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APA Official Actions

Published Online: 1 October 2018

APA Council Reports

Publication: American Journal of Psychiatry

https://doi.org/10.1176/appi.ajp.2018.1751001

At the fall component meetings of the American Psychiatric Association in Arlington, Va., September 12–15, 2018, the APA councils heard reports from their components. Following are summaries of the activities of the councils and their components.

The Council on Addiction Psychiatry

Andrew J. Saxon, M.D., Chairperson

The Council on Addiction Psychiatry (CAP) is committed to providing psychiatric leadership in the study, prevention, and treatment of substance use disorders. The component provides recommendations to APA on training, treatment, and public policy. To facilitate effective collaboration and communication, the Council invites representatives of the White House Office of National Drug Control Policy (ONDCP), the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Veterans Health Administration (VHA) to participate in its meetings. The Council has focused on physician training on treatment of substance use disorders, prescription drug monitoring programs, accessibility and availability of services, budgetary challenges, research priorities, and opportunities for APA to contribute meaningfully to important government initiatives.

Through its active collaboration with APA’s Department of Government Relations and Department of Policy, Programs, and Partnership, the Council has provided guidance on the association’s legislative and regulatory advocacy efforts regarding the national opioid crisis. As Congress has been working on a comprehensive legislative package to address the crisis, the Council has provided rapid responses to APA staff and guided the association’s response to both the relevant Senate and House committees. Members also helped staff respond to regulatory activities, such as the Food and Drug Administration’s Opioid Policy Steering Committee’s recent request for feedback and NIDA’s proposed HEALing Study, a national research effort to test interventions to address the opioid crisis.

APA is a partner in the SAMHSA-funded Providers’ Clinical Support System, a project developed to address the appropriate use of opioids in the treatment of chronic pain, as well as the recognition and treatment of opioid use disorder. More than a dozen medical specialty and stakeholder organizations provide free continuing medical education in support of the program. APA contributes webinars and online case vignettes that can be accessed through the association’s Learning Center and the program’s dedicated website (www.pcss-o.org). In addition, APA is a clinical site for the PCSS-MAT Implementation Program (PCSS-MIP), a pilot program funded by SAMHSA to provide technical support to health care organizations and providers for the implementation and integration of substance use disorder services, especially the use (or expansion) of medication-assisted treatment for patients with substance use disorders and in particular opioid use disorder.

The Council is also involved in a variety of training opportunities for psychiatrists and other interested clinicians. Waiver-eligible courses on office-based treatment of opioid use disorder with buprenorphine are offered at APA’s Annual Meeting and the Institute on Psychiatric Services (IPS). The waiver eligible courses were augmented by a monthly webinar series conducted by the association as a partner organization in the Substance Abuse and Mental Health Services Administration (SAMHSA)-funded Providers’ Clinical Support System for Medication-Assisted Treatment (PCSS-MAT). The highly rated webinars provide free continuing medical education credit. A clinical mentoring system further enhances the training by providing opportunities for psychiatrists and other physicians to consult with members who have recognized expertise in evidence-based medication-assisted treatment of opioid use disorder.

Council members represent the association and actively participate in the American Medical Association’s (AMA) Task Force to Reduce Opioid Abuse, which is comprised of representatives of state medical associations and medical specialty societies. The member organizations recognize that to address the epidemic of prescription drug abuse effectively, physicians should develop and implement strategies to reduce the harm caused by overprescribing of opioids and utilize evidence-based practice in treating pain and substance use disorders. Led by Dr. Patrice Harris, President-elect of the AMA and a former member of APA’s Board of Trustees, the Task Force has undertaken initiatives to 1) address substance use disorders as a medical condition; 2) enhance physician training on evidence-based treatment of pain and addiction; 3) increase physicians’ use of prescription drug monitoring programs and provide guidance to policymakers about program features that will ensure provision of clinically significant information; 4) reduce the stigma of substance use disorders; and 5) address overdose prevention through advocacy for increased access to naloxone.

A work group of the Council continues to focus on tobacco use disorder. Members include clinical experts and representatives of integrated care, public and community psychiatry, child and adolescent psychiatry, and residency education. The group has engaged on a series of Veterans Administration campaigns on smoking cessation, including International No Tobacco Day. The group is also working on creating a toolkit of resources for physicians treating tobacco use disorder. The group maintains a collaborative relationship with the Robert Wood Johnson Foundation’s Smoking Cessation Leadership Center, which funded APA’s initial efforts in this area.

The Council also has two new work groups focused on opioids and marijuana. In the short-term, the two groups have been tasked with reviewing position statements on these respective topics. In the long-term, the groups will provide guidance to APA staff on these emerging policy issues and consider the latest research, analyze training gaps that exist for psychiatry, and weigh in on relevant legislative proposals.

Members of the Council are also working to develop or revise several APA position statements, including “Prescription Drug Monitoring Programs (PDMPs),” “Physician Health Programs in the Treatment of Addiction and Substance Use Disorders in Physicians,” and “Addressing Health Disparities in Substance Use Disorder Treatment in the Justice System.”

The Council on Advocacy and Government Relations

Patrick Runnels, M.D., Chairperson

The Council on Advocacy and Government Relations, established in 2009 as part of the reorganization of APA councils and components, serves as the APA’s member-led coordinating body for advocacy activities involving federal and state government. Its responsibilities include anticipating advocacy-related policy needs; discussing government relations strategies; collaborating with district branches and state associations on state matters; and providing expert input to the APA Administration. The continued challenges associated with access to mental health and substance use disorder-related care continue to foster a keen focus on Capitol Hill, within the Administration, and in state governments. To help mitigate these issues, the Council remains active in its efforts to advance the APA’s advocacy priorities.

Combating the Opioid Crisis

Congress has spent a significant amount of time this year assessing proposals designed to address the opioid crisis, with more than 300 individual opioid bills introduced between the two chambers. Given the broad scope of the introduced legislation, touching on enforcement, prevention, treatment, and recovery, multiple congressional committees have held hearings and markups on different aspects of the crisis. Utilizing the Council’s expertise, the APA Administration directly engaged these committees and delivered several letters to Congress outlining Association’s priorities. In June, the U.S. House of Representatives overwhelmingly passed an opioid package, H.R. 6, the “Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act,” a broad legislative package that included provisions to expand the coverage and access to treatment for individuals with substance use disorders. In addition, the APA played a significant leadership role in working with our coalition partners to pass H.R. 6082, the “Overdose Prevention and Patient Safety Act.” If enacted, the bipartisan bill, which has already passed the House, would align privacy regulations for substance use disorder treatment records under 42 CFR Part 2 with the requirements under the Health Insurance Portability and Accountability Act. The Council will continue to work closely with the APA Administration to engage Senate lawmakers in ensuring opioid-related legislation is delivered to the President.

Family Separations at the Border

In the spring, the Trump Administration announced its intent to enforce a “zero-tolerance” policy for individuals illegally entering the United States. Over the past several months, the APA has repeatedly urged the Trump Administration to cease enforcement of policies that result in the separation of families at the border. In a series of letters, the APA has articulated that any forced separation is highly stressful for children and may cause lifelong trauma, as well as an increased risk of other mental illnesses, such as depression, anxiety, and posttraumatic stress disorder (PTSD). The APA was among the first organizations to denounce this practice and led a coalition letter that generated 18 signatories from the health care community. In addition, the APA has urged House and Senate Committee leaders to schedule prompt oversight hearings to investigate the current situation facing migrant children and families and ensure that appropriate mental health services are being provided at the relevant detainment facilities. The Council worked with APA Administration to encourage participation in grassroot advocacy efforts directed at the Administration.

U.S. Supreme Court Nomination

On July 9th, President Trump named Judge Brett Kavanaugh, of the U.S. Court of Appeals for the D.C. Circuit, as his nominee to replace retiring Supreme Court Associate Justice Anthony Kennedy. Following the announcement, the APA Administration sought input from the Council regarding mental health and substance use disorders issues that could be relevant during the confirmation process. Council members highlighted an array of topics, including but not limited to firearms, immigration policy, and access to mental health services, which staff from the Department of Government Relations (DGR) utilized to frame potential questions. The DGR team is in the process of engaging lawmakers from the Senate Judiciary Committee as they prepare Judge Kavanaugh’s formal confirmation hearing. The Council will work with DGR staff to keep the Association abreast of the confirmation process.

APA Resource Document: The Current State of Advocacy Teaching in Psychiatry Residency Training Programs

In the fall of 2017, Council members drafted a resource document illustrating the benefits of incorporating advocacy training into curriculum for psychiatric residents. Despite the parallels linking health care, practice, and policy, many residency programs fail to offer opportunities for engagement in legislative/political advocacy. Advocacy is a critical tool for raising awareness of mental health issues and ensuring that it remains a prominent aspect on the nation’s health-related agenda. By implementing advocacy-related curricula, medical residents will be able to tie topics of clinical competence to the implications of relevant state and federal policy decisions, which can result in better patient outcomes. In June, the Joint Reference Committee approved the document as an official APA resource tool for the Association.

Advocacy 101 Training Module for APA Membership

An overarching priority for the Council on Advocacy and Government Relation has been to strengthen APA’s member advocacy efforts when addressing federal and state issues affecting psychiatrists and their patients. The Council established a work group to develop resource tools to broaden APA membership’s understanding of advocacy and the importance of participating in these efforts. The work group developed an online training module to provide APA members with a comprehensive approach to advocacy by effectively communicating with policymakers about priority issues relating to the field of psychiatry. The Council used the training module as the foundation for an advocacy workshop during the 2018 APA Annual Meeting and continues to develop training tools designed to encourage membership to engage in advocacy efforts in mental health policy, whether at the federal, state, or local level.

Scope of Practice

The Council, APA Administration, and APA membership continue to work in tandem to defeat unsafe prescribing legislative proposals across several states. Psychologists are aggressively seeking the ability to prescribe independently with minimal education and training, endangering patient safety. APA is effectively employing innovative strategies of opposition, while proactively promoting evidence-based alternatives to mental health access challenges, such as expansion of collaborative care models, tele-psychiatry implementation, and parity enforcement. Through well-executed opposition campaigns, APA assisted in deterring the introduction, or prevented the movement of, psychologist prescribing legislation this session in six states—Connecticut, Hawaii, Kentucky, Minnesota, Nebraska, Oregon—and defeated a psychologist prescribing bill in West Virginia. In addition, Georgia, Florida, Mississippi, Oklahoma, and Tennessee defeated legislation that would give nurse practitioners more autonomy, independently practicing without physician supervision. Next year is expected to be just as eventful, with proposed workforce legislation expected to be introduced in several states. The Council will continue to work in conjunction with APA Administration and district branches in preparing for the 2018–2019 legislative session and to enhance strategic advocacy efforts aimed at addressing workforce issues.

The Committee on Advocacy and Litigation Funding

Originally created in 2002 and re-established in 2009, the Committee on Advocacy and Litigation Funding (Bhasker J. Dave, M.D., Chairperson) is charged with reviewing requests involving legislation, litigation, and advocacy within the state arena. The Committee serves as a mechanism to evaluate requests for financial assistance to district branches and state associations and to make recommendations regarding funding through the Council on Advocacy and Government Relations. With increased legislative activity and greater focus on state government responsibilities in the changing environment of health care workforce and the increasing cost of health care, the Council has worked with APA to ensure support for eligible and approved district branches and state associations as they seek to bolster their advocacy apparatus.

The APA Political Action Committee (APAPAC)

APAPAC is the bipartisan political voice of the APA that enables the Association to invigorate its patient and professional advocacy activities by supporting candidates for federal office. APAPAC (R. Scott Benson, M.D., D.L.F.A.P.A., Chairperson) is governed by a board of directors comprised of 14 APA members. The PAC works to ensure the election of federal candidates/incumbents who share mutual principles and goals with APA and who champion psychiatry’s position throughout the legislative process. Another role of the PAC is to educate Members of Congress as to why they should support positions vital to our patients and profession. The PAC raised almost $525,000 from APA members during the 2016 election cycle. Increasing our total cycle fundraising is the APAPAC’s top priority. Although APAPAC is among the smaller physician PACs, we are poised for growth. The APAPAC Congressional Advocacy Network (CAN) is another tool we use to bring an even greater voice to psychiatry’s advocacy efforts. There are 143 members of the APA participating in the CAN program, which is designed to help develop, train, and energize a national network of psychiatrists who will commit to communicating and building personal relationships with members of Congress and speak on behalf of the APA on issues facing mental health.

The Council on Children, Adolescents, and Their Families

Gabrielle Shapiro, M.D., Chairperson

The Council on Children, Adolescents, and Their Families works to advance the diagnosis and treatment of children and adolescents with mental health problems. The Council keeps psychiatric issues involving children and adolescents at the forefront of APA policy and works to assist general psychiatrists in learning more about treating or referring pediatric patients. To facilitate collaboration and communication, the Council is a convening body for allied psychiatry organizations and APA components, including the American Academy of Child and Adolescent Psychiatry, Caucus of Psychiatrists Treating Persons with Intellectual Disabilities, and the College Mental Health Caucus.

Component Update

Policy.

The Council addressed several issues, including solitary confinement, risks of adolescents’ online behavior, suicide, college mental health, and attention deficit hyperactivity disorder (ADHD) through proposed position papers and collaborative efforts across the councils. 1) In May 2017, the Board of Trustees (BOT) recommended that the Council revise the position statement on the risks of adolescents’ online behavior. The Council has built off of the work of the proposed position in an effort to educate and bring resources to various audiences to include members, nonchild psychiatrists, family members, and peers. 2) The Council partnered with the Council on Psychiatry and the Law (lead) and the Council on Minority Mental Health and Health Disparities in drafting a position statement on solitary confinement (restricted housing) of juveniles. 3) The Council reviewed and supported a letter addressed to the Netflix executive producers of 13 Reasons Why. This was a response to concerns about season 1 and upcoming season 2. The Council on Communications also reviewed and supported the document. The Council will continue to monitor and respond if needed. 4) The Council is working with American Academy of Child and Adolescent Psychiatry (AACAP) to complete the Parent Medication Guide on Anxiety and Obsessive Related Disorders. 5) The Council collaborated with APA Telemental Health Committee to review the Higher Education Mental Health Alliance (HEMHA) Guide, College Counseling from a Distance: Deciding Whether and When to Engage in Telemental Health Services. 6) The Council reviewed and provided feedback to the Council on Quality Care regarding a letter to the editor of the Journal of the American Academy of Child and Adolescent Psychiatry on the paper, “Specific Components on Pediatricians’ Medication-Related Care Predict Attention-Deficit/Hyperactivity Disorder Symptom Improvement” (Epstein, JN, et. al). 7) The Council recommended to JRC that Board of Trustees vote to retain the 2012 Official Action “Endorsement of United States Ratification of the Convention on the Rights of the Child.”

The Council has made it a priority to partner on an ad hoc basis with the APA Foundation, district branches/state associations, and allied organizations, such as the AACAP, to advance the relevant issues and legislation designed to reduce and eliminate childhood poverty in America. Synergies were identified in the work of the Council and APA Foundation, specifically regarding the “Typical or Troubled?” School Mental Health Education Program. The Council is aware that advocating must come in a timely manner and relied on the Council on Advocacy and Government Relations for their expertise.

Education and training.

The Council continues to identify and support opportunities for the development of quality abstracts on child and adolescent psychiatry topics for presentation at the APA Annual Meeting and other psychiatric meetings. The Council is interested in developing presentations on first-break psychosis as well as issues related to the immigration and family separation crisis. During the IPS meeting in 2017, the Council had two endorsed presentations and had seven presentations at the Annual Meeting in 2018.

The APA/APAF Child and Adolescent Psychiatry Fellowship is designed to promote interest and a career in child and adolescent psychiatry and falls under the purview of the Council. Selected fellows receive mentorship from child and adolescent psychiatrists and leaders in the field. Certain Council members have been matched as mentors for the 2017–2019 fellows: Taiwo Babatope, M.D., M.P.H., M.B.A. (University of Texas Health Science Center at Houston), Vasiliki Karagiorga, M.D. PhD candidate (SUNY Downstate Medical Center), Richard Ly, M.B.B.S., (Oregon Health and Science University), Alicia Londono, M.D., (Yale University), Robyn Thom, M.D., (Harvard Longwood Psychiatry Residency Training Program). This year, five additional fellows were selected for the 2018–2020 fellowship cohort. These fellows are Marian Rain, M.D.,(University of Texas Southwestern Medical Center, Dallas), Kunmi Sobowale, M.D., (Yale University), Jasmin Scott-Hawkins, M.D., M.P.H., (University of Southern California), Juliet Edgcomb, M.D. Ph.D., (University of California, Los Angeles), Matthew Fadus, M.D., (Medical University of South Carolina)

Awards.

The Blanche F. Ittleson Research Award and Agnes Purcell McGavin Award for Distinguished Career Achievement in Child and Adolescent Psychiatry fall under the purview of the Council. The Ittleson Award, established in 1976 in memory of the noted philanthropic friend of psychiatry, Blanche F. Ittleson, recognizes outstanding and published research in child and adolescent psychiatry that has resulted in, or promises to, a significant advance in promoting the mental health of children. This year, the Ittleson Award recipient is Hilary Blumberg, M.D. The Agnes Purcell McGavin Award for Distinguished Career Achievement, established in 2000, is presented to a child and adolescent psychiatrist who has been noted for outstanding contributions to the advancement of child and adolescent psychiatry in activities such as teaching, research, writing, clinical care, advocacy, and policy. This year, the McGavin Award recipient is James Lock, M.D.

New initiatives.

There are several interest groups within the Council: Integrated Care, Juvenile Justice/Corrections, Social Media, Transitional Age Youth/Adult Psychiatrists, Gender Dysphoria/Transgender Mental Health, Immigrant/Refugees and First Break Psychosis. The Council is considering position statements on First Break Early Psychosis and an APA call to action (action paper) regarding the forced family separation of immigrants. The Council is actively collaborating with the Council on Minority Mental Health/Health Disparities and seven Minority/Under-represented Caucuses on the APA Toolkit on Stress and Trauma Related to Social and Political Environments. In addition, the Council has a liaison from AACAP. Finally, there are mentor-mentee Council pairings among midcareer and senior psychiatrists with resident-fellow members.

The Council on Communications

Carol Bernstein, M.D., Chairperson

The Council is engaged in developing a standard procedure for the APA for the handling of sponsorship and/or partnership requests from entities involved in creating film, television, and other media projects. The members of the Council on Communications generally believe that the APA could greatly benefit from these types of partnerships, provided that the projects meet a few specific criteria still to be decided. Council members agree that regardless of a final set of criteria, any sponsorship or partnership with a film/television/media project must help to advance the mission of the APA, the practice of psychiatry, and the discussion of mental health treatment and awareness.

The Council is working to help the APA broaden its pool of experts to field media requests on different subjects related to psychiatry and mental health. This has begun as an internal effort within the Council, whose members are being asked to fill out a biographical information form listing their areas of study and expertise in psychiatry and any media experience they may have. It is hoped that the success of this effort will eventually branch out to subject-matter experts on other APA councils and components.

The Council on Communications plans to meet with leadership from other councils and the APA Administration to discuss ways to enhance communication of the specific initiatives they are undertaking. Part of this effort involves developing a short social media training session for other APA councils and components. Many APA councils and components are rich in specific subject-matter expertise but lack basic skills in social media that could help to publicize their work. The training session in development by the Council aims to address that gap and provide councils and components with the skills they need to effectively communicate using social media platforms such as Twitter, Facebook, Instagram, and LinkedIn.

The Council on Consultation-Liaison Psychiatry

David Gitlin, M.D., Chairperson

The Council on Consultation-Liaison Psychiatry focuses on the psychiatric care of persons who are medically ill and/or pregnant and works at the interface of psychiatry with all other medical, obstetrical, and surgical specialties. It recognizes that integration of medical and psychiatric care is vital to the well-being and healing of patients and that full membership in the house of medicine is essential for our profession.

For decades, consultation-liaison (C-L) psychiatry has been at the forefront of treating patients with comorbid psychiatric and physical conditions. As more psychiatrists become involved with the integration of physical and mental health care, C-L psychiatrists can provide valuable insight and expertise. The Council serves as an important resource to the APA Administration on best practices for integrating behavioral health with medical care. This past year, the Council underwent a name change from the Council on Psychosomatic Medicine to the Council on Consultation-Liaison Psychiatry, along with the rest of the subspecialty. The Council has undertaken an extensive effort, in coordination with the Academy of Consultation-Liaison Psychiatry, to help other physicians, including general psychiatrists, better understand the scope of practice and research expertise in the field, which includes unique expertise in women’s mental health, HIV psychiatry, psycho-oncology, cardiac psychiatry, and transplantation psychiatry, to name but a few. Educational efforts include a series of articles in Psychiatric News, sessions at the APA Annual Meeting, and the release of a video used to recruit medical students to the field.

Over the past year, the Council has focused on demonstrating the importance of the subspecialty through the development of educational material and the expansion of recruitment efforts. The Council is expanding the Position Statement on “Emergency Department Boarding of Individuals with Psychiatric Disorders” by developing a Resource Document focused on timely access to psychiatric emergency services. The Council also worked in partnership with the Council on Geriatric Psychiatry to finalize a position statement on “Palliative Care and Psychiatry.” A Workgroup completed a resource document in collaboration with the American College of Cardiology on “QTc Prolongation and Psychiatric Disorders,” which will be published soon. Other workgroups are in the process of developing resource documents on “Mental Health Issues and Infertility,” and “The Assessment of Capacity for Medical Decision Making.”

The Council also provides timely feedback on key priorities for APA by providing input on relevant legislative and regulatory issues, such as relevant quality measures and delivery system reform efforts. Council members also submitted comments on draft guidelines and policy documents for other medical societies and the APA.

Council on Geriatric Psychiatry

Robert Paul Roca, M.D., M.P.H., Chairperson

The Council supports APA in its work on behalf of older adults and the psychiatrists who care for them. To this end, the Council develops position statements and resource documents on important issues in geriatric psychiatry, thereby providing APA with background information essential for advocacy efforts and interactions with the media. The Council also works collaboratively with other professional groups to develop best practices in geriatric psychiatry, to promote research, and to provide education and training to psychiatrists, other physicians, residents, medical students, and allied mental health professionals.

During the past year, the Council worked on the following major activities and initiatives.

Position Statements

• Role of Psychiatrists in Long-term Care Settings: A workgroup consisting of volunteers from the Council on Geriatric Psychiatry and the Council on Consultation-Liaison Psychiatry developed a position statement on this topic. The Board of Trustees (BOT) has asked the Council for some clarifications and amplifications. The Council is working to incorporate these suggestions into a new draft.

• Role of Psychiatrists in Palliative Care: A workgroup consisting of volunteers from the Council on Geriatric Psychiatry and the Council on Consultation-Liaison Psychiatry created a position statement on this topic. The Joint Reference Committee (JRC) approved the statement and sent it forward to the Assembly for review. If approved, it will be advanced to the BOT for consideration.

• Elder Abuse, Neglect, and Exploitation: The Council reviewed the existing position statement on this topic from 2008 and determined that it needs to be updated. The Council submitted a revision to the JRC, which approved and advanced it to the Assembly for review. If approved, the statement will move to the BOT for consideration.

• HIV Infection in People Over 50 (2008): The Council reviewed the 2008 Statement and determined that it needs to be updated and broadened to include reference to other infectious diseases. This work is underway.

• Disaster Response: The Council discussed the potential value of a position statement on the needs of older adults during and after disasters.

Medical Beds and Ligatures Risks

In response to pressure from the Centers of Medicare and Medicaid Services (CMS), the Joint Commission is tightening its standards in relation to ligature risk in psychiatric hospitals. As a result, many psychiatric facilities have been compelled to make widespread and expensive renovations very rapidly, disrupting patient care and diverting resources from other critical needs. One especially disruptive element is the identification of medical beds as an important ligature risk. There is agreement that no medical bed is entirely ligature free, even if the electric cord is short or the bed is low to the floor. But it is important that CMS and the Joint Commission recognize that some persons in psychiatric hospitals (e.g., the elderly, persons with eating disorders) may require a medical bed and that it would harmful for these patients if such beds were not permitted in psychiatric facilities. It is essential that TJC and CMS accept suicide risk assessment and other clinical interventions as adequate measures to mitigate risks associated with the use of these beds without requiring that all patients in medical beds require 1:1 observation or other similarly onerous and impractical solutions.

The Council invited representatives from APA Division of Government Relations and Council on Quality Care to a recent component meeting to explore the possibilities of collaboration to advocate for this issue more effectively.

Use of Antipsychotics in Treatment of the Elderly: A Letter to the Centers for Medicare and Medicaid Services (CMS)

Currently, nursing homes are under pressure from CMS to reduce antipsychotic prescribing for dementia, and rates of prescribing are a quality measure for these facilities. CMS excludes patients with schizophrenia, Tourette’s syndrome, and Huntington’s disease from the calculation but includes patients with schizoaffective disorder and bipolar disorder, unreasonably penalizing nursing facilities willing to admit patients with these conditions. The Council worked with APA Administration to draft a letter to CMS that communicates support for including bipolar and schizoaffective disorders in the quality measure exclusion.

Resource Document on Decisional Capacity by the Council on Consultation-Liaison Psychiatry

The Council was requested to review a draft a resource document on this topic developed by the Council on Consultation-Liaison Psychiatry. Upon thorough review of the document, the Council responded that the document is well-written and will prove helpful to clinicians looking for guidance. The Council recommended highlighting the fact that physicians should not conclude that an individual lacks decisional capacity simply because she or he is making an unwise or unpopular decision. To say that an individual lacks capacity for psychiatric reasons, it is necessary to show that individual has a capacity-compromising condition (i.e., a diagnosis) and that the symptoms of his or her condition are interfering with the decision-making process.

Comments on the National Quality Form (NQF) Measure on the Use of Antipsychotics in Older Adults in Inpatient Hospital Settings

The NQF, the only nationally recognized quality measure endorser, invited comments for behavioral health quality measures in March 2018. Of the five measures under endorsement consideration, APA asked the Council to provide feedback on NQF measure #3315: “Use of Antipsychotics in Older Adults in the Inpatient Hospital Setting.” This measure is based on the premise that patients started on antipsychotics in medical-surgical settings for delirium or dementia-related behavioral disturbance are at risk of being discharged on these medications and harmed by them. The Council appreciated the fact that patients on psychiatric units are excluded from the denominator, as are patients with schizophrenia, bipolar disorder, Huntington’s disease, and Tourette’s syndrome; it was suggested that patients with schizoaffective disorder should also be excluded from the denominator. The Council also appreciated that patients being treated with antipsychotics because they were dangerous to self or others be excluded from the numerator; it was suggested that patients with documented psychotic symptoms (e.g., delusions and hallucinations), whatever the cause, should also be excluded from the numerator.

Culture, Heritage, and Diversity in Older Adult Mental Health Care (Formerly “Cultural Competency Guide for the Treatment of Elderly Adults”)

In 2004, the Council on Aging (former name of the Council on Geriatric Psychiatry) developed a cultural competency curriculum to guide clinicians treating elderly patients. Dr. Maria Llorente, who worked on the original curriculum, offered to work with DDHE to lead a project to revise the document. A workgroup consisting of members of the Council, representatives of AAGP, and APA/APAF fellows worked to develop the 11-chapter guide. Because of the importance of the topic and the quality of the document, the Council pursued the idea of publishing the guide in the form of a book. The manuscript was accepted for publication by APA Publishing.

Geriatric Psychiatry Awards

As in past years, the Council recommended honorees for the Jack Weinberg Award in Geriatric Psychiatry and the Hartford-Jeste Award for Future Leaders in Geriatric Psychiatry. The Jack Weinberg Award recognizes psychiatrists who have made noteworthy contributions to geriatric psychiatry as researchers, mentors, leaders, and clinicians over the course of their careers. The 2018 award recipient was Dr. Paul Kirwin. The Hartford-Jeste Award recognizes an early-career geriatric psychiatrist who has made significant contributions to the field of geriatric psychiatry through excellence in research, teaching, clinical practice, and community service and has demonstrated the potential to develop into a future leader in the field. The 2018 awardee was Dr. Sophia Wang. The awards were presented at the 2018 Annual Meeting in New York.

The Council on Healthcare Systems and Financing

Harsh K. Trivedi, M.D., M.B.A., Chairperson

The Council on Healthcare Systems and Financing (CHSF) continued its efforts to monitor and provide analysis for a number of significant issues that have an impact on the financing and delivery of, and access to, psychiatric care, including outreach to decision makers in the public and private sectors. The Council has provided guidance on the APA’s response to the Administration on health reform, quality and payment reform, parity, alternative payment methods, and scope of practice, while continuing to review and revise, as appropriate, existing APA policies and address concerns raised through the APA Assembly action paper process.

More recently, the Council has been closely monitoring the potential impact of health care mergers (like CVS and Aetna) on psychiatry, parity implementation at the state level and the Trump Administration’s efforts to address the opioid crisis, rising drug costs, and provider burdens. The Council has provided guidance on the association’s response to policy proposals, such as the Patients Over Paperwork initiative and CMS’s Two-Midnight Rule. The Council has also weighed in on APA’s joint statements with other physician partners on the Administration’s actions regarding insurance market stabilization and the announcement allowing states to tie Medicaid eligibility to work requirements through Section 1115 Demonstration Waivers.

The Council has also created a Level of Care Work Group, including members from the Council on Research and the Council on Quality Care. The work group has been tasked with evaluating the advantages and disadvantages of APA developing its own level of care tool. The group will begin by analyzing existing tools and assessing the logistics and costs associated with creating a useful and efficient tool. At the end of its analysis, the group will make a recommendation to the association on whether or not to move forward with the development of an APA-owned tool.

Committee on Integrated Care (Ken Hopper, M.D., Chair)

The Committee on Integrated Care is charged with advising and supporting APA on policy development and educational efforts—such as developing resource documents, tool kits, and advocacy materials—to improve access to psychiatric care through improved care coordination and effective integrated care models. This includes identifying financing mechanisms and other ways to advance the use of promising, innovative models of care used to effectively integrate behavioral health care, including mental illness and substance use disorders, with general medical care and other services needed to meet the whole health needs of patients. The Committee released a white paper, “Psychiatry’s Role in Improving the Physical Health of Patients with Serious Mental Illness.” The paper was presented to Congressional staff at an APA briefing and paper’s recommendations were highlighted in APA’s comments to the Interdepartmental Serious Mental Illness Coordinating Committee. Members are working with the Department of Research on a project using Medicare data to map mortality rates of individuals with serious mental illness by county. The Committee is also working to finalize a best practice guide for psychiatrists who provide cross-state consultations.

Committee on RBRVS, Codes and Reimbursement (Gregory Harris, M.D., M.P.H., Chair)

Members of the Committee on RBRVS, Codes and Reimbursements continued their advocacy efforts with the AMA CPT Editorial Panel and AMA RUC and private payers to ensure that CPT codes are appropriately defined and properly valued. They maintained their focus on educational outreach, which includes holding a well-attended CPT coding and documentation workshop at each APA Annual Meeting and updating online content on new coding options as well as changes in documentation requirements. The Committee members continued to provide one-on-one assistance to APA members on coding and documentation through the APA’s CPT Coding Network, which is maintained through the Practice Management HelpLine.

Committee on Reimbursement (Laurence Miller, M.D., Chair)

The Committee on Reimbursement continues to compile a list models of care for which alternative payment models may be appropriate. Ongoing review of the models will occur to determine which, if any, are appropriate for psychiatry. Members of the Committee are engaged with other stakeholders to consider payment options for services provided to patients experience their first episode of psychosis. The Committee, along with members of the Council, continues to review and comment on several regulatory proposals and requests for comment regarding the development of alternative payment models for behavioral health.

Committee on Telepsychiatry (Jay Shore, M.D., M.P.H., Chair)

The Committee on Telepsychiatry recently released its “Best Practices in Videoconferencing-Based Telemental Health,” a consolidated and update guide for doing telemental health. This resource was a joint effort between the APA and the American Telemedicine Association. The Committee provided a 3.5-hour workshop on the guide at the APA Annual Meeting. The guide has been widely disseminated to SAMHSA, the ONC, CMS, and APA’s district branches and area councils and was presented to the Mental Health Liaison Group on Capitol Hill. The guide will also be published in The Journal of Telemedicine and eHealth. The Committee will also be updating its Telepsychiatry Blog to include video log, or “vlog” content, featuring videos that demonstrate the use of telepsychiatry technology. For its 2018–2019 term advocacy priorities, the Committee will be focusing on reimbursement issues around telepsychiatry at both the state and federal levels, including parity between private payers and Medicaid; advancing asynchronous telepsychiatry reimbursement in Medicaid; and CPT issues. The Committee is exploring ways to partner more often with the ATA, particularly around education initiatives for both organizations. Finally, in May, the APA submitted a letter to the DEA, requesting a meeting to discuss the special registration for telemedicine process under the Ryan Haight Act. The ATA was a partner in this endeavor, and other organizations also signed-on, including the American Academy of Addiction Psychiatry, Mental Health America, National Alliance on Mental Illness, and the National Rural Health Association.

The Council on International Psychiatry

Bernardo Ng, M.D., Chairperson

Uyen-Khanh Quang-Dang, M.D., Vice Chairperson

The Council on International Psychiatry (Council) is focused on supporting bilateral education and development between psychiatrists around the world through opportunities for engagement focused on increasing international exchange, utilizing, in part, the network of the Caucus on Global Mental Health and Psychiatry (Caucus). The Council also supports the development of policy, education, and membership initiatives and recognizes organizations supporting the human rights of populations with mental health needs through the Chester M. Pierce Human Rights Award Nominating Committee (Committee). The Chair and the Vice Chair of the Council are Bernardo Ng, M.D. and Uyen-Khanh Quang-Dang, the Chair of the Committee is James Griffith, M.D., and the Chair of the Caucus is Gabriel Ivbijaro, M.D.

Education and Professional Development

Scientific program.

Council and Caucus members continue to identify and support opportunities for the development of quality abstracts on global mental health and international topics for presentation at the APA Annual Meeting and other international psychiatric meetings. The following is a selection of sessions presented at the 2018 APA Annual Meeting by Council and Caucus members: Cooperation Between American Psychiatrists and Colleagues in Developing and Emerging Countries; Cultural Issues of Suicide, Sociopathy, and Opioids: An International Latino Perspective; Emerging Ethical Considerations in a Globalized Psychiatry; Innovative Quality Improvement Initiatives: International Perspectives; Global Mental Health Research and the Fogarty International Center’s 50th Anniversary; Promoting Sustainable Mental Health Systems After Humanitarian Disasters: “Building Back Better” Strategies in Global Mental Health. In addition to these sessions, the topic tracks “Global, Political, and Social Issues” and “International Collaborations” reflect the breadth of issues on global mental health topics the Council and Caucus continue to monitor, including sessions on the topics of human rights, human trafficking, and refugee mental health presented at the 2018 APA Annual Meeting. Council and Caucus members are in the process of developing and submitting abstracts for the 2018 World Psychiatric Association World Congress in Mexico City, Mexico, September 27–30, 2018 and the 2019 APA Annual Meeting in San Francisco, California, May 18–22, 2019.

International presenter development.

In coordination with the APA Scientific Programs Committee and the APA Division of Education, the Council manages the International Poster Engagement Program to connect with international poster presenters at the APA Annual Meeting. The Council established a work group, led by Uyen-Khanh Quang-Dang, M.D., to manage the program for the 2018 APA Annual Meeting. The following eleven individuals are the 2018 International Poster Engagement Program participants: Reinhard Dolp (Canada), Edith Serfaty (Argentina), Juan Cano (Colombia), Weeranee Charoenwongsak (Thailand), Han Yang Khiew (Singapore), Sergio D. Apfelbaum (Argentina), Nicolaas Bouman (Netherlands), Raul Ricardo Quiroga (Spain), Penchaya Atiwannapat (Thailand), Ana Paula Souto Melo (Brazil), and Jaime Valero (Colombia). Identified reviewers were paired with participants to meet in-person during the 2018 APA Annual Meeting. Reviewers and participants engaged in dialogue and shared opportunities for participants to connect with APA through member activities and benefits. Reviewers also provided feedback regarding the participants’ research posters on format and layout, language and terminology, method and analysis, and presentation and communication, upon request by participants. The overall feedback from participants of the 2018 International Poster Engagement Program was positive, with participants expressing great appreciation for the opportunity to engage with APA members and to also receive feedback on their research posters. The Council continues to identify opportunities for greater engagement with international presenters.

International medical graduate psychiatrists.

The Council continues to discuss opportunities for collaboration with the APA International Medical Graduate (IMG) Psychiatrists Caucus. The Council met with the IMG Caucus President, Raj Tampi, M.D., during the 2018 APA Annual Meeting who provided an overview of Caucus activities, noting several areas where the Council and Caucus could collaborate, including addressing challenges faced by IMG psychiatrists trying to enter residency training programs, continued professional development and skill building, fostering growth of resident and midcareer members in the IMG Caucus, and other issues and challenges faced by IMGs. The Council and the IMG Caucus will continue to discuss intersecting opportunities for collaboration.

Global mental health model curriculum.

The Council established a work group to discuss the development of a model global mental health curriculum to serve as a “roadmap” for U.S. residency training programs. The work group is expected to review existing curriculums and address relevant and important areas of training and guidance.

Membership Development and Engagement

Global mental health caucus.

Caucus membership has increased to over 800 APA members, established with only 50 members in 2014, which may reflect the growing interest in the area of global mental health and the benefit of the Caucus and its activities to APA members. Under the leadership of the former Caucus Chair, Khurshid Khurshid, M.D., the Caucus established an executive committee structure comprised of candidates not elected to the Caucus Chair position in the previous election. This included Richa Bhatia, M.D. and Gabriel Ivbijaro, M.D. who facilitated the coordination of submissions for the 2018 APA Annual Meeting and provided guidance and mentorship to Caucus members interested in submitting. During the 2018 APA Annual Meeting, the Caucus established connections with the American Association of Directors of Residency Training (AADPRT) Caucus on Global Psychiatry, the National Institute of Mental Health (NIMH), and the World Psychiatric Association. The Caucus conducted an election for the 2018–2019 Caucus Chair position. The following four candidates were nominated: Richa Bhatia, M.D., Josepha Immanuel, M.D., Gabriel Ivbijaro, M.D., and Nubia Lluberes, M.D. Dr. Ivbijaro received the majority of votes to become the 2018–2019 Caucus Chair.

International distinguished fellows.

Council and Caucus members were involved in the 2018 nomination of APA International Distinguished Fellows. The APA Board of Trustees approved the following APA international members: Maria Diaz (Argentina), Andres Mega (Argentina), Ahmed Mubarak (Egypt), M.S.V.K. Raju (India), Silvana Galderisi (Italy), David Ndetei (Kenya), Iuliana Dobrescu (Romania), Tae-Youn Jun (South Korea), and Julian Beezhold (United Kingdom).

Policy Development and Recognition

Chester M. Pierce Human Rights Award.

The 2018 APA Chester M. Pierce Human Rights Award was presented to the Validity Foundation during the 2018 APA Annual Meeting. The Validity Foundation, formerly the Mental Disability Advocacy Center, is an international nongovernmental organization which uses the law to advance the human rights of people with mental health issues and people with intellectual disabilities worldwide. Validity has been at the forefront of using strategic litigation to promote equality, inclusion and justice and its achievements include framing guardianship as a human rights issue, tackling long-term institutionalization, and exposing abusive practices. Validity campaigns for reform of outdated legal systems in sub-Saharan Africa and regularly provides expertise at the United Nations Committee on the Rights of Persons with Disabilities and other international forums. To learn more about the Validity Foundation, visit their website at validity.ngo.

Human rights.

The APA Board of Trustees approved the updated APA Position Statement on Human Rights submitted by the Council which consolidated the 1992 Position Statement on Human Rights with the 2008 Position Statement on Denial of Human Rights Abuses (see position statement below):

The American Psychiatric Association (APA) recognizes that human rights abuses, such as, unjust incarceration, cruel and unusual punishment, torture, the misuse of involuntary psychiatric confinement for political purposes, the denial of access to care, and human trafficking, have adverse psychiatric consequences on victims of such abuses and their families. The denial or cover-up of well-documented human rights abuses by governments and institutions is antithetical to a humane society and the ability to attend properly to the psychiatric needs of those who have been subject to such abuse. APA supports working with agencies and organizations dedicated to advancing human rights and fighting human rights abuses.

The Council also supported the development and establishment of the Position Statement Health Care, Including Mental Health Care, is a Human Right.

Abuse and misuse of psychiatry.

The Council established a work group to review and consolidate the 1998 Position Statement on Identification of Abuse and Misuse of Psychiatry with the 2007 Position Statement on Abuse and Misuse of Psychiatry with feedback and guidance from the APA Joint Reference Committee and the APA Board of Trustees.

Immigrant mental health.

The Council established a work group to review a proposal for a position statement, submitted by APA members Jennifer Severe, M.D., Ralph De Simlien, M.D., and Josepha Immanuel, M.D., focused on the mental health of foreign nationals on TPS (Temporary Protected Status). The work group is connecting with the expertise of the Council on Psychiatry and Law and the Council on Minority Mental Health and Health Disparities. The Council also supported the development of the Position Statement on Mental Health Needs of Undocumented Immigrants, including Childhood Arrivals, Asylum Seekers, and Detainees, in coordination with the Council on Minority Mental Health and Health Disparities.

Council on Medical Education and Lifelong Learning

Mark Hyman Rapaport, M.D., Chairperson

The Council on Medical Education and Lifelong Learning monitors emerging issues in psychiatry education and facilitates the development of resources and programs. The purview of the Council includes medical education, graduate medical education for residents and fellows in psychiatry (both basic education and subspecialty areas), psychiatric aspects of graduate medical education for other medical specialists, and postgraduate continuing medical education and lifelong learning. The Council acts in an advisory role to the APA Division of Education in the development of its continuing education programs and initiatives. To facilitate collaboration and communication, the Council serves as a convening body for the allied psychiatry education organizations, including the American Association of Directors of Residency Training, the Association of Directors of Medical Student Education in Psychiatry, the Association of Academic Psychiatrists, the American Board of Psychiatry and Neurology, and the American Association of Chairs of Departments of Psychiatry.

The Council values the highest standards of clinical practice and lifelong professional development. As psychiatric educators, the Council on Medical Education and Lifelong Learning believes that the APA has an obligation to support the lifelong learning of its members. The Council’s major initiatives and activities are as listed below.

Graduate Education

The Council drafted feedback, in support of broader diversity and inclusiveness within medicine and medical leadership, to the Accreditation Council for Graduate Medical Education (ACGME) regarding proposed revisions to common program requirements. The 2018 ACGME revision of its Institutional Requirements ACGME includes new language:

The program, in partnership with its Sponsoring Institution, must engage in practices that focus on mission-driven, ongoing, systematic recruitment and retention of a diverse and inclusive workforce of residents, fellows (if present), faculty members, senior administrative staff members, and other relevant members of its academic community.

In cooperation with the American Association of Chairs of Departments of Psychiatry (AACDP) and the American Association of Directors of Psychiatry Residency Training (AADPRT), the Council and APA drafted comments to encourage the ACGME to limit the scope of responsibility of program directors and program evaluation committees to issues regarding the well-being, education, and scholarly activity of trainees.

The Council encouraged expanding access to psychiatry subspecialty fellowships. The Council monitored newer policies of ACGME and ABPN that expand access to subspecialty fellowships to AOA, ACGME-I, RCPSC, or CFPC trained physicians and exceptionally qualified international graduate applicants who do not satisfy the eligibility requirements listed but meet specific listed exception requirements. The new ACGME common requirements for fellowship programs went into effect in summer 2018.

Physician Well-Being

The Council proposed the formation of a Committee on Wellness and Burnout, under the Council on Medical Education and Lifelong Learning, as a permanent home for the wellness efforts that were undertaken by the 2017 Well-being and Burnout Workgroup. In October 2017, the workgroup launched a website (https://psychiatry.org/wellbeing) that includes an online self-assessment tool and well-being resources.

Maintenance of Certification (MOC)

The Council stays up-to-date regarding MOC requirements and considers the interests of APA members and the field. The American Board of Medical Specialties (ABMS), the oversight group for common elements of MOC, has formed a commission to review continued certification. ABMS is gathering input from stakeholders about what MOC should encompass going forward.

The American Board of Psychiatry and Neurology reported to the Council on its 2019 Pilot Project for MOC Part III (the recertification examination). The pilot will focus on open-book, take-home tests based on selected articles in the literature. Participants will answer questions on at least 30 papers over 3 years in order to be waived from taking the MOC examination.

The APA member Caucus on Maintenance of Certification is chaired by Ranga Ram, M.D. The Caucus works with the Council, the Assembly, the Assembly Committee on MOC, and the BOT to communicate on an ongoing basis about relevant issues faced by psychiatrists in the certification process. The caucus met during the 2018 APA Annual Meeting.

Position Statement and Assembly Action Referrals

The Council reviewed and recommended the retention of three position statements related to education: Consistent Treatment of all Applicants for State Medical Licensure; Residency Training Needs in Addiction Psychiatry for the General Psychiatrist; and Neuroscience Training in Psychiatry Residency Training.

The Council on Medical Education and Lifelong Learning reviewed actions of the Assembly related to education and provided feedback.

Recognition of Psychiatric Expertise: Efficiency and Sufficiency

The AMA has an existing policy that states that MOC should not be a requirement for maintenance of licensure, hospital privileges, insurance credentialing, or employment. APA has been supportive of this policy. The Interstate Medical Licensure Compact has already released its eligibility requirements (http://www.imlcc.org/do-i-qualify/), which require individuals to “hold a current specialty certification or time-unlimited certification by an ABMS or AOABOS board.”

The Council weighed in and supported: Designation of psychiatry as primary care for any medical school scholarships requiring primary care service and medical school loan repayment subsidies for psychiatrists practicing in community mental health centers and state psychiatric facilities.

Update on Projects of the Council

The Council continues to be involved in several projects. The Council is developing a survey regarding current feedback process in training: Survey on Teaching and Receiving Feedback. The Council is also involved with the Personal Learning Project Tool, a CME module for independent study on a problem in clinical practice.

The Council is looking at a project of resource sharing of creation of new residency programs.

Joint Sponsorship of CME Credit for District Branches and Allied Associate Groups

With input from the Council on Medical Education and Lifelong Learning, APA expanded its Joint Sponsorship program to 30 district branches and new allied associates, the American Society of Hispanic Psychiatry and the Mexican Psychiatric Association, AADPRT, and ADMSEP. Goals of the joint sponsorship program include strengthening allied relationships and expanded business opportunities, furthering educational goals, enhancing the APA learning management system, and bringing in new learners.

Education Awards

The Council initiates nominations for APAs education awards, the Nancy C.A. Roeske, M.D., Certificate of Excellence in Medical Student Education, Irma Bland Award for Excellence in Teaching Residents, and the Vestermark Psychiatry Educator Award recognizing excellence, leadership, and creativity in the field of psychiatric education. The 2018 Vestermark award recipient is Nyapati R. Rao, M.D.

The Council on Minority Mental Health and Health Disparities

Christina Mangurian, M.D., M.A.S., Chairperson

The Council on Minority Mental Health and Health Disparities (CMMH/HD) advocates for minority and underserved populations and psychiatrists who are underrepresented within the profession and APA. CMMH/HD seeks to reduce mental health disparities in clinical services and research, which disproportionately affect women and minority populations. CMMH/HD aims to promote the recruitment and development of psychiatrists from minority and underrepresented (M/UR) groups both within the profession and APA.

APA 2018 Annual Meeting

Scientific Sessions: Members of the CMMH/HD presented 13 scientific sessions at the APA 2018 Annual Meeting in New York in May. Sessions included: “Promoting Well-Being of African Americans: Tools to Treat Mental Health Needs and Promote Well-Being During the Current Political and Social Climate” (featuring fellow Carine Nzodom, M.D.); “Parental Leave: Luxury or Necessity?” (presented by Chair Christina Mangurian, M.D., MAS and fellow Carine Nzodom, M.D.); “Promoting Well-Being Among Women in the Current Political and Social Environment” (presented by Chair Christina Mangurian, M.D., M.A.S., and fellow Louisa Olushoga, M.D.); “Women of Color and Intersectionality” (presented by Vice Chair Helena Hansen, M.D., Ph.D.); and “Advances in Transgender Mental Health” (presented by Vice Chair Eric Yarbrough, M.D.).

M/UR Award Lectures Series: Seven award lectures were under the purview of the Council. These included:

• Simon Bolivar Award Lecture, presented by Juan Bustillo, M.D., on “How Is the Schizophrenia Brain Changing: Was Kraepelin Right?”

• John Fryer Award Lecture, presented by Jack Drescher, M.D., on “Dr. H. Anonymous and the Legacy of John E. Fryer, M.D.”

• George Tarjan Award Lecture, presented by Fructuoso Irigoyen-Rascon, M.D., P.A., on “Don Quixote and the IMG: A Mind State”

• The Kun-Po Soo Award Lecture given by Devon E. Hinton, MD, PhD, on “Trauma, Culture, and Complex PTSD: Cambodian Genocide Survivors”

• Alexandra Symonds Award Lecture, presented by Leslie Hartley Gise, M.D., on “We’ve Come a Part Way, Baby”

• Solomon Carter Fuller Award Lecture, presented by Patricia Newton, M.P.H., M.A., M.D., on “Mental Health Challenges Facing Patients and Providers of African Descent”

• Oskar Pfister Award Lecture, presented by John Swinton, Ph.D., on “A Matter of Faith? The Role of Faith in the Experiences of Christians Living with Severe Mental Health Challenges”

Conversations on Diversity: APA’s Division of Diversity and Health Equity (DDHE) sponsored Conversations on Diversity which included participants from CMMH/HD, M/UR Caucuses, and APA leadership. Vice Chair Eric Yarbrough, M.D., and Ruth Shim, MD, MPH, served facilitators. “Conversations” allows members to strategize ways to increase diversity and inclusion within APA. A total of 75 people attended. Strategies developed by Conversations participants will be prioritize at the CMMH/HD and M/UR Committee Joint Meeting during September Components.

2017–2018 Council Initiatives and Accomplishments

Joint Meeting of the CMMH/HD and M/UR Caucus Representatives: CMMH/HD sponsored a joint meeting with M/UR Caucus leadership (representatives) at September Components to strategize ways to enhance diversity and inclusion within APA and health equity among all patient populations. The meeting was held to attain the following goals:

• Prioritization of recommendations from the 2017 Diversity on Conversation to increase diversity and inclusion within APA

• Advance the development process of the “APA Toolkit on Stress and Trauma related to the Political and Social Environment”

• Create an action plan with specific, pragmatic, and feasible steps for increasing APA membership of M/UR population

• Discuss ideas for submitting workshops or symposium co-sponsored by the CMMH/HD and Caucus during APA Annual Meeting and IPS Meetings

Positions Statements

Multiple Positions Statements were developed or recommended for revision or retirement by the CMMH/HD.

Revised Position Statements:

• “Abortion”: CMMH/HD revised APA’s 1978 Position Statement on “Abortion” at the request of APA Board of Trustees (BOT). The workgroup included members of CMMH/HD, APA’s Caucus of Women Psychiatrists and APA Administration.

• “Access to Care for Transgender and Gender Diverse Individuals”: CMMH/HD approved the revised the 2012 Position Statement on “Access to Care for Transgender and Gender Diverse Individuals” in accordance with APA’s 5-year review cycle.

• “Discrimination Against Transgender and Gender Diverse Individuals”: CMMH/HD approved the revised 2012 Position Statements on “Discrimination Against Transgender and Gender Diverse Individuals” in accordance with APA’s 5-year review cycle.

New Position Statements:

• “Mental Health Needs of Undocumented Immigrants, including Childhood Arrivals, Asylum-Seekers, and Detainees”: CMMH/HD drafted a new Position Statement to address challenges related to the Deferred Action for Childhood Arrivals (DACA). The new statement— “Mental Health Needs of Undocumented Immigrants, including Childhood Arrivals, Asylum-Seekers, and Detainees”—incorporates content from the existing 2013 Position Statement on “Detained Immigrants with Mental Illness” and includes additional resources that address the current political and social climate.

• “Equitable Treatment of Substance Use Disorders Across Racial Lines”: CMMH/HD formed a workgroup to draft a new Position Statement on “Equitable treatment of substance use disorders across racial lines.” The statement was inspired by CMMH/HD members who noticed that APA did not have a formal stance on this issue, which has affected the mental health of many ethnic/racial minorities.

• “Discrimination of Religious Minorities”: CMMH/HD retired the 1997 Position Statement on “Religious Discrimination, Persecution, and Genocide” and separated into two new Position Statements as requested by the JRC. Accordingly, a new Position Statement on the “Discrimination of Religious Minorities” emerged.

• “Conversion Therapy and LGBTQ Patients”: The Position Statement on “Conversion Therapy and LGBTQ Patients” is an update and a replacement of the Position Statement on “Therapies Focused on Attempts to Change Sexual Orientation” (2000). With current legislation around conversion therapy, it is important that APA reaffirm its stance against conversion therapy and comment on gender diverse individuals as well. The new Position Statement considers all gender identities and sexual orientations and encourages psychiatrists to affirm these individuals rather than pathologize them.

• “Resolution Against Racism and Racial Discrimination and Their Adverse Impacts on Mental Health”: CMMH/HD revised and approved the 2006 Position Statement on “Resolution Against Racism and Racial Discrimination and Their Adverse Impacts on Mental Health” as requested the BOT.

• "Police Brutality and Black Males”: A workgroup composed of CMMH/HD members drafted a new Position Statement and incorporated feedback provided by members of the JRC, Caucus of Black Psychiatrists, and the Council on Psychiatry and the Law.

• “Mental Health Equity and the Social and Structural Determinants of Mental Health”: A workgroup led by CMMH/HD members developed the Position Statement and revised and incorporated feedback provided by members of the JRC.

• “Human Trafficking”: A workgroup led by CMMH/HD members developed the Position Statement and incorporated feedback as requested by members of the JRC.

Retired Position Statements:

• “Religious Persecution and Genocide”: CMMH/HD retired 1997 Position Statement on “Religious Discrimination, Persecution, and Genocide” and separated it into two Position Statements as requested by the JRC. Accordingly, a revised Position Statement on Religious Persecution and Genocide materialized.

• “Detained Immigrants with Mental Illness”: CMMH/HD recommended that the 2013 Position Statement on “Detained Immigrants with Mental Illness” be retired. A newly drafted Position Statement— “Mental Health Needs of Undocumented Immigrants, including Childhood Arrivals, Asylum-Seekers, and Detainees”—incorporates content from “Detained Immigrants with Mental Illness” and includes additional resources that address the current political and social climate.

• “Therapies Focused on Attempts to Change Sexual Orientation”: CMMH/HD recommended that the 2000 Position Statement “Therapies Focused on Attempts to Change Sexual Orientation” be replaced by the new Position Statement on “Conversion Therapy and LGBTQ Patients.”

APA Toolkit: Stress and Trauma Related to the Political and Social Environment

CMMH/HD, Division of Diversity and Health Equity (DDHE), Division of Communications, in collaboration with the Office of the Medical Director, is organizing a toolkit about stress and trauma related to the current state of the political and social environment in the U.S. The toolkit aligns with CMMH/HD’s mission of creating resources that focus on diversity and inclusion. Several workgroups, consisting of members from M/UR Caucuses and CMMH/HD, were formed to develop this resource. Final drafts were submitted to DDHE who will work with Communications on language and have versions vetted by experts in treating minority populations. DDHE leadership anticipates content completion by the end of Q3 2018.

Workgroup Discussions

Workgroups have been formed to help the CMMH/HD progress with its effort to provide support to M/UR psychiatrists, the communities they serve, and general APA membership. Workgroups are organized around the following topics:

• Efforts to increase M/UR membership

• Community-based work and reducing stigma

• History and intergenerational relationships

Accreditation Council for Graduate Medical Education (ACGME)

APA—via CMMH/HD—communicated to the ACGME its support for development of an ACGME accreditation standard for the Common Program Requirements that would require residency training programs to include a component of diversity, inclusion, and health equity. The requirement approved by ACGME June 29, and reads “The program, in partnership with its Sponsoring Institution, must engage in practices that focus on mission-driven, ongoing, systematic recruitment and retention of a diverse and inclusive workforce of residents, fellows (if present), faculty members, senior administrative staff members, and other relevant members of its academic community.”

APA Comments on Proposed Conscience Rights Rule

CMMH/HD members provided comments on the Department of Health and Human Service’s proposed Religious Freedom Rule as requested by APA’s Department of Practice Management and Delivery Systems Policy.

New Arrivals and Farewells

The following new members were welcomed to the CMMH/HD in June: Farha Abbasi, M.D., Samina Aziz, M.D., Morgan Medlock, M.D., Barbara Robles-Ramamurthy, M.D., and Laura Willing, M.D.

CMMH/HD bade farewell and thanked to Felix Torres, M.D., Debbie Carter, M.D., Francis Sanchez, M.D., Amanda Ruiz, M.D., Ijeoma Chuwu, M.D., and Sidney Hankerson, M.D. They also thank all departing APA/APAF Fellows.

The Council on Psychiatry and the Law

Debra A. Pinals, M.D., Chairperson

The Council on Psychiatry and the Law is responsible for evaluating legal developments of national significance that affect the practice of psychiatry and the availability and quality of mental health care, including case law, legislation, regulation, and all other forms of legal regulation of psychiatric practice. It includes a focus on practice areas including correctional psychiatry and the subspecialty of forensic psychiatry. In the past year, the Council has worked on a wide variety of issues. This report highlights some of the topics covered between 2017 and 2018.

Weapons Use in Hospitals and Patient Safety

The Joint Commission issued a report in 2010 highlighting concerns that armed violence has increased in the clinical and public spaces of hospitals, and subsequent studies have shown that the circumstances of most cases raised questions about hospital policy and practice regarding the use of weapons in clinical settings. With these reports, members of the Council on Psychiatry and the Law determined that guidance on the topic would be useful, as the use of weapons in hospitals warrants particular scrutiny and demands specific safeguards. In 2016, the Council formed a workgroup to consider this issue. The workgroup produced a position statement that discourages the use of weapons as a clinical response in the management of patient behavioral dyscontrol in emergency room and inpatient settings because such use conflicts with the therapeutic mission of hospitals. Recommended steps include minimizing the unauthorized presence of weapons on their premises, using clinical approaches to address the needs of patients who pose a risk of harm to others, and prohibiting the use of weapons as a clinical response by clinical or security staff as a means of managing a situation. There is also a recommendation for consideration of policy development to determine when situations warrant a law enforcement response. The statement has been approved by the APA Assembly and Board of Trustees and will soon be made available on the APA website.

Juvenile Solitary Confinement

In 2017, the APA Assembly requested that the APA adopt the American Medical Association’s position on solitary confinement of juveniles (also referred to as restrictive housing or segregation). The Council formed a workgroup to consider the issue, which included representatives from the Council on Children, Adolescents, and their Families, Council on Mental Health and Health Disparities, and the Ethics Committee. The workgroup produced a position statement that discourages solitary confinement of juveniles due to potential for psychiatric harm. In the rare case that a juvenile must be placed in solitary confinement, meaningful access to mental health care, medical care, education, and recreation should be provided in order to minimize the potential for psychological harm. The statement has been approved by the APA Assembly and Board of Trustees and will soon be made available on the APA website.

Restricting Firearms Access During a Crisis

In 2014, the APA published a “Resource Document on Access to Firearms by People with Mental Disorders,” which addressed the complex relationship between firearms, mental illness, suicide, and violence. Since then, the national dialogue on gun violence has progressed, including further consideration of risk-based firearm restriction as a strategy that allows intervention under any high risk circumstance, whether mental illness is a factor or not. Following its meeting in September 2016, the Council formed a workgroup to develop a resource document that summarizes the growing body of research surrounding risk-based firearm removal laws. The resource document was approved by the APA Joint Reference Committee in June 2018 and is available on the APA website.

Committee on Judicial Action (Marvin Swartz, M.D., Chairperson)

The Committee on Judicial Action, chaired by Dr. Marvin Swartz, is a component of the Council that considers and recommends APA involvement as a friend of the court in cases at every level of the judicial system and covering a range of issues. This year, APA, with other related organizations, authored an amicus brief to the U.S. Court of Appeals for the Third Circuit in the case of Doe v. Boyertown, considering bathroom and locker room access for transgender students. Similarly, APA coauthored an amicus brief to the U.S. Court of Appeals for the Second Circuit in the case of Charles v. County of Orange, addressing the standards for assessing intellectual disability and the duty of correctional facilities to provide discharge planning. APA then participated in a petition for certiorari to the U.S. Supreme Court in the case of Dassey v. Dittman, concerning the standard of voluntariness of a confession made by a juvenile with cognitive limitations. Most recently, APA also joined the American Psychological Association in a brief to the U.S. Supreme Court in the case of Madison v. Alabama, which involves the death penalty and the effect of dementia and other manifestations of mental health issues on the legality of execution of an individual.

Council on Quality Care

Grayson Norquist, M.D., M.S.P.H., Chair

Melissa Arbuckle, M.D., Ph.D., Vice-Chair

The Council on Quality Care monitors developments and carries out activities to ensure the highest standards of care remain an integral part of APA’s mission. This includes, but is not limited to, participating in initiatives and disseminating information in the following areas: clinical practice guidelines; quality and performance indicators; implementation of patient registries; standards and survey procedures; mental health information technology; psychotherapy; and patient safety. The Council collaborates with other groups within APA’s governance structure to respond to topics of mutual concern, such as patient outcome measures and the effects of quality improvement efforts on patient populations and clinical practice.

Committee on Practice Guidelines

The Committee on Practice Guidelines continues to focus on developing evidence-based practice guidelines to assist psychiatrists and others with clinical decision-making. The newest guideline, Practice Guideline for the Pharmacological Treatment of Patients with Alcohol Use Disorder, was published in January 2018, along with an Executive Summary in the January 2018 American Journal of Psychiatry; an online CME vignette; family/care provider information; and provider summary/teaching slides. This and other guidelines are available for free on Psychiatry Online: http://psychiatryonline.org/guidelines.

There are currently three assembled Guideline Writing Groups. The first writing group, chaired by Dr. Victor Reus, which produced the last two approved guidelines, will soon begin work on a guideline for the treatment of bipolar disorder based on an Agency for Healthcare Research and Quality (AHRQ) systematic review, along with supplemental reviews and an expert survey. A second writing group, chaired by Dr. Catherine Crone, will begin work on a guideline for the treatment of eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, night eating syndrome) based on AHRQ systematic reviews, as well as additional updated reviews and an expert survey. A third writing group, chaired by Dr. George Keepers, is currently working on a guideline for treatment of people with schizophrenia, including psychopharmacological and psychotherapeutic treatments. This guideline is based on an AHRQ systematic review plus additional published meta-analyses.

The APA contracted recently with Doctor Evidence, a systematic review company, in an effort to obtain the results of literature reviews for the writing groups more rapidly than they had received them under reviews completed by organizations whose priorities and timelines did not often align with those of the APA. Collaborating with Doctor Evidence provides greater flexibility for determining topics, enables simultaneous development of guidelines, and aids in speedier completion. A demonstration of quicker guideline development will begin with preparations for the upcoming systematic review of treatments for borderline personality disorder, followed by a guideline for delirium and one for treatment of co-occurring anxiety symptoms.

Committee on Mental Health Information Technology

The Committee on Mental Health Information Technology (CMHIT) continues to work on several topics related to federal incentive programs (pay-for-performance or pay-for-reporting programs) and the development of member resources. The group recently provided feedback on the new Promoting Interoperability (formerly “Meaningful Use” and “Advancing Care Information”) category for the 2019 Fiscal Year Inpatient Prospective Payment System (IPPS) Proposed Rule, including provisions for inpatient psychiatric facilities. The Committee will also provide feedback on the Medicare Physician Fee Schedule and Quality Payment Program (QPP). Proposed changes to the QPP include updates to the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). The Committee also plans to comment on a proposed rule released by the Office of the National Coordinator for Health Information Technology (ONC) on interoperability and information blocking.

The group is currently developing a plan for working with membership and APA Administration to expand upon its current evaluation model and tool for mobile applications (apps). The impetus for this project originated from the Board of Trustees (BOT) Workgroup on Access and Innovation. The expansion is intended to provide a review of standards for apps that can be used by members to review current mental health apps. In addition, the Committee will offer feedback and recommendations on the FDA’s Software as a Medical Device (SaMD) Precertification Pilot Program. The intent is to offer guidance on the FDA’s proposed regulatory structure around mHealth and behavioral health apps used in clinical practice.

SAMHSA has invited the group to develop a webinar for SAMHSA about recent advances in behavioral health IT. The group expects to present ideas for the webinar to SAMHSA within the next quarter.

Finally, as recommended by the BOT Workgroup on Access and Innovation, CMHIT is developing patient-focused resources on behavioral health information technology. As part of this effort they will draft a series of articles for Psych News. The first article in the series will review the dos-and-don’ts for psychiatrists when using social media and engaging patients through this technology.

Committee on Quality and Performance Measurement

As a result of changes to the former Committee on Performance Measurement’s charge, the Committee on Quality and Performance Measurement (CQPM) was formed and first convened in May 2018. The new CQPM focuses on matters stemming from national shifts in health care payment reform, like the migration from volume-based health care payment models (e.g., fee-for-service and Physician Quality Reporting System, PQRS) to value-based payment models (e.g., Centers for Medicare and Medicaid’s (CMS) QPP).

Under MACRA, CMS streamlined and remodeled individual quality and efficiency pay-for-reporting programs (linked to the former Medicare Sustainable Growth Rate), like PQRS, the Electronic Health Records Incentive Program for Meaningful Use (MU), and the Value-Based Modifier (VBM). From these respective programs, CMS formed one arm of the QPP, MIPS. APMs is the second arm. Due to provisions of MACRA, private and public payers will need to reduce health care spending and pay health care providers based on their patients’ health outcomes. CMS will focus on both the quality of care delivered as well as the costs incurred to achieve the particular outcomes. This requires members of the CQPM to possess expertise in value-based payment programs and associated measures.

CQPM is responsible also for defining patient-centered meaningful quality measurement for psychiatrists. This includes prioritizing measurement topics and quality measures for development and implementation, as well as providing guidance on how to best educate members about these increasingly important topics.

The CQPM discussed APA collaborations with other entities such as the PCPI (formerly the AMA-Physician’s Consortium on Performance Improvement) and performed a comprehensive environmental scan of quality measurement in the behavioral health area. APA is working to define quality measures for the diagnosis and treatment of mental and substance use disorders. As the national health care system moves toward value-based payment, it will be critical for APA to be involved in defining these quality measures. Otherwise, crucial measures pertaining to psychiatry will be defined by payers or other provider groups. There are unique issues in the development of quality measures specific to psychiatric disorders that need to be incorporated in measures used to assess health care (e.g., care coordination, medication reconciliation).

The Committee developed a document entitled “Essential Domains of Quality Measurement” that was approved by the Council in September 2017. This document (originally referred to as the “Quality Measurement Gap Analysis”) is the first set of recommendations APA-convened technical expert panels will use when developing new, or updating existing, quality measures.

Reporting Workgroups and Other Work With Member-Experts

Several other workgroups report to the Council. The Patient Safety Workgroup focused this past year on a variety of safety issues such as patient observation and refinement of case studies for use in mock root-cause analyses for psychiatric training programs. The Standards and Survey Procedures Workgroup and other APA member-experts addressed policies related to institutional surveys, like ligature-point and other self-harm risk assessments. The Caucus on Psychotherapy continues to raise the profile of psychotherapy and psychosocial treatment in psychiatry and works to ensure skills in these treatment areas are part of the training and identity of psychiatrists.

Technical Advisors

The Council on Quality Care, with support from its component groups, participated in several internal and external expert panels this year. For example, the Council, including members from the CQPM, participated in strategic discussions on continued development and updates to APA’s mental health registry (PsychPRO). These APA experts advised the APA Registry Oversight Workgroup, on appropriate screening tools and quality measures to use in PsychPRO’s computer platform. The Council on Quality Care has been successful in achieving multiple appointments on external quality measurement panels and accrediting organizations’ decision-making bodies, like the American Academy of Neurology’s Mild-Cognitive Impairment Measure Development Workgroup, PCPI’s Preventive Care and Behavioral Health Measure Development Workgroups, and the Joint Commission’s Behavioral Health Advisory Committee. These multistakeholder panels are responsible for defining national quality measurement strategies, developing meaningful quality measurement tools, recommending appropriate use of quality measures and how institutions will be surveyed for behavioral health care. These appointments afford APA an authoritative voice in the national quality enterprise.

The Council on Research

Dwight L. Evans, M.D., Chairperson

Carolyn Rodriguez, M.D., Ph.D., Vice Chair

The Council on Research continues to help to ensure that research on mental health remains integral to the American Psychiatric Association’s (APA’s) mission and in the forefront of the national health agenda. The Council embodies APA’s commitment to advance psychiatric knowledge through the conduct of research by physician scientists across a broad range of research fields and issues: basic science, clinical diagnosis and assessment, treatment research, epidemiology, health services, computational psychiatry, prevention research, disaster psychiatry, and research training. These areas are represented by the committees, caucuses, and task forces under the Council’s jurisdiction. The following is a brief report of the May 2018 meeting of the Council on Research and its future plans.

APA Registry Discussion

The Council continues to help guide and support the refinement and scaling of APA’s Mental Health Registry, PsychPRO. PsychPRO reported MIPS data to the 2017 CMS program for 369 clinicians, which represented 61% of the clinicians who signed agreements to join the registry by December 15, 2017. Reporting was successful with most of the practices scoring over 70 of a total of 100 points. To date, 349 clinicians in 49 practices have their EHR systems integrated with the registry with ongoing data extraction and the ability to review their quality measures on their dashboards. PsychPRO staff continue to work with EHR vendors to onboard another 150+participants who are currently registered. Another 20% have no EHR, however several of these clinicians are taking advantage of PsychPRO portal and webtool with 20 successfully reporting to CMS MIPS program for 2017. New agreements since March 2018 total 30 practices, including a large health system in Maryland and several in Texas. PsychPRO participants are now in over 20 states, with the majority in Maryland, California and Pennsylvania.

The registry team submitted a grant proposal for quality measure development to CMS on June 5, 2018. PsychPRO’s designation as a QCDR allows for the development and testing of new quality measures that better reflect the value of mental health care delivered in a variety of settings.

For more information on how to join PsychPRO and to view our promotional video, please visit: www.psychiatry.org/PsychPRO.

Component Updates

Committee on Research Training: The Council’s Work Group on Research Training, chaired by Charles B. Nemeroff, M.D., Ph.D., met separately to discuss the outcome of the 2018 Research Colloquium for Junior Psychiatrist Investigators (Colloquium) and plans for the 2019 Colloquium. Steven Siegel, M.D., Ph.D., chair of the Department of Psychiatry at University of Southern California, was asked to co-chair the workgroup going forward. The Colloquium continues to be jointly funded by a National Institute on Drug Abuse (NIDA) R-13 grant, the APA Foundation (APAF), and through our partnership with the American College of Neuropsychopharmacology (ACNP) and the Society of Biological Psychiatry (SOBP).

The 2018 Colloquium was extended from one to two days and took place on Saturday, May 5, and Sunday, May 6. On day 1, representatives from APA/APAF, NIDA, ACNP, and SOBP presented on work-life balance, career trajectory, mentorship, research training, and funding opportunities to early-research career (ERC) psychiatrists.

On day 2, Colloquium awardees were divided into 2 Tracks: Track 1 included ERC psychiatrists in the beginning stage of developing area(s) of research interest and needed mentorship in doing. Track 2 included ERC psychiatrists who had identified one or more clear research areas of interest but needed mentorship in moving forward to develop a K-award project or finetuning their research portfolio. Participants were further divided into 5 different research areas (i.e., Alcohol, Pain, and Drug Abuse Research; Clinical Psychobiology; Health Disparities and Health Services Research; Molecular, Translational, and Neuroscience Research; Treatment from Psychopharmacology and Psychotherapy to Neural Strategies) for small group discussions with their team mentors.

A total of 49 senior psychiatric research mentors such as Drs. Wilson Compton, Cynthia Neill Epperson, John Krystal, Anand Kumar, James Potash, and Carolyn Rodriguez, from the Council on Research, took part in the Colloquium. Twelve biostatisticians/methodologists participated and provided valuable perspectives often unavailable to young researchers. The 2018 panel of statisticians/ methodologists originated from the APA (2), Columbia University (5), New York University (4), and Wayne State University (1). The Work Group hopes to continue its efforts to include a panel of statisticians/ methodologists to help senior psychiatric researchers in the mentorship of the Colloquium awardees.

Continued efforts to expand the Research Colloquium to include international ERC psychiatrists, led by Maria Oquendo, M.D., Ph.D., APA’s Past President, 2016–2017, and Bernardo Ng, M.D., chair of the Council on International Psychiatry, was successful, with 12 international mentees from the following countries: Argentina (1), Belgium (1), Brazil (1), France (2), Mexico (1), the Netherlands (1), Nigeria (2), Peru (2), and Switzerland (1). The mentees were selected and sponsored by their institution, country’s psychiatric association or branch of the SOBP, or were self-funded.

Currently, we are working with our ACNP partners to plan a half-day program at the ACNP Annual Meeting in December for the colloquium awardees to attend free of charge. Simultaneously, we are preparing for the new cycle of 2019 Research Colloquium applicants and will begin promoting this event in August 2018. Plans to continue the research mentoring experience for the Colloquium awardees, including quarterly post-Research Colloquium webinars and attendance at the ACNP and SOBP annual meetings, are currently underway.

Research Awards and Fellowships

The Award for Research, the highest award for research given by APA, was presented to Maria Oquendo, M.D., Ph.D., on May 8, 2018, during her award lecture, “Subtyping Suicidal Behavior: A Blueprint for the Development of Biomarkers.” In addition, the Judd Marmar Award, established in 1999 to honor an individual who has made a substantial contribution to advancing the biopsychosocial model of psychiatry, was presented to Alan F. Schatzberg, M.D., on May 7, 2018 during his award lecture on the search for developing a biopsychosocial perspective for psychiatry.

Several other prominent researchers were acknowledged for their outstanding contributions to psychiatry and psychiatric research during the 2018 Early Research Career (ERC) Breakfast: David A. Ross, M.D., Ph.D., Yale School of Medicine, received the 2018 APAF/ American Association of Chairs of Departments of Psychiatry Research Mentorship Award; Hilary P. Blumberg, M.D., Yale School of Medicine, was the recipient of the Blanche F. Ittleson Award for Research in Child and Adolescent Psychiatry; and the mentor-mentee team of L. Elliot Hong, M.D., and his trainee, Joshua J. Chiappelli, M.D., University of Maryland School of Medicine, received the Kempf Fund Award for Research Development in Psychobiological Psychiatry. During the ERC Breakfast, John Torous, M.D., a staff psychiatrist and PGY-7 fellow at Harvard Medical School, was acknowledged as the recipient of the APAF Psychiatric Research Fellowship.

Roberto Lewis-Fernandez, M.D., Columbia University, received the 2018 APA Health Services Research-Senior Scholar Award, and Sonya Gabrielian, M.D., M.P.H., University of California Los Angeles, received the 2018 APA Health Services Research-Early Career Award. Dr. Lewis-Fernandez will present his award lecture at the IPS: Mental Health Services Conference meeting in Chicago on October 6, 2018.

Committee on Psychiatric Dimensions of Disasters

The Committee on Psychiatric Dimensions of Disaster coordinated with the APA Communications Department to reach out to the district branches and state associations impacted by recent tragic events including, but not limited to, shootings in Florida, Texas, and Nevada, wildfires in California, and the areas impacted by the 2017 hurricane season. The newly appointed committee chair, Dr. Joshua Morganstein, M.D., was also present for the awarding of $30,000 to the American Red Cross (ARC) by the APA Foundation for disaster relief efforts in the United States and Puerto Rico. The funds will help support the ARC’s mental health volunteer program, made up of 3,500 licensed professionals, including psychiatrists, social workers, counselors, marriage and family therapists, psychiatric nurses, psychologists, school counselors, and school psychologists, all of whom are trained in disaster mental health interventions. Lastly, training programs specific to disaster psychiatry were conducted in early 2018, including an inaugural training course for Disaster Psychiatry Canada: Psychiatric Dimensions of Disasters and a course on disaster response at the APA Annual Meeting.

Diagnostic Biomarkers and Novel Treatment Workgroup

This Workgroup, chaired by Charles B. Nemeroff, M.D., Ph.D., generated several recent publications, including “A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders,” published in JAMA Psychiatry (April 2017) and “Clinical Implementation of Pharmacogenetic Decision Support Tools for Antidepressant Drug Prescribing,” published in the American Journal of Psychiatry (April 2018). The manuscript, “EEG Prediction of Treatment Response in Depressive Episodes”, had been reviewed and approved by the Joint Reference Committee (JRC) and the Board of Trustees (BOT) and is now in press in the American Journal of Psychiatry.

The Workgroup provided an overview of recent initiatives, including the examination of hormones in the treatment of depression, the use of psychedelics as therapeutic agents, and the role social media plays in clinical research. Draft manuscripts of these topics will be submitted for critique and approval by the Council on Research, JRC, and the BOT.

The Workgroup also successfully led the Presidential Symposium during the 2018 Annual Meeting that focuses on the state of biomarkers in psychiatry. Lastly, members expressed interest in studying the clinical utilities of biomarkers for Alzheimer’s Disease, early developmental markers of schizophrenia, biomarkers of autism spectrum disorder, and machine learning for psychiatrists.

DSM Steering Committee

Chair: Paul S. Appelbaum, M.D.; Vice-Chairs: Kenneth Kendler, M.D. and Ellen Liebenluft, M.D. The DSM-5 Steering Committee, its Subcommittee on Minor Changes, and its review committees continue to be active since the last report in the Fall of 2017. At the APA Annual Meeting in NYC, four proposals for minor corrections and clarifications were approved. Currently, there are three proposals for major revisions in various stages of the review process. Two proposals are under review by their relevant review committees: 1) the addition of a new disorder to the trauma- and stressor-related disorders, i.e., persistent grief disorder; and 2) changes to existing criteria set in the feeding and eating disorders, i.e., avoidant/restrictive food intake disorder. One proposal, text changes to the development and course of pedophilia, was approved by the Steering Committee for posting for public comment from July 16 to August 29, 2018. APA utilized a combination of communication strategies, i.e., posting on psychiatry.org, Psych News article, direct contact with relevant organizations, and social media (e.g., Facebook)—to alert the field and APA members to the public comment period. Lastly, a subcommittee comprising DSM Steering Committee members was formed to evaluate the need for developing potential criteria for placement of new diagnostic categories into Section III of DSM.

Information & Authors

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Published In

American Journal of Psychiatry

Volume 175 • Number 10 • October 01, 2018

Pages: 1028 - 1045

History

Published online: 1 October 2018

Published in print: October 01, 2018

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