September 6, 2023

Navigating Ethical Frontiers in Psychiatry: A Conversation with Rebecca Brendel, MD, JD, Immediate Past President of the APA

Written by

Carlene MacMillan, MD

Embarking on a distinguished journey through the intricate world of psychiatry, Dr. Rebecca Brendel, the immediate past president of the American Psychiatric Association, has become a beacon of ethical considerations within the field. Currently helming the Center for Bioethics at Harvard University, Dr. Brendel's insights have been pivotal, especially during challenging times like the recent pandemic.

In this conversation, we delve into:

  • Leading the APA through a global pandemic.
  • Dr. Brendel's journey within the APA and her ascent to the presidency.
  • Ethical considerations, including the Goldwater Rule's relevance in today's climate.
  • The APA's strides towards diversity, equity, and inclusion.
  • The transformative PsychPRO Registry and its implications for the future.
  • The embrace of technology and its potential in psychiatry.
  • Training the next generation: The importance of ethics in medical education.

Leading the APA through a Pandemic: Navigating Unprecedented Challenges

In an era marked by global upheaval, Dr. Brendel's leadership at the APA during the pandemic showcased her resilience and adaptability. She highlights, "There was a lot of unexpected travel, and a lot of work really holding together our policy and getting APA back into person fully and into the post-pandemic future."

Dr. Brendel's Inspiring Journey Within the APA

From starting as a research fellow to navigating the corridors of power in Washington D.C., Dr. Brendel's rise to the president of the APA is nothing short of inspiring. Overcoming personal anxieties about being "in the right place at the right time", her journey exemplifies dedication, foresight, and growth.

Ethical Considerations: The Goldwater Rule in Modern Times

The Goldwater rule, which prohibits psychiatrists from offering opinions on public figures they have not examined, has seen its relevance surge in today's political atmosphere. As Dr. Brendel puts it, "Nothing really shifted, although there were a lot of misconceptions about the Goldwater rule." This emphasizes the delicate balance psychiatrists must navigate in such charged times.

Championing Diversity and Inclusion: A Vision for a Unified APA

Dr. Brendel's leadership was instrumental in ensuring the APA's commendable strides towards diversity, equity, and inclusion. The summer of 2020, marked by significant social movements, underscored the importance of addressing structural racism and inequities.

As Dr. Brendel mentions, "The summer of 2020 in particular really focused a lens on structural racism and inequities more broadly within our society." The APA responded by "forming a structural racism task force, hiring consultants, working with the board to lead, and really coming up with a set of measurable outcomes and recommendations."

This proactive approach showcases the association's commitment to fostering an inclusive environment for all its members.

The APA's PsychPRO Registry and Collaborative Care Models: A Glimpse into the Future of Psychiatry

Discussing the transformative PsychPRO Registry, Dr. Brendel states, "One of the other areas I'm particularly interested in that the APA is involved in is their PsychPRO Registry." Dr. Brendel elucidates, "The registry aims to collate data, not just from psychiatrists but from various health systems, paving the way for comprehensive research and insights."

Within this context, collaborative care models have emerged as an indispensable bridge, connecting psychiatrists with primary care providers to achieve integrated patient care. At the heart of this approach lies a consultation model where psychiatrists collaborate with primary care physicians or pediatricians, offering guidance and expertise.

The cornerstone of this model is its focus on measurement-based care. Dr. Brendel notes, "Through those kinds of models, it's measurement-based care. We've seen really good data, both on outcomes, improved outcomes, and the improved ability of a single psychiatrist to participate in the mental health care of more than one patient at a time." In essence, collaborative care models, backed by comprehensive data documented in the PsychPRO Registry, have the potential to reshape the landscape of mental health care, ensuring a broader reach and optimized patient outcomes.

Embracing Tech: The Dawn of a New Era in Psychiatry

Dr. Brendel, once a skeptic of telemedicine, shares, "I'm now doing exclusively telepsychiatry." Her excitement about the "explosion of technology, innovation, and opportunity" showcases the potential of technology in shaping the future of psychiatric care. She further emphasizes the importance of "earning trust through transparency and doing good work" when collaborating with corporations in the tech sector.

Preparing the Next Generation: Ethics Training for New Medical Students

In an age where ethical dilemmas abound, Dr. Brendel underscores the significance of comprehensive ethics training for new medical students. As she mentions, "All medical students have a required ethics and professionalism core competency, as well as teaching requirements."

Summary and Conclusion: A Glimpse into the Ethical Pulse of Psychiatry

In our enlightening conversation with Dr. Rebecca Brendel, we've traversed the terrains of ethical considerations, leadership, and the future trajectory of psychiatry and the APA. Her insights provide a window into the challenges and opportunities that lie ahead for the field.

Key Takeaways:

  • Adaptive Leadership: Dr. Brendel's leadership during the pandemic showcased the APA's agility and readiness to address global mental health challenges.
  • From Research Fellow to President: Her journey within the APA serves as an inspiration, emphasizing the importance of being in the right place at the right time.
  • Goldwater Rule's Relevance: This ethical guideline remains pertinent, with Dr. Brendel shedding light on common misconceptions.
  • Championing Diversity: Dr. Brendel's focus on diversity, equity, and inclusion underscores the importance of a holistic and inclusive approach within the APA.
  • The Promise of the PsychPRO Registry: This initiative aims to shape the future of psychiatry through consolidated data and strategic investments.
  • Tech's Transformative Potential: Embracing technology, especially telepsychiatry, can redefine patient care and treatment modalities.
  • Ethics in Medical Education: Comprehensive ethics training for budding psychiatrists is pivotal in navigating the moral complexities of the profession.

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