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Dr. Saul Levin on steering the APA into the 21st century
by Sarah Toce

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On May 15, the American Psychiatric Association's (APA's) board of trustees announced that CEO and medical director Dr. James H. Scully, Jr. would be succeeded by psychiatrist Dr. Saul Levin—the first openly gay head of the Department of Health in Washington, D.C. With this historic selection, Levin would become the first out gay head of the national medical specialty society.

"I have known Saul for over 20 years. He brings extraordinary intelligence, vision and great energy to the challenges ahead for our profession. I look forward to working together with him as we transition to new leadership," Scully said in an official statement.

Levin's history with the APA is a long one, beginning in 1987. At the time, he was a member himself and served on the American Psychiatric Association Delegation to the American Medical Association, the American Psychiatric Association PAC Board, the Scientific Program Committee, and as a consultant to the Finance and Budget Committee.

As the interim director of the District of Columbia Department of Health, Levin led efforts to promote access to quality health care for D.C. residents, including provision of school-based nursing services and implementation of an electronic health information exchange since July 2012. He oversaw the merger of the Department of Health's Addiction Prevention and Recovery Administration and Department of Mental Health into D.C's Department of Behavioral Health.

Levin's connection to substance-abuse addiction treatment led him to the District's Addiction and Recovery Administration alongside the U.S. Substance Abuse and Mental Health Services Administration. Before his employment with the District of Columbia, Dr. Levin was the Vice President for Science, Medicine and Public Health at the American Medical Association. He is also a member of the Maryland Psychiatric Society.

Windy City Times: Dr. Levin, you shattered the glass ceiling by becoming the first openly gay head of the D.C. Department of Health in 2012. In what ways did the weight of that historical title sink in during your tenure?

Dr. Saul Levin: I always feel responsible to the LGBTQ community—because I'm part of that community and I live in that community. So, obviously I view my day-to-day existence as a gay man sees it through that prism—being an openly gay man.

In terms of me being the first openly gay head of the Department of Health and the American Psychiatric Association, I think one of the wonderful things with the LGBTQ movement has occurred over the last 10-15 years: It's no longer an issue of you being openly gay in that position. It's that we, just like anyone else, are appointed to a position because we have the expertise to do the job. And one of the added things we bring to it is the fact that we do have, if you are LGBTQ, some minority component to that and, therefore, you have in some ways a prism that makes sure you always look at it from the perspective of the minorities as well as the majority.

WCT: Given the responsibility of carrying the torch, so to speak, were there initiatives that stood out as more critical than others during your time with the DOH?

Dr. Saul Levin: I looked at what was good for the city as a whole. But then obviously you do have different populations, different illnesses, different socioeconomic situations that impacts their health as well—the biosocial determinants of health. In Washington, D.C. we know that we have a much higher incidence of cancer and diabetes in the African American population and, therefore, we need to make sure we have programs to really look to take care of them. Likewise in the LGBT community, we would have programs that took care of some of the big issues that occurred in the LGBT community … in terms of HIV, in terms of substance abuse, in terms of mental health, and psychological issues. So I think it isn't that I focused particularly on a population—I looked at all the populations that make up the District of Columbia.

WCT: Fast-forward to July 2013 when you will begin the transition period to step into the shoes of Dr. James H. Scully Jr. at the American Psychiatric Association. What is your background with Dr. Scully?

Dr. Saul Levin: I've known Dr. Scully now for close [to] 15 years. I started off as—obviously I'm a psychiatrist—a resident in psychiatry, so I joined the American Psychiatric Association. He worked there at one point as the senior person on the staff, so I got to interact with him there. I also interacted with him once he became the medical director, and was also involved with the American Medical Association, that I've been involved both as a resident and then a psychiatrist and a physician involved with the American Medical Association.

And then when I became the vice president of science medicine and public health for the American Medical Association, obviously mental health and substance abuse was a big part of science medicine and public health that the American Medical Association looked at, so I worked with him as well. He has been a mentor, friend, colleague, and above all, an exceptional leader. It's my privilege to follow in his footsteps. He's a great man. He has a great sense of humor, also great intellect.

WCT: Why did this specific position and organization speak to you at this juncture in your career?

Dr. Saul Levin: I think—as I look at my career from my psychiatric training, looking at having been a clinician, and then realizing that policy and administration were just as important for psychiatry and for medicine and ensuring that those parts were taken care of—it became clear [to me] that policy and administration was where I showed a very particular aptitude. I began to do those jobs that looked to lead the people that you were representing.

As a psychiatrist, particularly in the Affordable Care Act of today—and health-benefits exchanges and health-information exchanges that clearly the country is moving toward—I hope that I've been able to help the American Psychiatric Association and our members, all 38,000 of them, become familiar with what we need to do as psychiatrists in this country providing the expert care we give to patients. This job enabled me to do that, so it was a privilege to be chosen and selected.

WCT: How might your approaches to the profession of psychiatry differentiate from that of your predecessor?

Dr. Saul Levin: I'm not too sure our approaches are going to be different. I think times are different, though. And with the Affordable Care Act, the whole nation is looking at the health care delivery system and the physicians and practitioners that practice care is going to change. So, I think it's all the same basic tenets that we have to look at: research, particularly in the neurosciences that we obviously are literally at the beginning of the threshold of the brain that we truly are going to understand what are the illnesses of the brain, bio-psycho-social. The genetic components of it, the psychological, and also the social component of it.

The research has to be done to find those biomarkers of an illness that we will be able to give treatment for that particular illness. And then you've got education, which Dr. Scully had to deal with and I will—how do we ensure, in this time of exploding knowledge from our researches and expeditions, that we're able to teach everyone—medical students, residents and lifelong learning of those practicing psychiatrists—about those changes? I think in some ways it's going to be the same things he faced and then we will also have additional looks around the Affordable Care Act and the health information and electronic health records that will add to some of the things we're going to do.

WCT: As a psychiatrist specializing in substance-abuse treatment, what can you tell us about the correlation between LGBT youth homelessness and substance abuse? Are they completely separate issues or do they work together in a distinct way?

Dr. Saul Levin: I believe that they do work together. If you are homeless or facing the stress of having to live on the street, aware that your safety may be at risk, where are you getting your sleep? Where are you getting your food? How are you taking care of yourself health-wise and also your mental health? And, in some ways, if you are on the street where you can't go into an air conditioned place or where the temperature rarely drops, the natural inclination would then be for someone to say, "How do I get some relief to what I'm feeling, this horrible place I feel that I'm in right now?" Therefore, there is an increase in substance use amongst the homeless and particularly amongst our adolescents and young kids that use—and many of them are LGBT. We need to look to what programs we can do for them, both in terms of finding them shelter, finding them a safe place to say, but also helping them if they do have a substance abuse problem.

WCT: In your opinion, what strides have we collectively taken over the past 10 years to further social understanding of the mental health and stability of gay individuals?

Dr. Saul Levin: Well, as many of us know in the community, for many years—generations and decades—LGBT people were really stigmatized, were abused mentally, physically and sexually at time. As society began to realize that that was inherently discriminatory and wrong, the American Psychiatric Association looked at it and ultimately removed homosexuality [from the guide] as it became clearer that it wasn't something that you voluntarily chose.

The Diagnostics Statistics Manual removed homosexuality in 1973, which was the first very big step for health care providers and physicians to understand that you should not look at a gay or lesbian person [as if they] had a disorder; that these were people who needed the respect and equal treatment just like you would give anyone else. Look how proud we are of seeing where even marriage equality has come about in some of the states. Look at the data coming out of the nation where the majority of people today are very positive to say that there should be LGBT marriages allowed.

WCT: What actions do we still need to take to arrive at a place of compassion and understanding for our fellow man, despite classifications and acronyms?

Dr. Saul Levin: I think one of the wonderful things about the United States is that this country is clearly looking at all the different groups that have been discriminated against and are beginning to move under the rubric of our Constitution is that we're all created equal and that we all should be able to pursue happiness. And I think that's the wonderful thing of where we are coming to in terms of compassion and understanding for our fellow man. We're not quite there yet, but I think we're at least in a very positive trajectory to ensure that everyone in this country is treated without discrimination and have the best opportunities afforded to them.

WCT: Is there evidence available that supports that raising a child in a same-sex household is detrimental to said child? It seems to be the fallback argument we hear from anti-gay groups like the Family Research Council and the National Organization for Marriage—but is it actually true?

Dr. Saul Levin: A study that has summarized data from 30 years of research into the wellbeing of children being raised by gay and lesbian parents was released by the American Academy of Pediatrics in March of 2013. That study found no detrimental effects from being raised by gay parents and suggests that it is the quality of the relationship between the child and his/her parents that affect their resilience in regards to their social, psychological and sexual health rather than the gender of the parents.

However, the study also suggests that marriage strengthens families and has a very positive effect on children, which therefore suggests that permitting gay parents to legally marry would also most likely have a more positive effect on the children. They would then get to see a very committed relationship to the full extent of the law and equality of this country. The argument that same-sex households should not be able to have kids or raise kids I think is in some ways a very opaque view of what true love and parenting is for a kid.

WCT: Lastly, the transgender community has its own unique challenges within the larger LGBT community. Can you address how the American Psychiatric Association will address the evolving needs within this group?

Dr. Saul Levin: Well, you're right. They are in some ways—the last discriminated groups from the LGBT continuum in our community. The American Psychiatric Association just released its Diagnostics Statistical Manual and has basically removed Gender Identity Disorder, which was used to describe the feelings of some of the transgender people. And they've now replaced it with what's called Gender Dysphoria—and that category does not medicalize the state of identifying with the opposite-sex in who they are, but provides a pathway to treatment for the distress that can accompany feelings that one has been born into the wrong body. The new category is not intended to stigmatize the transgender person, but to provide a way for the insurance companies—Medicare and Medicaid—to provide supportive services, including possible gender reassignment surgery, hormonal treatment, or other forms of treatment for the transgender person. The American Psychiatric Association has said it's time for us to realize that transgender people need to get treatment and they should have their insurance pay for their treatment just like any other health condition— primary care, mental health, substance abuse—should have equity in having access to that treatment.

The American Psychiatric Association confirmed that Dr. Saul Levin will join the organization in mid-July as CEO-designate and work closely with Dr. James Scully until his retirement in this fall, when Levin will make the transition to his role as CEO and medical director of the APA.

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