American Psychiatric Association: Healthy Minds, Healthy Lives
Corporate Spotlight
Written by Amanda Gaines   
Thursday, 31 January 2008
American Psychiatric Assoc.: Healthy Minds, Healthy Lives - Health Executive - RedCoat Publishing
Dr. James Scully, Jr. explains the importance of clinical research and patient advocacy in the field of psychiatry.
Recent survey results show that, although 85% of Americans agree their mental health is as important as their physical health, only 24% know how to get help. Which is why, when the House and Senate passed the Mental Health Parity Act of 2007 this past fall, the members of the American Psychiatric Association breathed a small sigh of relief.

American Psychiatric Assoc.: Healthy Minds, Healthy Lives - Health Executive - RedCoat Publishing
Dr. James Scully, Jr., Medical Director and CEO
The bill was developed to stop the discrimination of insurance coverage for treatment of mental illness. According to Dr. James Scully, Jr., APA medical director and CEO, some federal insurance programs require a 50% co-pay from patients suffering from mental disorders while other medical disorders only require a 20% co-pay.

“It simply makes no sense,” he said. “Schizo-phrenia, for example, is a brain disorder just as multiple sclerosis is a brain disorder. MS strikes areas in the brain related to sensory and motor function, while schizophrenia strikes areas in the brain related to information processing. Both are relapsing, and both are chronic. There should be no cost difference to the patient.”

On the bright side, in the past 30 to 40 years, many of the misperceptions regarding mental illness have been dispelled. And as the insurance industry catches up with the scientific evidence regarding mental illness, APA is there to let those with psychiatric needs know they are not alone. In a large part, the Mental Health Parity Act does the same thing.
“The act will give patients better access, and physicians will be better equipped to help them because they will seek better care when they don’t have such high co-pays,” Scully said. “The bigger issue, though, is that discrimination of brain diseases is no longer acceptable.”

Clinical documentation
APA is the largest publishing enterprise in psychiatry in the world and owns the majority of English-language intellectual property in the field. Its handbook, the Diagnostic and Statistical Manual of Mental Disorders (DSM), continues to play an important role for mental health professionals around the globe.

The history of the DSM dates back to the 1950s, but according to Scully, it wasn’t until the third edition that the handbook changed the field of psychiatry by turning its focus to science-based evidence. “We’re still looking for the basic biological underpinnings for many mental health issues while not forgetting their psychological and cultural origins,” he said. “All of that is considered, but today, genetics has become a very exciting area. Progress happens on a weekly basis, so the handbook will eventually need to accommodate future discoveries in genetics throughout the next decade.”

The DSM-IV was published in 1994, and 13 years later, the process to develop the fifth edition, DSM-V, has begun. With the help of federal government funding, APA spent several years looking at the psychiatric research database and came to the conclusion that, if the process started in 2007, by 2012, the fifth edition would be completed. The issue of whether or not to wait for further discovery is always present, said Scully, but because 18 years separate the publication of fourth and fifth editions, enough progress had been made.

In September, APA’s board and a committee of roughly 200 mental health professionals appointed a 27-person task force of world-renowned scientists to oversee the five-year project. Members have been involved with organizations such as the NIH, the World Health Organization, the National Institute on Drug Abuse, and the National Institute of Mental Health. As the fourth edition was a text revision, meaning only explanatory text was updated, stricter disclosure statements were required for those on the task force for edition five.

“We wanted the best people to handle the revision, but we also wanted people who were willing to divest themselves from potential conflicts with pharmaceutical or other corporate entities,” Scully said. “At the end of the day, this is a clinical document and will be used by clinicians around the world. It must be scientifically valid and produced without conflict.”

Patient and mental health advocacy is as important as clinical research in the eyes of APA. Although a stigma lingers in the minds of many regarding the relevance of mental health conditions, in recent years, the organization has made extensive progress by spreading its message and educating the public online.

In May 2005, the organization launched HealthyMinds.org, a Web site providing a wide array of information, including the “Let’s Talk Facts” brochure series to promote discussions of psychiatric disorders and treatments and video testimonials from patients suffering from mental disorders. To reach a wider audience, and to keep up with the changing demographics of the US, APA recently translated many of those materials, including information on ADD, substance abuse, and post-partum depression, into Spanish.

In addition, as concerns regarding the over- medication of children and teens grow, APA launched parentsmedguide.org, but Scully believes the responsibility on this topic also lies in the hands of mental health professionals. “Those kids need to be carefully diagnosed by professionals,” he said. “It’s up to the mental health professionals to do the research and make sure they’re doing the right thing. We also work with our colleagues at the American Academy of Child and Adolescent Psychiatry to get the facts to parents so they can make those choices, further ensuring the treatment is done properly and effectively.”

APA also has ongoing dialogue with large corporations regarding the importance of investing in employees’ mental health through equitable insurance benefits, educational programs, and other approaches. More and more employers understand how the bottom line will improve if the workforce is healthier both mentally and physically, said Scully, and leading companies such as Cisco Systems, JPMorganChase, and Pitney Bowes are showing that improving mental health of employees also improves the corporate bottom line. And, in the past five years, APA’s membership enrollment has grown almost 10%.

“I’d like to see a faster rise, but the fact that enrollment is going up and not down is a good sign,” Scully said. “It tells us we’re on the right track, and it’s an exciting place to be.”
 
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