry has yet to see its full maturity. If we keep innovating and expanding our knowledge, the millennium will be ours!

I seek your support to work for our future.