Join us as Dr. Rebecca Brendel, immediate past president of the American Psychiatric Association (APA) and current leader at the Center for Bioethics at Harvard University, shares her wisdom on leading the APA during tumultuous times, ethical considerations in psychiatry, and the promising future of the field. From her personal journey within the APA to embracing technology's transformative power, this episode promises a deep dive into the ethical heart of psychiatry.
Navigating the challenging terrains of psychiatry requires a blend of expertise, vision, and ethical grounding. Dr. Rebecca Brendel, MD, JD, exemplifies these qualities. As the immediate past president of the APA and a luminary at Harvard's Center for Bioethics, she has consistently showcased her commitment to upholding ethics in the ever-evolving field of psychiatry. In this episode, she offers a panoramic view of her journey, the APA's strides under her leadership, and the directions in which psychiatry is headed, especially in the realms of technology, diversity, and medical ethics.
Timestamped Shownotes:
Links and Resources Mentioned:
That's one of the pieces that we've really been looking at. What are the things that psychiatrists do that are unique to being a psychiatrist, and how do we think about a system that gets patients to the right care at the right time, in the right place, and in a sustainable way? In a way that funds that care and compensates it appropriately.
Welcome to the Psychiatry Tomorrow podcast. I'm Dr. Carlene MacMillan, and in each episode we interview thought leaders in the deep end of Psychiatry's Next Frontier, and dive into the latest research, innovative treatments, technology and policy development, shaping the future of psychiatry. Join us on this journey to discover what's next in mental healthcare so you can stay ahead of the curve.
Today I had the honor of speaking with Dr. Becca Brendel, the immediate past president of the American Psychiatric Association, which I of course am a longstanding member of. She currently leads the Center for Bioethics at Harvard University. Our dialogue traces Dr. Brenda's journey within the APA, including her decisive leadership during the pandemic.
We discuss her contributions around ethical considerations in psychiatry, like the role of the infamous Goldwater rule in an unprecedented political climate, and the APA’s recent push for diversity and inclusion. Delving deeper. We explore the APAs 5 0 1 C foundation's outreach and the development of its psych Pro registry, which has the potential to really move our field forward.
As we shift to academia, Dr. Brandell shares insights on the collaborative care model, measurement-based care, and the vital balance between leadership roles and maintaining clinical work. Finally, we discussed the exciting fusion of data science and tech innovation, shaping psychiatry's future address ethical considerations surrounding corporate collaborations, and explore opportunities for aspiring medical professionals.
Having Becca since I was a resident psych in training and she was an attending in the psychiatric emergency room, I'm in awe of breadth and throughout and you. Let's dive in.
Welcome, Dr. Brindell. How are you doing today? I am well, thanks for having me. Wonderful, wonderful. Well, so you've just wrapped up a, a term, uh, with the a p a and I would, uh, love to maybe just start, like, what's, what's a day in the life of a a p A president? Like what, what, what was last year like for a typical kind of, I don't know, Monday?
Uh, well, you know, last year was a really unusual year. There was so much. Much going on in mental health that we could have never anticipated. And so there were a number of different phases to the year between a lot of advocacy in Washington and in state government around access to mental health to the world, reopening to travel and meetings, being able to reconnect with colleagues and uh, really, um, Rekindle APAs, uh, global connections and leadership.
Mm-hmm. Uh, in person for the first time. Uh, and then, uh, a host of other responsibilities to the organization, to running the board, setting a strategic vision, uh, for the coming. Uh, coming years, uh, and thinking about how psychiatry is gonna move forward into the future. So, uh, there were, there was a lot of, a lot of travel, a lot of unexpected travel, and then a lot of work really holding together our policy and, uh, getting a p a back into person fully and into the post pandemic future.
Mm-hmm. And how did that all go? Well, it was, it was dizzying, I have to say. When I finished, I was really happy, uh, uh, really happy to be able to wake up in the morning and not feel like my to-do list was already getting longer. Uh, but reflecting back on the. On the experience, just an extraordinary opportunity to work with, you know, the more than 200 people who work at a p a to support mm-hmm.
Psychiatry and our members, and that that was just, uh, every day was learning something new and being part of something that really matters. Yeah. The, the a p a staffers, really, I mean, they're there full time. They're there for many, sometimes many years, and they really kind of have a lot of institutional knowledge to.
To share. Um, was there anything about what they, you know, what you learned from them that kind of surprised you about the a p a that you sort of didn't know kind of going, going into the role? So, you know, over the past 20 years, I'd spent a lot of time in different roles at a p a. Mm-hmm. And I thought I had a sense of the scope, but I have to say that, you know, the, the, um, command of.
Uh, all the different systems, uh, that go into, uh, mental health and the knowledge and expertise that the a p A administration has is really extraordinary. So I work for a really large hospital system in Boston. Mm-hmm. Mm-hmm. And I, I teach at Harvard and, you know, I started getting calls from people saying, what's really the skinny on this policy?
Or how should we really approach it? And you know, there were wasn't one person but 10 people at a p a who really, um, knew the history, uh, had the relationships and, and the knowledge to really push forward important, uh, mental health issues. So that, that was really just, um, a gift to be part of. Yeah, a lot of, I think smaller societies, smaller professional societies, they, they don't necessarily have that.
They have people that are staffers, but they're kind of administrative. They're not really actually in there in Washington getting stuff done. And I get the sense the a p A is not like that at all. It's really quite productive. Quite generative. Yeah. And you know, the oldest professional association, um, so a really long history.
A lot of learning from that history also, so, Hmm. That, uh, and, and they were ready. They're, every a p o was really ready for the unprecedented attention, uh, that was paid to mental health as the twin pandemic. Mm-hmm. The second pandemic, as well as, um, pr, you know, prepared, um, and, um, And ahead of the game in so many ways by having such, uh, just such a deep and broad staff.
Mm-hmm. I didn't realize that they were the oldest professional organization for the societies. Wow. Yeah. That's that's great. That's great. And what was your first. Role with the A p A? Like when you're a much younger psychiatrist, like what do you first be like, I think I might wanna get involved with this organization other than just signing up to be a member?
Which many people do? They pay their dues, they kind of don't. Then they do it once a year. Don't really think about it. Maybe they come to annual meeting. What, what was it like for you kind of early on? Well, my first exposure to a p a really was through a fellowship program, uh, as a PGY three resident, so mm-hmm.
I was nominated for what's now called the leadership Fellowship, and so I got to go, it funded me to go to the meeting, so that seemed pretty great. To be able to go, yeah, free travel and meet people, go to a big meeting and see what a professional society was like. And then as part of that, uh, we got to participate in one of the components.
So I spent, um, a year as a fellow on the Council on Healthcare Systems in financing, and then a year on the council on psychiatry and law. And then, um, my. Then as in my second year, I was elected by the, um, my co-fellows to be our representative to the board of trustees. So we didn't vote in any way, but we were guests of the board and we got to learn about what was going on at a p a and then it kind of abruptly ended, the fellowship ended.
I went into my fellowship and, um, I had nothing to do with anything. And, uh, slowly over time, um, some of my, um, Some of my colleagues nominated me for some committees. So I was on the Good Mock Award committee, which it turns out you have to read a lot of books and articles 'cause it's the award in forensic psychiatry ah, for that.
Uh, but that, you know, that was a reintroduction to service to the a p a and then in a small world story, the current president-elect, uh, Dr. Vi, um, Was sitting with me at, uh, a consultation, liaison, psychiatry meeting, and told me that he was rotating off the bylaws committee and he assumed that since I was a lawyer, I'd be a really good person to maybe, of course, be a new member.
And that's actually how I got. I, I got my start. Um, uh, it turned out, uh, you know, this was also a source of a lot of anxiety as I was coming up in my career, that if I weren't in the right place at the right time, nothing would've ever happened. It was kind of a right place, right time thing, because right after I was appointed, I.
Uh, Washington DC where APAs Incorporated changed their nonprofit corporation law. And in order to keep business as usual going, uh, we needed to change our bylaws. And at that time we had a relatively new general counsel, um, Colleen Coyle, who remains with the organization. She's still there. Yeah, she's still there.
Mm-hmm. And, uh, they asked, uh, They asked me if I would chair that process. And so that's really when I got my start. I went around, I had to present the bylaws, they had to be passed by the assembly and the board, and we had to get buy-in and we had to explain why we had to do right. So, um, so I think that's really when I went around, uh, Sol Levin, Dr.
Levin became c e o around that time. And, um, That was really, I think my introduction post-training, uh, to being part of the a p a. Um, and then I went from there to be involved, uh, in, um, the project to look at, uh, ethics at the A p a. Uh, when Paul Summer grad, uh, and Renee Bender were presidents, they asked if I would chair a work group, um, to really look at the ethical guidance we were providing for our members.
Um, so that's, you know, that's kind of the long story, uh, not that short, but it's, but it, but that's the story of how I became involved. And when I became chair of the ethics committee, I, um, I couldn't imagine anything more special to be able to do. Uh, at a p a I thought this was really something that was making a difference.
Uh, the ethics committee was the most wonderful group of colleagues, and, uh, what we were doing really felt like it mattered. Um, and it did matter. And it does matter. And so I never had any anticipation of doing anything else until the nominating committee, um, made an announcement and, um, A member of the nominating committee said, Hey, have you ever thought of running for something at the a p a?
So that, that's how it all happened. Yeah, that seems, it seems like a common thing when, you know, I'm involved an organization as well. Um, more so with acap the child study, but just sort of one thing leads to the other and, Hey, have you ever thought of, seems to be, well, what do you, I really wanna hear about ethics from you.
What do you think it is about? Like you in particular that has made you, other than the jd that makes you sort of well suited to this type of organizational psychiatry work, because it's not for everybody. I, I love it, but I'm wondering how you would think and, and as other listeners might think, gee, is this for me?
Well, I think. It's a, it's a lot of work and a lot of volunteer mm-hmm. Time, right? Yes. Over the, over the years. I think what made it, uh, work for me was that it really fit with the things that I was doing and the things that were motivating me and creating both joy and fulfillment in my career. So around, around the ethics, right?
We were, we came into a time in our society where people were questioning knowledge where we were. Mm-hmm. Really having core questions of. You know what's truth and what's science and you know, I work at a university that's been um, uh, Front and center in a lot of the debates about the values we, that matter to us or that ought to be considered, uh, in thinking about the privileges and opportunities in society.
And so being able to be part of leadership around the values that do matter and must matter to. Mm-hmm. Medical subspecialty to, uh, the medical profession, the profession of psychiatry felt like, um, the way that I would be well suited to making impact in the world. And so that's really what drew me in. Uh, you know, students often ask, you know, do I have to be a lawyer to be good at these kinds of things?
And I think the answer to that question is a resounding no, right? Mm-hmm. Most people who go on to, to leadership in organized medical societies of many different. Aren't lawyers, but I do think it helped, um, to be able to, with those, to figure out how to line my laws and, and come up with language and understand how to translate an ethical principle or an idea mm-hmm.
Into, into words that could be broadly applied. So I, I think that, I think that's how it happened. And it always felt consistent. It never felt like something that was different than my, uh, than my day job or te teaching ethics or practicing psychiatry. Mm-hmm. Um, until I became president. And then that was really profoundly uncomfortable.
There were things about that that I really thought I really have to learn. Like, I don't like hanging on video. I don't like being on tv. Goodness on tv. You know, uhhuh, you know, like constant reminders. Look at the camera, don't look down. Smile. Be nice. Things like that. Um, I am nice, but I'm private and so to, you know, being out and being ready to be the public spokesperson took a lot of practice and I'm so grateful to a p a for all their help with that.
Yeah, I imagine you had a lot of opportunities to, to represent psychiatry and not everyone is always friendly to psychiatry, so that can be challenging. Um, with the Ethical committee, what kind of work products came from that? Like what did the organization sort of change as, as a result of, of your time there?
Well, one of the big things that came up that's, uh, coming back around again was the work that we did related to the Goldwater rule. So that was one very particular area that there was a lot of concern back in 2016 about how much psychiatrist, I wonder why about public figures. Right. And I, I think it continues to be the defining challenge for, uh, for the profession about how do we find a place to secure our voice.
And lead mm-hmm. From truth in the interest of helping people, uh, without overstepping what we know, uh, and what the legitimate aims, um, and, uh, and values are of the profession. Right? Mm-hmm. So what is it that we know by virtue of being psychiatrists that others don't? How do we use that knowledge in a way that advances, uh, the human condition and wellbeing without weaponizing it, uh, in the short term for what we believe to be a legitimate.
Um, political or public aim, and that that's very different than saying, these are the values we see to be good in society, or Here's why it matters when we talk to each other this way. Here's why it matters when there's rampant discrimination. Here are the effects on mental health. We have so much to say about that.
Um, and how do we say that in ways that advance the greater good rather than become fodder for a 24 hour news cycle that would be happy to have us speaking right 48 hours a day if we could. Right, right. Saying sort of inflammatory things. So with the Goldwater rule, uh, I know, you know, a lot of psychiatrists felt very conflicted about what they could or couldn't say about what was happening politically with the political leaders.
Um, what's sort of the APAs stance now, or what, what shifted in, in how they look at the Goldwater rule? Yeah. Nothing really shifted, although there were, I would say there were a lot of misconceptions about the Gold War rule. Okay. Like people were calling it a gag rule. You can't say anything and you know, Uh, psychiatrists are people too.
You know, we, we can speak in our per, in our personal capacity, but when we speak in the capacity of, um, our. Profession and we don the mantle of authority. Really, uh, in speaking from that, I think it's really important to be clear about the basis for our knowledge and the purpose of what we're saying.
Mm-hmm. And so, um, that's really. Where the, what the gold border rule is about, it's about rendering a professional opinion. Right? So it's very different to say, I think the current tenor of our discourse in this country is really damaging. And in particular, it affects those who have been marginalized or oppressed or excluded from full realization of the goods of society.
It's one thing to say that it's another thing to, uh, say things about particular people. Mm-hmm. Especially. When there's so much information out there, don't, people can make their own, people can make their own judgements, right? Mm-hmm. We don't have any special knowledge of the inner workings of, of people just because we've seen their public behavior and really important.
I think, you know, the a m A had come out with a statement about physicians in the media, uh, uh, around the same time really, uh, drawing on the influence. Of medical authority and to be careful, right, that, uh, people don't misinterpret that we don't overstate or we don't, uh, really weaponize knowledge, uh, for, for political beliefs.
And, you know, it's well known for example, that psychiatrists are pretty liberal along the spectrum. Um, not every psychiatrist, but across the spectrum of. Specialties. And we also don't want, uh, we have an obligation to be sure that we can provide treatment to all people who believe all things. Um, and so how do we create, uh, create a space both to educate the public, advance mental health and also remain welcoming to anybody who might need to come for us, to us, for, um, for our expertise.
Yes, it's, it's it's tall order and I'm glad to see the a p a kind of taking, taking that on. And I, I know like many professional organizations, they also have, you know, have received criticism over the past several years around d e I stuff around inclusivity. And maybe you could talk a little bit about the efforts that the A P A has made in that regard as well.
You know, I, the, um, summer of 2020 in particular, um, really focused a lens on, on structural racism and inequities more broadly within our society. And, um, I. E for a p a, like so many other organizations, it ought not to have been such a learning curve for any of us. Uh, but I'll speak just for myself. I wasn't really in involved at that time.
Um, I was on the ethics committee. Uh, I wasn't on the board. Um, but I can say even with, you know, in our community at, um, our academic community, uh, We were really coming to terms with the ways that bioethics, which is all supposed to be all about the ways we use science towards human flourishing and think about the human condition.
Uh, we were missing a lot of the really important questions. And so, um, I think it was a really, really important opportunity. And, um, a p a did something really, really brave by going internally to members. Mm-hmm. Forming a structural racism task force, uh, hiring, um, hiring consultants, uh, working with the board to lead, uh, and really coming up with a set of measurable outcomes and recommendations.
Uh, That, uh, for a p a to hold itself accountable to. So, uh, that scorecard, the, uh, structural racism task force recommendations, uh, is on the website. During my presidency, we developed, uh, a report card that's I. Up on the, uh, internet so people can see where we are making progress. That's great. We've been collecting data that's great on the diversity, both of our member membership and of the organization itself.
And then this parallel process, um, has been going on within, uh, the administration of the A p a, led by, um, Dr. Levin and his team to, uh, really advance D E I B in every part of, of a p a, so, mm-hmm. Now the division of Diversity and Health Equity is one of the largest divisions, uh, led by, um, Dr. Regina James, uh, one of the biggest divisions, um, at a p a.
Um, and, um, in. Just continuing to advance the work, uh, both to make the profession as bold and responsive as it can be, uh, and to advance the mental health more broadly. The other, the other place a lot of members don't really know that APA is doing work is through our foundation. Mm-hmm. Um, and, um, You know, the a p A foundation is works as a nom, uh, 5 0 1 C three, so a full charitable organization in advancing mental health.
Uh, in all the places people find themselves pretty much outside of psychiatry, I. Uh, clinical offices, right? So mm-hmm. Uh, at work, at school, uh, in sports, um, in faith, uh, and working with community leaders to advance mental health as well as, uh, funding and supporting the development of up and coming psychiatrists so that our workforce is as diverse as our population itself.
Hmm. How do, how do people get involved with the foundation? I'm familiar with the a p a, uh, pac, the Political Action Committee, and that's sort of when you pay your dues, you can elect to do some of that. But how, how does it work with the foundation? Yeah. You know, the foundation people can donate to the foundation.
There's a big benefit every year. And, uh, if there's a particular area people are interested in supporting the work of the foundation, uh, just reach out to the foundation. Um, The foundation team, uh, to be able to become involved in any of those programs. And there are many people who volunteer, uh, and, uh, what coming up the more health equity run, so it'll be the third year.
Oh, uhhuh of a virtual and in-person. Um, A fundraiser to raise money for, uh, youth mental health. Uh, that's, that's something that, uh, many of the district branches and other groups within a p a compete for who can raise the most, the most, no, a friendly competition. So that, that, that's been another way of being out in the community and really being part of both raising awareness, walking around in the shirt, you know, in a local community, people ask, Hey, you know, what's that?
What are you doing? Um, as well as showing solidarity together on site. Um, in, uh, the D M V to, uh, rotating sites, uh, in a, in a walk or run. Hmm. Very, very cool. Very cool. Enjoying the Psychiatry Tomorrow podcast and hungry for even more insights into the future of mental health care. I. Then you won't wanna miss out on the Psychiatry Tomorrow newsletter from Oz Mind.
Join hundreds of forward-thinking psychiatrists and mental health professionals staying ahead of the curve with the latest research, technology and practice strategies delivered straight to your inbox. It's free, it's easy, and it's the best way to keep your finger on the pulse of mental health care.
Just head to osmond.org/tomorrow and we'll see you inside. You mentioned data, and I'm glad that the APAs take, you know, doing more around data of its membership and the workforce. I know that it, uh, issues of inequity and access issues extend to patients getting, you know, accessing care, um, for a variety of reasons.
And I think I. One of the other areas I'm particularly interested in that the a p A is involved in is their Psych Pro registry mm-hmm. And how that can collect data. So maybe could, could you tell us a little bit about that, uh, that initiative and, and your thoughts on next steps for that? Yeah, sure. Um, that's one of the things that we're all really invested in the board last year passed a really ambitious, uh, strategic roadmap for the future.
Really asking the question of where does psychiatry. Need to be, uh, in five and 10 years time. Mm-hmm. Where do we think the field is going to go so that we can make the strategic investments and prepare ourselves now to prepare, both, prepare and train our members and provide the resources members will need.
Mm-hmm. Also, right to really advance the field itself. And so the, um, We, we know how powerful, uh, limited, there are many, many challenges that we have with using large data sets to advance, understand, and advance our work. But how important it is to have aggregate data that can help us understand the places that we are meeting needs and also the places where we really aren't having the outcomes.
And one of the things about the Site Pro Registry, which is relying on health systems to come into the registry, um, is that the registry is not only psychiatrists. Mm-hmm. And so one of the big questions we really have is how psychiatrists can team, uh, with other members of other mens member, members of other mental health professions to really bring comprehensive care to patients.
One. You know, one of the things that was so surprising to me is that psychiatrists make up only about 6% of the mental health workforce, and yet we know, right? Nobody ever thinks that, right? It's so small, especially when you're a psychiatrist, you think, no, we we're the center of the world. So, you know, that's like a huge, you know, from an ethical perspective, that's a huge responsibility, right?
Mm-hmm. There's a lot of public investment in the work that we do in our training, and there are a lot of patients who can, who are complex and can be uniquely. Treated by someone with the expertise and skills of a psychiatrist. So, I mean, you, you know, as a child psychiatrist, you know how necessary it is to have, um, to, and how many kids, uh, need treatment that they really, that there just isn't access to with the shortage.
Mm-hmm. You know, that, that's one of the pieces that we've really been looking at. What are the things that psychiatrists. Um, do that are unique to being a psychiatrist. And how do we think about a system that gets patients to the right care at the right time, in the right place? Hmm. Um, and, and, and in a sustainable way, in a way that funds that care and compensates it appropriately.
And so those are really the challenges ahead. And that's just the tip of the iceberg of the kinds of questions that data from a registry can help us answer. Mm-hmm. And do you think there's a world in which the registry would ever tap into others that are delivering mental health care? I know like, you know, pediatricians primary care, they're, they're prescribing a lot of meds that we think of as quote unquote our meds as psychiatrists, but they're not, you know, they're the ones doing it.
How do you think we can get. Information from them, get buy-in from them to understand what's going on. Well, you know, one obvious way is through collaborative care models that the a p a mm-hmm. Has supported, some of our federal advocacy has been around getting block grants and funding for startup costs, for community practices, for collaborative care.
And for listeners who don't know about collaborative care, it's really based on a consultation model where a psychiatrist would, uh, work with, uh, primary care. Physician or a pediatrician to provide consultation mm-hmm. For patients, um, consultation to the, um, uh, to the primary care physician or the pediatrician be available.
Um, and through those kinds of models, it's measurement based care. Uh, we've seen really good data, both on outcomes, improved outcomes, and, uh, decrease, and, um, the improved ability of a single psychiatrist to participate in the mental health care of more than one patient at a time. Right? So, mm-hmm. Some, some models show that the, the collaborative care model increases the number of patients for whom a psychiatrist.
Can inform the treatment of by a factor of 20. Mm-hmm. So, you know, we still need to get to 202,000, uh, if we're gonna really deal with the shortage of psychiatrists. But the, um, the reality is that all those psychiatrists in those models, right, all that data registry data, um, could all, that data could be brought into registries to really look at what the impact of these, um, of these care models are.
Yeah. Yeah, no, I, I, uh, I worked for a number of years in a collaborative care model with a, a Medicare Advantage plan, and it was great. We had a dashboard with the PHQ nines and the GAD sevens, and there were people administering them in the primary care. And I wasn't meeting the patients directly, but felt like I could have a much larger impact.
Even simple things, or th you know, check the thyroid, you know, how do we, maybe 10 of Prozac isn't enough Prozac, right? Things that are kind of basic to us, but we can educate. Um, and yet, I think in our main profession, many, many colleagues are not incorporating measurement-based care. Why do you think that is?
What, what can we do to get people more engaged in actually measuring things like PHP nines and GAD sevens since, you know, primary care's doing all right there? Well, you know, it's interesting. I think, um, I'm. You know a lot more about this than I do, but I think that the advent of electronic medical records, um, you know, have led to, um, you know, been associated with increased screen time for physicians.
Mm-hmm. Um, it's a source that physicians cite in their burnout, and there are a lot of, yes, a lot of challenges. Um, to the documentation and availability requirements. On the other hand, it's also made it really easy to not actually have to go over to your file cabinet right. And pull and pull out a scale and fill it out on paper with a patient.
So I think just one, the availability is really helpful. And then letting people know that you're not being replaced by an algorithm. This is a tool, right? Right. So if, you know, if the PHQ nine isn't changing, it doesn't override your clinical judgment or your knowledge of a patient that. Patient is still in acute distress, right?
So really, uh, helping physicians understand how to use measurement-based care, uh, as a tool, right? But, but, but not as a replacement for clinical judgment. And, um, you know, the more I was, I was kind of resistant, right? I grew up, I grew up in a training environment that was heavily focused around psychotherapy, around, uh, knowing what was happening in the, um, treatment relationship.
To assess, assess, uh, how a patient was doing. And yet I came over time first working in a P T S D clinic, uh, using, um, measurement based care and then, um, through, uh, universal. Uh, depression screening, at least using a PHQ two and look, and then looking at really the data on collaborative care models as a CL psychiatrist and the potential power of incorporating, uh, measurement as a tool.
Rather than as, um, as directive for treatment is really, really helpful. And I, I found myself a few times, um, saying to patients, you know, here are my boring questions again. Yeah, exactly. We're like, we're gonna go through them again. So actually if you wanna ask them to me and I'll try to answer them for you.
Right. Um, but actually being able to see early right. When a predictable pattern of, uh, of. Um, seasonal, uh, affect of shifts is starting or, uh, around an anniversary reaction or something seeming a little bit off and not really being able to quantify it and then having some real data to say, gee, do we need to be making some changes?
Mm-hmm. So I think we're getting there. We're doing, we're doing better. And um, but how we continue to incorporate all the tools we have is we have more and more tools and care does seem to be getting. Also at the same time, a little more impersonal. How do we hold onto the things that made it so special to become a psychiatrist and have a connection with a patient, um, longitudinally.
Um, and as well as being able to advance the mental health care of a, a broader, um, portion of the population. And not, not be replaced by a, a bot or something like that, or, yeah, yeah. No, that's, that, that makes sense. I've had patients want to, uh, I don't like this question. Can you change the wording on this question?
Doesn't quite capture that. And, you know, there's data in that too. Like the whole, I find the whole process to be part of like grist for the mill, as they say therapeutically. Um, so your, your term as, uh, president has ended. So what's, what's next for you? What's, what's coming up over the years ahead? For right now.
Uh, it's really nice to be home. So I took only, um, one trip in the month of July. Uh, it turns out, uh, I live in a pretty nice place, so it's been great to be back home with family on the ground. Uh, but really exciting. July 1st I took a new job as the director of the Center for Bioethics at Harvard Medical School.
Congratulations. So I thank you. So heard of that place. Yes. So, um, I've been really settling into, um, my new position, um, my new position here, and, uh, thinking about how we within the medical school, um, and then, um, uh, Outward fa in an outward facing way, really advance, uh, the research and knowledge around ethics and the intersection of, uh, empirical work, uh, values-based work in science, especially now.
Right? So everyone's talking about big shifts in ai. I think we're pretty far way off. From autonomous artificial intelligence. Yeah. However, you know, though, we, we do need to be thinking, you know, back to the registry about what data we're using, uh, how we're calling that data from everything, all the way from academic integrity to our scientific integrity, and to mm-hmm.
Really incorporating questions about not just can we do it. But should we do it and why, right? Mm-hmm. Where should we put our priorities as we think about, uh, what ought to matter, uh, and what does matter to, uh, advancing human flourishing? And so that's a really exciting place to be. And I can't think of anything beyond, uh, wrapping my, my arms and my head around this, uh, new challenge that's before me right now.
That's, that's wonderful. And do you, um, do you have any patient care at all or is that. Uh, on pause for now. Yeah. I've continued this whole time to keep one clinic session a week. Mm-hmm. Uh, and so I do see patients. I'm glad I do. Uh mm-hmm. I've been doing that. Uh, I was not an enthusiastic adopter of, uh, of telemedicine and telepsychiatry.
Uh, I'm now doing exclusively telepsychiatry. I'm thinking about how to come back into person and why patients, um, Patients have really found, uh, the option for virtual visits, um, to be, um, such a, an improvement over coming into downtown Boston and finding a place to park and dealing, dealing with coming in in person.
Right. So I was thinking about that and then, you know, wondering, um, and thinking carefully about where new opportunities might come up. Uh, for, uh, to expand, uh, but still keep a small, small, but, um, expanded amount of clinical work. Yeah. I think most of the leaders in this space I've talked to, um, do like this, like one clinic day or small clinic panel.
Uh, for you, what's, what's the why behind that? Why do you do that? I do that too. What, curious, curious. What pulls us to do that? Well, you know, a number of things. Number one, um, I became a psychiatrist because I wanted to work with patients and treat patients and, um, improve lives so that, you know, that stands behind it.
I think the relationship, um, you know, A number of the patients who I'm presently treating, I've been treating since I was a resident, uh, for a really long time. So those relationships are really powerful, um, and important. And, um, it also just provides the continuity and the, uh, The knowledge and the experience for credibility.
Right. So, um, in terms of leading and being part of organized psychiatry, uh, having that on the ground experience of what it's like to practice, uh, navigating being in the employee of a huge health system that seems to keep getting bigger and bigger. Um, you know, managing an inbox, knowing where, where we can manage and where it can become onerous.
Uh, even one day a week, uh, is something that's been really important experience to inform, uh, where we might make changes and where we place our advocacy. So I think it's for the individuals, it's for the system and for the collegiality. I mean, what a wonderful profession. We have the privilege of being part of.
I, I, I agree. I agree. So speaking of collegiality, how do you think young people could start to get involved in organizational psychiatry, either with the A p A or other organizations? I think are you involved with, with Apple as well, or? Yeah. You know, I've been a member of Apple for a long time. Um, the place that I really grew up in psychiatry was in consultation, liaison, psychiatry.
Oh, okay. So that was my, that was my, My home, I wa um, uh, sat on the board for a decade of, um, of A C L P, um, and, um, uh, eventually became the president, um, a couple years ago. Um, so I think, you know, there's a lot of ways both in leadership and then just in being part of the collegiality in different ways.
So, you know, we often think about the a p A because it's so big, and yet so much of the work that we do and so much of medical practice is, is. Uh, determined at the local level. So district branches, your state, um, psychiatric society, uh, state medical societies, um, uh, welcome, uh, the input of young people, both students, and, um, Trainees.
And you know, also, um, those state medical societies bring people to the A m a, which has a very, very active medical student and resident and fellows at and young psychiatrist, uh, young physician section, uh, through, uh, going to meetings, volunteering. You know, one of, we talked a little bit about the, um, structural racism task.
Force of the a p a, one of the things that we've moved towards is an open call for participation and components and councils. So, mm-hmm. That might not be immediately the place that a young person would go because, um, it requires a certain amount of, of expertise in an area. But, you know, dropping in on meetings that are open, contacting chairs, uh, connecting with colleagues, attending meetings, so many different ways of getting involved at different levels of engagement.
Yeah, I know at the a p a, a lot of those, those committee meetings, house meetings, they're open to visitors and you can kind of just come in and sit and, and find out, you know, if you'd like to be on it someday. It's, uh, I think hopefully more people will do that. So, yeah, that, that, that's great. And, um, what are you most excited about for the future of the field?
We talked about the a p a, having a vision for five years, 10 years, but what, what do you think is sort of the next kind of big frontier for us as a profession? I, I think there's a, a couple things right now. Um, one that's really exciting is the way that psychiatry is reintegrating with the house of medicine.
Mm-hmm. So not that psychiatry should be, um, will ever really be the same as every other medical specialty. Although we, you know, we continue to hope that our data and our science allow us to exactly improve our treatments. Right. Um, so that, that's one thing about the. Opportunity to really collaborate with other colleagues, to learn how to be leaders of teams, to innovate in the way we deliver care and to, uh, to promote a mentally healthy, um, country and world.
That's something really exciting. I think, you know, the other, the other piece is really the explosion of technology, innovation and opportunity. So how are we going to harness. That, uh, in ways that make lives better, um, and empower psychiatrists to do better work. Mm-hmm. Uh, that that's. I, I, I don't really know what direction that's gonna take.
We've heard a lot of apocalyp, apo, apocalyptic predictions about where all of this will end up. Yes. But I think there's also really the, if we, if we think about this, um, the way that young psychiatrists entering the field are thinking about it now with an innovation mindset and with the idea that their careers won't look like what?
Our mentors careers look like they're not gonna be seeing patients one-on-one. Right? So there are the downsides of being part of the system that we know about, but there are also the upsides of being something, um, in which the sum of the parts is greater than each individual one. And I think there's really the potential for psychiatry to lead and innovate, uh, to improve overall health, not just mental health or physical health.
Mm-hmm. Yeah, I was very impressed at the most recent annual meeting about, I guess the in innovation zone that they have and all of the different, it was like, you know, you have your, the exhibit hall, which is quite commercial. You have the academic talks, but then you have this sort of in-between zone where you have people presenting serious subjects, interacting with industry, and that used to be kind of rebo and now it's being welcomed and.
Um, that's very exciting to, to, to me, is sort of, I've crossed over into that, that world, but what do you see as the sort of ethical concerns that should be at the top of our mind as we engage more directly in industry as psychiatrists? Yeah. Well, you know, the obvious one and the, and the first one is really being clear about what the purpose is of the collaborations, right?
Mm-hmm. You know, there's been a, a lot of well-intentioned collaboration that really has, um, ended with a profit motive that really mm-hmm. Undermines the integrity of the work, even if the work is good. Yeah. Right. The public perception or the perception, um, uh, is, is becomes a challenge, but you know, I, I think that, um, we've, with moved towards transparency, with clear guidance about what, um, about who, you know, what the motivation and the compensation and the investment is behind the work.
Um, and being really clear about the values, right? Who, who's part, who are the participants. In the research and who gets the benefit of the outcomes mm-hmm. Of these innovations and collaborations. So we can actually do a lot of good, uh, but we have to do the thinking ahead of time. Right. We can't figure it out as we go along.
We have to be really, really deliberate about building in our commitment to. Uh, each individual's humanity and our collective humanity into the advances that we make and mm-hmm. Um, that, you know, uh, we're getting better at that. Um, and, uh, but continuing to establish ourselves and lead from the fact that we're professionals, that we are worthy of trust and every day we.
Work and uphold that position of trust, uh, once we earn it, uh, by doing good work and doing that work with transparency and a commitment to the greater good. Ab Absolutely. Now, when I was a medical student, I don't recall. Doing a ton of specific work around ethics. Maybe we did, it was just a long time ago.
But it sounds like now at, at at, um, Harvard Medical School, they're making a much more concerted effort to give folks training. Like what does that look like for a medical student now un under your watch? Yeah. Well, for a medical student, um, all medical students have a required, uh, ethics and professionalism, core competency, as well as, um, teaching requirements.
And so for our medical students, it looks like courses, um, in the preclinical. Um, the pre, the preclinical year, uh, as well as, um, in post-clinical year consolidation, right? Or ongoing, um, work. So our medical students are all doing, um, an integrated course essentials of the profession that happens, um, at two different, um, time periods during their training and even beyond that because of this rapid development in our technology and our ability, but, Are also ongoing disparities and questions about, about who's benefiting and how, and is this good in the long run for humanity?
Bioethics itself is becoming a, um, a, a a field in its own right. So we have a professional organization, the Americans Society, bioethics and Humanities. Mm. Okay. Uh, we are one of a growing number of bioethics master's programs, um, in the country, in the world. So we currently have about 130 students. Uh, who will be joining us in the fall, either virtually or in person part-time and full-time.
Uh, really from a whole variety of backgrounds. Uh, many from medicine and science, but also many from law and policy, uh, and other disciplines. Uh, really learning about how to both define and address, uh, these challenges that we're just beginning to see, that we're just beginning to see in the, in the life sciences.
Oh, that's wonderful. Maybe some of our listeners can check out those, those opportunities. Um, any final words, final thoughts on, uh, looking back over the years as president? Well, just, you know, I, I am, um, uh, even more humbled at the end of the year by the trust that my colleagues, our colleagues put in me to be able to, uh, Lead our profession through this really challenging time, um, and this time of incredible opportunity.
Um, and just, uh, a lot of gratitude for the opportunity to learn, uh, to make mistakes, to learn from them. Um, but also at, in the end, I think to really come out with, uh, solid grounding that, uh, psychiatry can rise to the challenge, uh, and can lead into a future that advances, um, Health with an understanding that there is no health without mental health.
Absolutely. Well, thank you so much for being here, Dr. Brindell, and wish you well on the, on the rest of your day. Thank you so much for having me. This was great fun. That's it for today's episode of The Psychiatry Tomorrow podcast. We hope you found our discussion informative and inspiring. If you enjoyed the show, why not share it with one mental health clinician in your network?
Your support means the world to us and helps us reach a wider audience. And if you're enjoying the podcast, we'd really appreciate it if you could leave us a rating and review on your favorite podcast platform. It only takes a moment and your feedback helps us to improve the show and reach even more listeners who are passionate about mental health.
Thanks for listening, and we'll see you in the future.