First Anniversary of

This blog is written to mark the first year of being on the Internet. The readership has expanded from 25 hits/week to over 300 hits/day and it is still growing. A followup on the topics of several of the blogs written in the past year was reported.

I started PsychiatryTalk  a little more than one year ago and it has been an interesting experience for me. I have met people from around the world via this blog  and it is very gratifying to see the number of hits on it to continue to grow. Initially, there would be an average of 25 pages /day that were read. Now it is well over 300/day and growing. I originally thought that the blog would generate online discussion.  I was surprised to find that readers are reluctant to put comments on the blog itself, although many people will write to me or people whom I know will speak with me in person about various subjects about which I have written. I still encourage any readers to put comments directly on the blog in the comments section and they will be posted usually within a day or two. It is easier for me to write the blog every other week rather than weekly so I have recently switched to biweekly postings.

I thought that this might be a good time to report some follow-up on various blogs which I have written .

The first blog that I wrote on October 12, 2009 was Review of Fox TV Show Mental. It was a critique of a new television show  which was about a psychiatrist. In my opinion, the program lacked authenticity and missed the opportunity to depict psychiatry and mental illness in a realistic manner.The show was not renewed. There is an excellent program about a psychotherapist on  HBO titled In Treatment which  just began it’s third season. It stars Gabriel Byrne as Dr. Paul Weston who has weekly sessions with patients , including one with his own therapist. This is a scripted show and although the writing is quite good, it is fiction based on a similar Israeli TV show.  I believe that it  would be possible to develop a high quality reality tv show of an actual ongoing therapy which could not only show real therapy sessions but also allow for interesting discussion by experts. There would be some ethical considerations in doing it which but I believe could be overcome and it  could be done in a thoughtful manner.

The second blog on October 19th was titled When a Mother Kills Her Children. It was about post partum psychosis with a discussion of the Proposed bill before the US Congress tiltled the Melanie Stokes Mothers Act . I am pleased to say that in March of 2010 it was passed and signed by the President. This  legislation will establish a comprehensive federal commitment to combating postpartum depression through new research, education initiatives and voluntary support service programs.

In December 2009 I first wrote a blog Condolence for Soldier Suicide where I made the case that it was wrong for the President of the United States not to write a letter of condolence to the families of American soldiers who have died by suicide. Another blog was written on this subject in August  2010 titled We Can’t Avoid PTSD and Suicides . While the President has still not changed his policy, the Secretary of the Army has recently written to some of the families and expressed his regret on the death of the soldiers. Perhaps this may be a sign of things to come. I authored an Action Paper with Dr. Roger Peele of Washington D.C. requesting the Assembly of the American Psychiatric Association to ask the President to reconsider his policy on this issue. It was passed by the APA Assembly and also endorsed by the Board of Trustees of the APA . This makes it the policy of our 38,000 psychiatrists organization. In addition Mental Health America and the American Foundation for the  Prevention of Suicide has passed similar resolutions and also are in the process of gathering signature for a petition to  President Obama. I believe we are getting closer to this long over due recognition to the families of these soldiers .

Another important military issue  and human rights issue was discussed in the February 2010 blog titled Abolishing Don’t Ask Don’t Tell (DADT).  Polls have consistently shown a majority of the public supports letting gays serve, and Defense Secretary Robert Gates and top military commanders such as Admiral Mike Mullen have recently endorsed it. In September 56 Democratic senators voted for the defense authorization bill, which included DADT repeal, but the measure failed to achieve the 60 votes needed to overcome a Republican filibuster.  A recent study conducted by the Pentagon concluded that ” …while a repeal of DADT will likely in the short term bring out some limited and isolated disruption to unit cohesion and retention, we do not believe this disruption will be widespread or long-lasting, and can be adequately addressed. The report, based on responses from 115,000 service members and 44,266 spouses, includes interviews with former gay or lesbian service members, some of whom were discharged from the military under the “don’t ask, don’t tell” policy. Of those surveyed, 69 percent said they had served with a gay service member and 92 percent of those respondents said they were able to work together.Fifty to 55 percent of those surveyed said the repeal won’t have any effect, 15 to 20 percent said it would have a positive effect and 30 percent said the effect would be negative.The report went on to say that  “The reality is that there are gay men and lesbians already serving in today’s U.S. military and most service members recognize this,” the report states. “Much of the concern about open service is driven by misperceptions and stereotypes about what it would mean.”I still like the words of Barry Goldwater on this issue who said, ” It is not important if your are straight , just that you can shoot straight.”

When there was a proposal for a 39% hike in healthcare rates purposed in California by private insurance companies, I raised the question in a March 2010 blog titled  Stockholders Must Vote CEO Pay whether  there should be  law where stockholders,not Board of Directors of Compensation Committees, should be required to approve any compensation packages more than 200 times the minimum wage in the US. That controversy seems to have been revived just this past month when compensation at Wall Street firms was reported to be  expected to hit $144 million . A column in the Wall ll Street Journal raised the question I brought up that since the 2008 financial crisis profits remain 20% below the 2006 level while the pay at these firms rose an astonishing 23 % over that time frame,  shouldn’t the owners of these firms be the ones to decide if they want to spend their money raising the compensation of their executives. ?

The May 12th 2010  blog titled Autism & FragileX- New Treatment has become the most looked at blog of PsychiatryTalk of the year so far. In it,  two new research projects concerning Autism Spectrum Disorder and Fragile X Syndrome are briefly reviewed. In the first, a random controlled study of children with Autism Spectrum showed that the Early Start Denver Model showed statistically improvement over a control group in regard to intellectual development and adaptive behavior. In the second study, preliminary research showed that a new medication improved behavior associated with Fragile X Syndrome compared to the control group. There is also some belief that such medication would be effective with children with Autism Spectrum.  As a followup I don’t find any announcements of new breakthrough research. However, there is  a $211 million HHS-wide initiative that would invest an additional $1 billion over the next eight years in autism related activities, the NIH budget includes $141 million in FY 2010 for research into the causes of and treatments for autism spectrum disorders (ASD). The funded research will  include identifying biomarkers; improving ASD screening; establishing ASD registries; understanding genetic and environmental risk factors, as well as interactions between the immune and central nervous systems; and enhancing services that can help people with ASD across the lifespan.

Also in May I wrote two blogs addressing financial issues in the  American Psychiatric Association and they were Impact of APA Budget Cuts and  Increase APA Budget $1.5 Miilion. In the the former I discussed the expected impact of the cuts on the APA Assembly and APA Components particularly the Communications Committee and the Disaster Committee. In the second blog I outlined several specific suggestions how I felt that the APA could gain this large increase in it’s budget. Certainly the APA continues as a very vigorous organization representing 38,000 psychiatrist and speaking out on important issues concerning mental health. It is still too early to determine if the cutbacks will seriously hinder it in it’s effectiveness. I understand that some of my suggestions are being considered by some of the leadership but as far as I know no steps have been taken to implement any of them

In a July 14th blog titled I would Like to Thank My Psychiatrist It was stated that Los Angeles Laker Ron Artest after his team won the NBA Championship thanked his psychiatrist on national television. This is was noted to be  example how an increasing number celebrities are comfortable publicly discussing their psychiatric history. Television programs, movies, the Internet and the new media have all contributed to the reduction of stigma about mental health problems and treatment. My colleague Bill Arroyo informed me that Artest was mistaken in that his therapist was not a psychiatrist but another mental health professional. While I appreciate the correction, the changing attitudes towards discussing therapy still  holds and is a good trend.

Last month I wrote my first blog on Miners in Chile anticipating any psychological issues that people who have gone through  a traumatic event may experience. As the miners began to emerge from the successful rescue efforts asecond blog was written in conjunction with a blog that I wrote for which I suggest that in this situation I believe that resiliency will be the default and most if not all of these miners will not have any long lasting psychological effects. In fact this brush with death may end up being a positive experience for them . It is obviously too early to tell  but it is very gratifying to see the good feeling around the world for these miners. However, just recently  29 miners  died in an explosion in New Zealand and we are reminded how such tragedies occur all the time and so cause great mental anguish for so many people. In this regard still another report of a recent tragedy caught my eye and that was the traumatic event in Cambodia where more  more than 378 people died and hundreds more were injured in a stampede at the end of the annual Water Festival late Monday in Phnom Penh. So many of these victims  were young people , many in their teens. I hope that there are mental health professionals and others available to help the survivors, families and friends deal with their grief.

Needless to say, I am still enthused about continuing this blog. I do appreciate the growing readership and I would want to encourage each of you to feel free to comment directly on the blog with your own views are particular topics. Whenever I have had occasion to give a talk whether it has been at a national meeting, a Grand Rounds or even a local group, I am always very pleased if there are 25 people in the audience, as it is privilege to share my interest with others. So it becomes a special opportunity to use the Internet to reach much larger numbers throughout the world through this wonderful medium. Thank you all for your continued interest.

Increase APA Revenue $1.5 Million

There are several possible sources of increasing APA revenue. The dues could be increased an average of $50/year over a five year period which would bring an average increase of revenue of $500,000/year. Profits from the sale of DSM V even with half of it going into reserves would probably add at least another $500,000/year to APA revenue. If the APA Foundation took over part of the public affairs activities of the APA, that would allow for an estimated $200,000 year. APPI, publishing arm of the APA, could use the district branches as a commissioned sales force which could provide another $200,000/year of revenue. Having more videoconference could replace some travel costs and increase revenue about $50,000/year. Finally having the APA “go global” could bring in a large number of international members which could increase revenue an estimated $100,000/year. There ideas have the potential of increasing APA revenue $1.5 million/year which could be used to reinvigorate the Assembly and reestablish the APA Components in a responsible manner

Recently I wrote about budget cuts which the Board of Trustees has made to the APA Assembly and the Components as well as the possible implications of them. While attending the APA meeting this past week in New Orleans I had some informal feedback also expressing concerns about the recent cutbacks in the Assembly and the Components. There seems to be a difference of opinion among psychiatrists whether it is time to restructure the APA  to a “ leaner and meaner” organization where activities and functions by necessity have to be cut back because of reduced income. Whereas others wonder if there are untapped sources of income and believe there are reasons for the APA to continue to grow and expand it’s advocacy for our patients and our profession.

I would like to examine several possible sources of increased revenue for the APA, which could be used to prevent a cut back of the Assembly and the Components, as well allow for consideration of developing new important programs.

Dues Increase

If the membership wishes increased services, they should be willing to consider paying directly for them. The national dues have not been increased for several years. There are different categories of membership, which have different levels annual dues. If the dues are increased an average of $50 / member over a five year periods, this would gradually increase the income starting with $380,000 the first year. At the end of the five year period the APA  income would be increased $1.9 million /year. Of course, there is the possibility that some small percentage of the 38,000 members would drop out because of the dues increase. On the other hand, if new exciting activities were developed as described below, we could increase membership. A conservative estimate would put this at an average of $500,000/year

How to Use Profits From DSM V

The APA has made an arrangement with APPI so for DSM V the APA will own the rights to DSM V when it comes out in 2011. I understand the previous performance of DSM IV cannot reliably predict the profits from DSM V. However, we still can anticipate this book will be used worldwide as will the accompanying texts which will be published. Most mental health professionals, institutions, government agencies, attorneys, etc  will want to own a hard copy of it, even though there is a trend to looking things up on the Internet. I also assume that there will be DVD versions of it which will be sold. On the basis of some discussions I had  with people who know something about these things,  I would predict that the APA can anticipate a profit of $10 million over the next 8-10 year for this product. This would be a conservative estimate. Therefore if half the proceeds were put into the APA  reserves that would allow another $500,000/year available for the APA budget.

APA Foundation Could Take Over Significant Part of Public Affairs

The APA Foundation is suppose to be 100% in sync with the APA and certainly shares the same goals and aspiration for mental health and education of the public, increasing public awareness and raising money to do good projects for mental health. It is only because of some technical, legal issues related to taxes that there are separate Boards of the APA and the Foundation . There are efforts being made to allow these organizations to function more in unison in the future. As I mentioned in a previous blog, I believe, the forced reduction of the Communications Component has seriously taken away many opportunities for public affairs programs. I therefore suggest that the Foundation should appoint staff consultants who are very familiar with the previous APA public affairs program as well as the current ones . They should use the resources of the Foundation  to run national, state and  local public affairs programs as a major initiative. They can run a Public Affairs Institute, advise and assist mental health advocates from various District Branches write letters to the editor, run educational training for psychiatrists  etc. They can liaison with the APA while still keeping their independence, if that is necessary. They can take over some of the spending in public affairs that have been in the APA budget. I would estimate that this could easily result in a savings for the APA of at least $200,000/year without any loss in the quality of public affairs for mental health and American Psychiatry.

APPI Should Use APA District Branches as a Commissioned Sales Force

APPI was originally developed as an arm of the APA, which was expected to serve a completely dedicated to the APA mission. It has become the most successful publisher of psychiatric books in the world. Even after having sold the rights of DSM back to the APA they still should be able to make considerable profits. Although there is still that problem of having separate Boards although appointed by the Medical Director of the APA, they should be interested in doing everything possible to support the APA. Every publisher makes arrangements with sales teams to take their books into a particular setting, make sales and then pays them a commission. I propose that each District Branch should become a commissioned sales representative for APPI. They should include APPI advertisement for APPI books in all their mailing with special discounts as well as promoting books at all meetings and activities. District Branch members should be aware that buying their books through the District Branch would allow their DBs to receive significant commissions. Once it is determined how much money the DBs are receiving, a certain percentage of APA support or revenue sharing from the Assembly budget being given the DBs should be reduced. The net result should be increased funding for the DBs and decreased support from the APA to the DBs. It might turn out that APPI might make less of a profit but they would be serving their overall mission to support the APA. There would be an incentive for the DBs to promote APPI books and products which could include sales to the local mental health community who they know best as well as the public in their area. These activities might even drive up APPI profits.  I estimate the APA could save at least $100,000/ year by this method.

Use of State of the Art Video Communication

I know that the APA has made great strides in introducing some video communications and have encouraged the use of conference calls, webinar and perhaps Skype meetings. I personally believe that face to face in person meetings should not be completely eliminated and that the combination of at least one face to face meeting combined with state of the art video/personal computer conferencing is now feasible.  I would suggest that the APA become very aggressive in advocating such communications for at least some percentage of most committee meeting including, as an example, of at  least one Board of Trustees meeting. The savings in hotel, travel, food can make a considerable savings for the APA. One would almost think that the members should contribute to buying their equipment own since they would save time away from practice. However, I believe that an investment by the APA in providing equipment in the short and long  run would save the APA money. I would suggest that the APA could save at least $50,000/year.

APA Needs to Go Global

I have saved my most ambitious proposal for last. I am convinced from what I see happening in the economy, business and in the various activities of so many people that I know, that our lives are becoming more global in every way. I believe that the APA has to begin to take significant steps to become a global (still American) organization.  We need to look at every aspect of our organization and see how we can become more global.

Starting with membership, we should offer a membership category to international members at a reduced cost  (to cover journals , mailings etc plus enough to make a profit for the APA). This lower rate should be contingent on the international members being a member of their own national psychiatric organization or the World Psychiatric Association.. This way we won’t compete with international organizations but would allow them to encourage membership as global members of the APA. Obviously we will need to provide international members with special benefits such as discounts of APPI books, facilitated access to disaster materials, perhaps some special online or Skype CME courses. As part of our efforts to go global, the newly invigorated Assembly (with some increased funding) should have a certain number of international delegates to the Assembly perhaps one from each country or from each major area of the world for a start. Oh yes, the APA Assembly should be broadcast live online (as well as being archived) so our members in the US and all over the world can see American psychiatry in action. While we are doing this we should set up electronic voting which I unsuccessfully advocated for when I was Speaker of the APA Assembly – the price has come down and we do need to showcase the fantastic democratic methods we use in the Assembly when we broadcast the proceedings around the world. I estimate over the next five years we should be able to add at least 1000 global members – so lets figure in the long run we add at least another $100,000 /year income after added expenses are taken into account.

How It All Adds Up

I realize that I am letting my imagination get a little carried away. I tried to build these ideas on facts and speculation that has good foundation. I may be wrong in some of my calculations or may be a little ahead of my time (or perhaps behind if some of these things are being contemplated already). However I tried to be conservative in my estimates and I came up with almost  $1.5 million dollars/year available for reinvigorating  the Assembly and reestablishing the Components in a responsible manner.  I am also suggesting that there may be innovative approaches to increasing available funding.  I encourage our members and leadership to continue to look for newer and better ways of doing things for our patients and our profession.

Impact of APA Budget Cuts

The American Psychiatric Association has recently made budget cuts and cutbacks to the APA Assembly and APA Components. The potential impact on the Assembly and particularly on the Communications Committee and Disaster Committee where the author had previously been very active were discussed. The APA may be at an important crossroads.

APA Budget Cuts Hit Assembly and Components

This week in New Orleans the Assembly of the American Psychiatric Association will be in session just preceding the annual meeting of the APA. In certain ways this will be a momentous meeting  in that the APA  may be taking the first steps in a restructuring process which may significantly change how it functions.


During the last Assembly Meeting which I attended in my capacity as Distant Past Speaker, the Assembly had a mandate from the Board of Trustees to cut it’s budget by $200,000.  This was due to a of  loss advertising revenue and  diminished income from the annual meeting. In addition changes made several years ago left  the APA unable to  utilize income from APPI publishing and the APA Foundation which are required to function independently of the APA.

Assembly of the APA In Session

After discussion and debate, the Assembly accomplished this task. The Board rescinded a request of another major cut. The result of the cuts that were made is that there are less representatives and alternative representatives will not have financial support to attend meetings. There are other cuts in staff and activities of the Assembly. Many are concerned about the diminution of alternate and younger representatives, as the Assembly is often the training grounds for APA leadership. There is also the question of whether these cuts are taking away the voice of under represented minorities as well as that of various sub-specialty groups which have been traditionally represented in the Assembly. These and future cuts are viewed by many as leading  to a less democratic process with increased executive functioning.


The Assembly was not the only part of the APA to be cut. The Fall Components Meeting was essentially eliminated, as were most of the Components. This doesn’t mean that activities in the areas previously covered by the Components were destroyed. In some cases an individual was appointed as representative to a Council charged with the responsibility of an area previously handled by a Component. Some committees might meet at the annual meeting in reduced size or have conference call and in other cases staff were assigned duties previously handled by Components.

It is not clear how these changes will impact the APA. However, I would like to express my concern about two Components upon which I have been very active in the past.

Communications Committee

APA Public Affairs Broadcasting Live From APA New Orleans Meeting 2001

In the past each Area had a representative on what previously was called the  Joint Commission on  Public Affairs which also had s several knowledgeable members who were consultants. This was a vibrant vehicle of communication and exchange which brought back ideas and activities to the various Areas and local DBs, each of which had their own PA Committee. In addition, this APA Component arranged biannual Institutes where there were exhibits, demonstrations of programs and exchange of ideas. I learned about a clergy dinner that Kentucky was holding which I brought to my then DB in Westchester which now has  been running such a program  for more than 15 years. I participated in an education program about how to approach newspaper editorial boards, which led me to start a local newspaper column that ended up being syndicated for Gannett Newspapers. Training which occurred at these institutes in radio and television provided many others and myself with the confidence to pursue projects in these media . At these meeting we also were introduced to ideas how to establish our Area and DB web sites which were in a nascent stage. I can see reverberations in many public affairs activities of psychiatrists throughout the country, which can be traced to the interaction, and exchanges which came from this Component. I understand from some initial inquires that most of these activities have not been occurring recently and certainly not at the level which they occurred in the past.

Disaster Committee

Most psychiatrists (except those the military) become involved with this aspect of psychiatry because of some incident which occurs in their locale. That was the case with myself and I ultimately found myself on this committee with a group of remarkably experienced and dedicated psychiatrists. There were creative projects which  emerged from this group which included, awards and recognition for psychiatrists working in disasters, an emergency funding mechanism for district branches at the time of disaster, development of a manual for use in disasters which was translated into Japanese after a request during the Kobe earthquake, a special place on the APA website for disaster information, the development of disaster workshops for the DBs (in conjunction with the Assembly), the development of courses for the annual meeting which were conceived , discussed and developed at these meeting as well as  many other things. Last time I looked there was no Disaster Component and disaster activities are under the oversight of one very capable member) and staff. – Addendum– Since writing this I have learned that a Committee of the Board led by Dr. Sullivan and Bernstein have reinstated the Disaster Committee. I don’t know if it will meet in person and what resources it will have but that is a good piece of news. There still needs to be some indication what will happen to all the other activities of the Components.

Where Do We Go From Here

Realistic financial restrictions can’t be overlooked. A vibrant organization has to constantly reinvent itself. Some people have advocated cutting back the Assembly even further. It has been questioned whether APA  members want governance by a representative group. After all less than 25 % of APA members even vote in national elections. Utilizing members to be an active part of the governance is more expensive than just having paid full timestaff run the whole show.  Even though members donate their time, the fact is that travel and hotel are expensive and the deliberate process takes more time. On the other hand, there are other potential revenue streams and the  creativeness of members in the past has been very productive in finding new ways to do things. Some believe rather than limit participation, we should increase it, which could also expand APA membership.

APA Will Continue to Be Vibrant But Different

I have a confidence and optimism about the APA. We are fortunate in having a very talented Medical Director and have always been able to attract outstanding staff. However I believe that the he APA 10 years from now will be quite different than the APA of 10 years ago. What that difference will look like, will depend on the  priorities and values which we hold and what kind of governance we will choose .

I welcome comments on this topic . In next week’s blog I will offer some suggestions as to how I believe that  the APA can increase it’s income more than $1 million / year  and continue to support the Assembly, Components and new programs.

American Psychiatric Association - 2020