Systems Innovation & Transformation Committee
The Committee focuses on the intersection between psychiatry and mental health services
ABOUT OUR COMMITTEE
The GAP Systems, Innovation, and Transformation committee envisions a future of psychiatry in which a value-driven approach identifies opportunities to promote enhanced access, efficiency, and effectiveness of services across diverse populations.
In pursuing true systems innovation and transformation, the committee looks beyond traditional models, including utilizing community support, extra-clinical resources, and a team-driven interdisciplinary professional workforce. It strives for innovative social and financial models that foster a continuous, comprehensive, equitable, and humanitarian health system that champions personal and community well-being.
4/25/25
The Mental Health Disaster: A Call to Action
A mental health crisis in the United States has been building for years, and has now reached disastrous levels. Although more insidious than a sudden and catastrophic natural disaster, events of recent decades - economic crisis, the COVID pandemic, racial strife, international conflicts, climate change, and sociopolitical polarization - have compounded to create a deep and an evolving traumatic impact on the population.
The term “disaster” is used intentionally, because like sudden destructive natural calamities, these events have had a major impact on our communities and have depleted resources, disrupted relationships, and caused overwhelming casualties.
Psychiatry is at a critical juncture. We are witnessing the rise of authoritarianism: the erosion of scientific truth, the subjugation of public health and social services to political agendas, and the spread of ideologically driven, irrational policies that threaten the foundations of American democracy.
We do not speak out of abstraction or alarmism, but from historical memory and present urgency. Already, scientific inquiry is being restricted, with funding withheld and research censored. We fear that psychiatry may again be turned against those it is meant to protect.
Psychiatry wields unique power over liberty, autonomy, and dignity. That power can be misused—especially under authoritarian regimes—if we fail in our ethical vigilance.
History is filled with chilling examples: in Nazi Germany, psychiatrists played a central role in the T4 program, selecting individuals with mental illness for extermination under the pretense of medical necessity. In the Soviet Union, the fabricated diagnosis of “sluggish schizophrenia,” characterized by vague or absent symptoms, was weaponized to confine political dissidents under the guise of treatment. In South Africa, the Apartheid government used mental health institutions to suppress political dissidents and withhold psychiatric care from black citizens. These were not isolated abuses but systematic betrayals of medicine and justice in which psychiatry was repurposed to serve state oppression.
We refuse to return to an era in which our field has been used to stigmatize and suppress. In the face of political coercion, neutrality is not an option. Psychiatry must be a force for the preservation of dignity and autonomy—for individuals, communities, and society as a whole.
We call on our colleagues and the entire mental health workforce: Engage with your communities. Reject the erosion of civil liberties. Resist the political misuse of our institutions. Challenge the threats to our Constitution’s integrity. Uphold ethical boundaries. Advocate, publicly and unapologetically, for science, equity, and democracy.
History demands our conscience. The present requires our resistance. The future depends on our courage.
POSITION STATEMENT
Health indicators in the United States are among the worst in the developed world, even though its health care system is, by a wide margin, the most expensive in the world. It is a disparity that stems from a fragmentation of services and financial arrangements that often prioritize commercial interests over public health.
Seeking Value: Balancing Cost and Quality in Psychiatric Care, a comprehensive volume by the Group for the Advancement of Psychiatry's Systems Innovation and Transformation Committee, examines the myriad factors that have led to the current state of health care in the United States—starting with an analysis of the meaning and history of value measurement—but it does not stop there. It offers a holistic vision for health care reform, one in which psychiatric professionals play a pivotal role.
A section on system interventions tackles traditional models of financing health care and the role of market forces as it considers broad public health strategies, from elimination of administrative waste to integration of care, that can reduce costs and improve population health, with a special emphasis on the interaction between mental and physical health.
Recognizing that these larger-scale interventions require time to bear fruit, the book also explores the ways the psychiatric profession and individual psychiatrists can contribute to a more skill-diverse, collaborative, activist, value-conscious, and visionary specialty.
Several chapters also identify public policy issues and cultural constructs that go beyond the typical role of clinicians and health care administrators, but that have the potential to impact population health in significant ways, illustrating how different choices could result in remarkable improvements in social well-being. The incorporation of healthy practices in the workplace, efforts to mitigate the impact of climate change, and the elimination of counterproductive incarceration practices all feature in this discussion.
Exhaustive in approach, the book aims to spur thought, conversation, and action to improve value in the services the psychiatric profession provides and the systems in which it operates. Its clear and compelling message will equip readers to develop an advocacy agenda that will resonate with nonmedical stakeholders and the practical strategies needed to see it realized.
MEMBERS
Co-Chairs: Deepika Sastry and Wes Sowers
Members: Bruce Fage, Joanna Fried, Hunter McQuistion, Michelle Joy, Nubia Lluberes, Jules Ranz, Mardoche Sidor, Anna Skiandos, Donovan Wong, Rachel Zinns, Kenneth Thompson
Guests: Miriam Tepper, Graham Ellis, Kenneth Thompson