Ethical Challenges in Psychiatric Administration and Leadership.

As with all professional ethical principles, those in psychiatry have to evolve over time and societal changes. The current ethical challenges for psychiatric administration and leadership, especially regarding for-profit managed care, need updated solutions. One solution resides in the development by the American Association of Psychiatric Administrators (AAPA) of the first set of ethical principles designed specifically for psychiatric administrators. These principles build on prior Psychological Theories of leadership, such as those of Freud, Kernberg, and Kohut. Supplementing these theories are the actual real life models of psychiatrist leadership as depicted in the memoirs of various psychiatrists. Appreciating these principles, theories, and models may help emerging leaders to better recognize the importance of ethical challenges. A conclusion is that psychiatrists should have the potential to assume more successful leadership positions once again. In such positions, making the skills and well-being of all in the organization seems now to be the foremost ethical priority.

Ethical principles for psychiatric administrators: the challenge of formularies.

Rising costs continue to plague healthcare and mental healthcare. The latest variation of managed care techniques has been to try to reduce medication costs by instituting formulary restrictions. To date, the results have been spotty at best, with a suggestion of a ballooning of more general mental healthcare costs, as well as possibly worsening of quality of care. New challenges are looming in terms of the results of the CATIE study comparing typical and atypical antipsychotic medication, as well as the beginning of Medicare D medication coverage. In the midst of the uncertainty and complexity, the psychiatrist administrator has the ethical challenge and chance to make a major difference. By keeping the well-being of patients first, but also addressing the needs of the institution, payor, and other stakeholders, the psychiatrist administrator can ethically find ways to reduce costs and increase quality. One such product could be medication algorithms that also incorporate costs, side effects, and general healthcare.

The future of community psychiatry.

Leaders of national groups that have focused on issues of community and social psychiatry present their ideas about the future of psychiatry. They identify five areas: theory development; the relevance of community psychiatry in the 21st century; education and training; the relationship between community psychiatry and health maintenance organizations; and role of community psychiatry in bridging medical science with humanism. The unifying theme for these topics is that community psychiatry can be a vehicle for modifying general psychiatry's propensity towards individualism and reductionism by offering a more holistic and integrative approach to illness and well-being.