Letter from the President

JANUARY 2017

It is indeed an honor and I feel grateful to have this opportunity to serve as the President of the California Academy of Child and Adolescent Psychiatry (CALACAP). As a nation, we find ourselves at a crossroads today, and it is difficult to fathom what kind of a metamorphosis our health care system may undergo as we begin a new era, under new and untested leadership. It remains to be seen how all the forthcoming changes will impact the field of mental health. Notwithstanding all the potential changes coming our way, we child and adolescent psychiatrists must continue to do what we do best; serve and take care of our patients and their families. We must continue to work for and represent the best interests of our child and adolescent patients and their families in the most thoughtful and admirable manner possible.

Child and adolescent psychiatry is indeed a complex subspecialty, which demands a high degree of skill, patience and perseverance from the professionals who practice it. Child and adolescent psychiatrists are, in general, well-intentioned and dedicated professionals. We undergo rigorous training during our residency and fellowship. We learn to do thoughtful, thorough, and comprehensive assessments, and to obtain relevant collateral information from various sources. We're trained to develop a good rapport, so that we get to know the child first-hand. We are constantly faced with difficulties and hurdles, many of which emanate from a system that is in many ways not a whole system, but rather one that is fragmented and fractured. We learn to work with the information and resources we have at hand, which are often not ideal. Sometimes we make vigorous efforts to assist our patients, in the hope that they can maintain their current academic setting and placement. As physicians, I believe that it is our mission to help and assist, in the best possible way, despite the challenges we consistently face.

As child and adolescent psychiatrists, we have to work under rather difficult circumstances at times, as a result of persistent flaws that face our system. We deal with complex clinical situations, given the various biopsychosocial problems with which our patients are faced. The system frequently doesn’t cooperate or come together. There is a crucial need for a substantial amount of advocacy, to reach out to those who potentially could reshape the system; to legislators and other key members of the system, in order to have a chance of improving it. Unfortunately, many of us don’t learn the art (and perhaps science) of advocacy (probably because of minimal formal instruction in this area) either in medical school, residency, or fellowship. However, advocacy is a crucial need in today’s society, and the importance and significance of organizations such as CALACAP is difficult to overstate. It is through organizations such as CALACAP that individuals collectively attempt to discuss the issues we face as a profession, in order to potentially make a real impact and a palpable difference.

CALACAP’s mission statement is indeed broad and well-intentioned. It reads, “The purpose of CALACAP is to represent the California regional organizations of the American Academy of Child and Adolescent Psychiatry regarding legislation, public policy, advocacy, scientific knowledge, and clinical services relevant to the mental health of California's children and adolescents and their families.” In order to properly represent and advocate, it is of paramount importance to partner with other organizations, especially those that share our goals and mission. Fortunately, CALACAP has been collaborating closely and effectively with CAL-NAMI, UACF, and others. It is imperative that we continue to nurture and further bolster our partnerships.  During our recently held, joint 8th Fall Advocacy Day in November 2016 in Millbrae, CA, it was evident that there is a common thread that runs between our partner organizations and us. Common themes emerged and it is now up to us acknowledge the similarities we have as organizations, and work toward common goals for the betterment of mental health services in our communities. Some of the key issues and problems that were identified by groups include: access to care, fiscal and administrative barriers, lack of an integrated model of treatment, continuing stigmatization of mental illness, school mental health issues, and bullying in schools.

From a state perspective, we have seen a significant amount of legislation proposed and/or passed that directly affects our role and functions as child and adolescent psychiatrists, particularly those working with foster youth. Although most legislators do have the welfare and wellbeing of our children and adolescents and their families in mind, these intentions do not always translate into well-written bills that produce significant benefits. In fact, it is concerning that as a result, there have been significant delays and hindrances in our patients’ receiving or obtaining appropriate care and treatment. However, CALACAP always has sought to work constructively and collaboratively with legislators, various agencies, and sponsors of various bills, with the ultimate goal of preserving and enhancing the best interests of youth and families.

It is deeply concerning and troubling that child and adolescent psychiatrists are inaccurately being portrayed as promoters of inappropriate treatments and prescribers of “mind-numbing” and “dangerous” medications. A tremendous amount of work needs to be done to expand resources, especially the availability of and youths’ access to non-pharmacological treatments, including school-based mental health interventions and other evidence-based psychotherapeutic treatments for various disorders. As an organization, we must continue to strive to provide useful information and education to the public, caregivers, fellow providers, legislators, and other professionals to reduce the stigma of mental health problems and their treatment. We must continue to effectively advocate for our child and adolescent patients, so that they feel comfortable and motivated to seek out and continue treatment for their problems. By giving voice to one another, we give voice to our patients and their families. It is in enabling and enriching that voice that we stand a better chance of fulfilling our mission together! Thank you so much!

Hanu Damerla, MD
President- CALACAP