Across the course of APA 2022, there was a broad range of talks looking at the future of our field. However, given the checkered history of outside factors influencing clinician behavior, we have become cautious about working with the industry. In the past, that mostly meant pharma and maybe a few devices. But all of us have work we do as psychiatrists, whether we are a private practice, hospitalists, researchers, or other roles. Too many people need too much help, and a common theme at the conference was how difficult it was to complete the work we must do. Whether it was a lack of appropriate payment, the difficulty of charting, or finding services for patients in need, psychiatrists alone can’t meet the needs of our communities.
Throughout several talks across APA, presenters would either appropriately disclose their financial conflicts of interest or glibly announce that they had no disclosures. Today, I feel that no engagement with the industry is no longer a sign of virtue.
We have APA test groups spending hundreds of clinician hours to create rubrics, which allow for the evaluation of mental health applications. It strikes me that this process would be perhaps more productively spent engaging with the production of excellent mental health apps in the first place. I am aware of SMI Adviser, a product of the APA, but as branding goes, SMI Adviser doesn’t have the same ring as Nike, Headspace, or any of those brands I interact with daily.
When mental health products premiere on the market, they often do not have clinician leadership to help to define either the goals or understand the risks of their products. The general public does not understand the difference between psychiatry and psychology, much less related disciplines. Mental health is a market. It is not the medical discipline of psychiatry. We are medical specialists and subspecialists, and that expertise can and should guide products that influence the mental health of millions.
The more we engage with the industry, the more chances we have to change how health care is paid for, what is considered appropriate or acceptable in a health care product, and, frankly, to decrease the amount of digital snake oil that ends up in the marketplace.
We had several excellent talks across APA, particularly in the digital health track, from groups like Northwell Health and their digital psychiatry clinic. Several presentations also focused on innovative and now breakthrough FDA designations on digital therapeutics.
Without psychiatrists in leadership positions of these organizations, we miss out on the opportunities to have a guiding voice in what health care becomes, and we abdicate our role as leaders. Psychiatrists should be helping industry understand the difficulties patients struggle with, both in their mental health and in the many social determinants of health and general medical conditions that interface with these concerns.
We know not everything is simply depression and/or anxiety. Severe mental illness exists and needs addressing. Psychiatry is the medical discipline that understands this, and psychiatrists need to be the leaders of industry. Otherwise, uneducated and inexperienced innovators will disrupt, for good or ill, the systems that support our patients. It’s our responsibility to have more disclosures at the end of every year, not less. If we’re not working with industry, we’re not leading.
So I would advocate that, next year, we all try to have more relevant financial disclosures. Because that means we are spending some of our time working with scaling in mind. That means we can address many of the problems our patients face beyond what we can do in our individual practice.
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