APA Council Reports

As APA’s member-led advocacy body, CAGR has committed to a regular advocacy submission to Psych News, designed to inform readers about specific legislative issues or activity. Articles written by CAGR members have ranged from calls to action—Making Parity a Reality Requires Ongoing Advocacy, Vigilance (August 2019)—to raising awareness—Trump’s ‘Public Charge’ Rule Takes Effect; Discourages Use of Safety-Net Services (April 2020). The articles have been a resource for APA members to engage in informed discussions with their policymakers.

CAGR and the APAPAC Board established a joint workgroup to develop strategies to increase member participation in the Congressional Advocacy Network (CAN). Chaired by Dr. Mary Helen Davis and Dr. Brian Hart, the workgroup is developing recommendations for CAGR and the APAPAC Board in engaging APA members in personal advocacy, enhancing existing relationships, and developing new relationships with federal legislators. The workgroup has reviewed APA's advocacy programs and discussed the barriers to advocacy that many psychiatrists face; and has identified concrete steps that members can undertake to promote advocacy and developed recommendations for pursuing advocacy during the epidemic.

The Council established the District Branch Advocacy Collaboration Workgroup tasked with identifying new strategies for communications that can better engage district branches to enhance member involvement in advocacy and increase their collaboration with the APA in state and federal advocacy efforts. Chaired by Dr. Debra Koss, the workgroup will continue to identify metrics of success for these strategies.

Since March, Congress has passed, and the president has signed a series of four COVID-19 stimulus packages designed to bring support to our economy and public health systems. Each package included APA-supported provisions, including long-sought legislation to improve patient safety by modernizing patient privacy regulation, expanding access to telehealth services, funding mental health support services for healthcare workers, and creating the provider relief program. With each supplemental package, CAGR members jumped into action advocating for various provisions, including the continuation of telehealth and the appropriation of billions of dollars needed in emergency support to preserve access to mental health care during and after the pandemic.

During the fiscal year 2021 appropriation process, APA continued to advocate for adequate funding of APA’s priority mental health and substance use disorder programs, including programs housed within the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institutes of Health (NIH), the Centers for Disease Control and Prevention, and the Health Resources and Services Administration (HRSA). Among several other requests, APA sought increases in funding for programs including the Community Mental Health Services Block Grant with a newly proposed $35 million set-aside for crisis services, additional funds for the Minority Fellowship Program, and a sustained investment in the Loan Repayment Program for Substance Use Disorder Treatment Workforce program.

APA strongly supports increased implementation and enforcement of parity for mental health and substance use disorder treatment. APA endorsed parity legislation (H.R. 7539) was introduced by Reps. Kennedy (D-MA), Bilirakis (R-FL), Porter (D-CA), and Upton (R-MI) that would require the Labor department to conduct random audits of health plans to ensure compliance. In July, H.R. 7539 was favorably voted out of the full House Energy and Commerce Committee.

This year, APA faced a major scope of practice battle on the federal level with Congresswoman Judy Chu (D-CA) introducing H.R. 884, the Medicare Mental Health Access Act. The bill would expand the definition of a “physician” under the Medicare program to include clinical psychologists, which APA opposed. APA President Jeffrey Geller testified in opposition to H.R.884 before the House Energy and Commerce Health Subcommittee, and more than 3200 APA members wrote 5000 letters to their U.S. Representative to oppose the legislation, which was subsequently not called up for a Committee vote in July.

Amid the COVID-19 pandemic, there have been consistent reports of coronavirus-related discrimination against Asian Americans. Rep. Grace Meng (D-NY) and Sen. Kamala Harris (D-CA) introduced resolutions (H.R.908/S.580) that stipulate that Congress condemns all forms of racism and scapegoating, and calls on public officials to denounce any anti-Asian sentiment. APA supported both the House and Senate resolutions. Through a grassroots advocacy alert, CAGR and APA members sent more than 450 letters reaching 180 federal representatives urging them to support the congressional resolution condemning the anti-Asian sentiment.

The pandemic placed a strain on the health system and underscored the persistent shortage of health care professionals across the country. Throughout the 116th Congress, APA worked on several fronts to ensure protections for IMGs to retain their ability to train and practice in the United states.

APA was one of the first medical associations to publicly advocate for enhancing access to telehealth at the beginning of the COVID-19 health emergency. After APA member input, APA sent a letter to Congress urging that a waiver of existing restrictions be included in the first COVID-19 package from Congress. These swift actions and continual advocacy with Congress and the Administration this year allowed many psychiatrists to transition to delivering mental health care to their patients via telehealth and receiving payment equivalent to an in-person visit. The desire to retain many of the changes that have facilitated the telehealth delivery model after the public health emergency declaration ends has led APA to recommend extending current telehealth waiver authority for at least a year after the end of the public health emergency declaration, and permanently removing the site of services and geographic restrictions. CAGR and APA members sent 550 letters to urge Congress to permanently lift or extend these temporary flexibilities to ensure continuity of care for mental health patients. Several district branches also sent their own letters supporting federal telehealth access changes.

As states lifted stay-at-home orders and data showed COVID-19 continued to spread in some areas, the use of telehealth remained an important tool for patients to access mental health and substance use disorder treatment while keeping patients, clinicians, families, and communities safe through physical distancing. To better inform our membership, APA hosted an educational webinar for members to refine the use of telehealth to better serve their patients. CAGR Chair Dr. Kiki Kennedy presented on APA’s advocacy efforts at the federal and state levels to continue telehealth flexibilities, in addition to APA leadership speaking to the need for greater access to mental and substance use disorder treatment amid the pandemic.

The Congressional Advocacy Network (CAN) is a tool CAGR uses to bring an even greater voice to psychiatry’s advocacy efforts. More than 340 APA members participate 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. As CAN members themselves, CAGR members meet with their federal lawmakers to foster these relationships and better serve as mentors for other advocates living in their region.

Many states have made positive, albeit temporary, changes to increase access to care during the COVID pandemic, with many states requiring all payers to cover care delivered via telehealth services the same as in-person care. APA has developed model legislation to make these temporary changes permanent. APA has already provided draft telemedicine legislation to over 20 district branches that have voiced interest in pursuing this legislation; APA will be working closely with these district branches and others as they continue the legislative process.

As another means of offering proactive solutions to ameliorate access-to-care problems, APA has also developed model legislation designed to require transparency and accountability from insurers and state regulators pertaining to compliance with federal MH/SUD parity law. APA model legislation concerning parity of coverage for MH/SUD services continues to make its way through many state legislatures. In 2020, Arizona, Indiana, Maryland, Oklahoma, and West Virginia enacted APA’s model legislation. Virginia signed sections of APA’s parity legislation into law this spring, as well.

APA has worked closely with district branches and state associations across the country to address legislation that would expand scope of practice for psychologists, nurse practitioners, physician assistants, and pharmacists. Through the hard work and dedication of members, legislation in many of those states has been prevented from moving forward, and the outlook is positive for other states who are still working to ensure patient safety in their states.

As part of APA’s state advocacy efforts, the Committee for Advocacy and Litigation Funding (CALF), currently chaired by Dr. Bhasker Dave, reviews district branch/state association grant requests for specific public affairs challenges on the state level. Due to limited budgets in many of APA’s district branches/state associations, CALF grants are heavily relied upon by states in confronting new legislative policy challenges. Once CALF approves an initial request from a district branch/state association, the request is sent to voting members of CAGR to approve, and the Board of Trustees (BOT) makes the final determination to award a grant. So far this year, CALF, CAGR, and the BOT have approved CALF grants to Nebraska, Montana, and Arizona.

The Child Council developed a mentorship program and guide for its APA/APAF Fellows. The guide has the potential to be used as a template across APA Councils as a roadmap to successful mentorship of feature APA leaders. Names of mentorship attendees are presented in Table 1.

In 2019, the Child Council, on behalf of APA, voted to endorse the Anxiety Disorders: Parents’ Medication Guide by AACAP with modifications. The guide is slated to be released in 2020.

Over the past two years, the Council and the Caucus worked together to develop the Resource Document “Developing a Global Mental Health Curriculum in Psychiatry Residency Programs.” Former Caucus Chair, Dr. Geetha Jayaram, and Council member, Dr. Bibhav Acharya, led efforts to finalize the document for approval by the APA. The Resource Document is now available on the APA website and serves as a guide to assist psychiatric residency training programs interested in developing and implementing a global mental health curriculum and for medical students and psychiatric residents interested in global mental health. The Council received feedback from members of the APA Council on Medical Education and Lifelong and the APA Council on Quality Care who shared that it will be helpful to institutions developing global mental health programs and the Global Mental Health Task Force of the Association of Directors of Medical Student Education in Psychiatry (ADMSEP), who are in the process of developing learning objectives for global mental health education for U.S. medical students and resources to meet those objectives, shared that the Resource Document would be helpful to their work as well.

In lieu of the 2020 APA Annual Meeting not occurring, several Council members coordinated to include a recording of the session “The Social Determinants of Health: Essential Elements to Global Health Care Quality and Outcomes” in the 2020 APA On Demand. The original session included Dr. Sergio Grande to discuss underserved populations, Dr. Roy Kallivayalil to discuss rights to health, Dr. Vincenzo Di Nicola to discuss child development factors, and Dr. Eliot Sorel to discuss social determinants of health and mental health. A summary of the session was presented to the Council during their virtual April meeting which included a review of information on social determinants of health from Robert Wood Johnson Foundation and the University of Wisconsin Public Health Institute. A brief overview of the course “Global Mental Health: A Training Curriculum” originally scheduled for the 2020 APA Annual Meeting was also shared with the Council by Dr. James Griffith and Dr. Vivian Pender. The course was to highlight the difference in global mental health education in residency and fellowship programs and the need for global mental health training to better understand how to work with diverse populations. The presenters plan to resubmit the course next year.

In lieu of the 2020 APA Annual Meeting not occurring, the 2020 International Poster Engagement Program, which engages with international researchers on their poster presentations and coordinated by Council members and former APA/APA Foundation Minority Fellows, Dr. Josepha Immanuel and Dr. Jennifer Severe, adjusted its format to connect with participants electronically. At the beginning of the year, the Council submitted a report reviewing the first three-years of the program which has included 41 participants from 24 countries. Participants include non-U.S. psychiatric residents and early career psychiatrists with reviewers from the Council and Caucus engaging with participants in bilateral learning, knowledge exchange, and professional enrichment to support membership development. While many participants were already APA members, those who were not became members after participating in the program and many continued on as members beyond their participation, reflecting the value of the program as a member benefit. Additionally, participants reported the program made them feel “welcomed,” “included,” and “valued” at the APA Annual Meeting. One participant noted that “the practice of psychiatry can be very different” around the world, and that the Annual Meeting provides a great opportunity to “share what we do in our own health care systems.” The program has proven to be enriching not only to participants, but also to the APA members serving as program reviewers.

The Caucus has maintained a membership of about 1,000 APA members reflecting the interest in global mental health. The former Caucus Chair, Dr. Geetha Jayaram, worked closely with the Council to finalize the development of the Resource Document “Developing a Global Mental Health Curriculum in Psychiatry Residency Programs” and also offered guidance to Caucus members developing abstracts for consideration for the 2020 APA Annual Meeting. The Caucus election of the 2020–2021 Caucus Chair position included as candidates Dr. David Ndetei of Kenya and Dr. Samuel Okpaku of the United States. Dr. Okpaku received the majority of votes to become the 2020–2021 Caucus Chair. At the writing of this report Dr. Okpaku has connected with the past Caucus Chairs, including Drs. Milton Wainberg, Eliot Sorel, Khurshid, Vincenzo Di Nicola, Gabrielle Ivbijaro, and Geetha Jayaram, to discuss the future priorities and goals of the Caucus.

The Council’s APA position statement on “Mental Health of Foreign Nationals on Temporary Protected Status” was approved by the APA. The Position Statement aims to increase education and awareness of the mental health of foreign nationals in the United States with Temporary Protected Status (TPS) as many health providers, including psychiatrists, are unaware of this immigration status and its impact on individuals and families in the United States. The Council previously participated in the development of the APA Position’ Statement on the “Role of Psychiatrists in Addressing Care for People Affected by Forced Displacement. Both position statements are available on the APA website.

The 2020 recipient of the APA Chester M. Pierce Human Rights Award was the nonprofit news organization Global Press. Global Press works to ensure that people around the world have access to more dignified, precise information about the world and the people in it. Among Global Press’s innovations is its Duty of Care program, which ensures the physical, emotional, digital and legal safety of its reporters, who are located all over the world. The Global Press Duty of Care Training Manual is the first guide of its kind to address the specific risks and challenges faced by local journalists who are often in more danger than foreign correspondents who parachute into global communities temporarily. In 2019, Global Press made this program available to more than 1,000 local journalists outside of the Global Press network for the first time, to demonstrate that high-quality local journalist safety and well-being is complex, but possible.

The following Council members were nominated and accepted to be candidates in the upcoming 2020 World Psychiatric Association Election:

While the WPA Election is scheduled to take place virtually in October 2020, the WPA World Congress of Psychiatry, originally scheduled to occur at the same time, has been rescheduled to take place March 10–13, 2021 in Bangkok, Thailand.

The Council’s Work Group on Research Training, chaired by Charles Nemeroff, M.D., Ph.D. and Steven Siegel, M.D., Ph.D., met to discuss the 2020 Research Colloquium for Junior Psychiatrist Investigators (Colloquium). The Colloquium, originally scheduled for April 25 and 26 during the APA Annual Meeting in Philadelphia, was postponed due to COVID-19. The Work Group is planning to host a virtual Colloquium at the end of this year with the date yet to be determined. The Colloquium is typically a two-day event held on Saturday and Sunday at the APA’s Annual Meeting. In contrast, the virtual Colloquium will be an intensive one-day event. The first half of the day will see representatives from APA/APAF, NIDA, ACNP, and SOBP present on work-life balance, career trajectory, mentorship, and funding opportunities to early research career psychiatrists (ERC). During the second half of the day, awardees will be divided into two tracks: Track 1 will include ERC psychiatrists in the beginning stage of developing area(s) of research interest and need mentorship in doing so; Track 2 will include ERC psychiatrists who have identified one or more clear research areas of interest but need mentorship in moving forward to develop a K-award project or finetuning their research portfolio. Participants will be further divided into 5 different research areas including Alcohol, Pain, and Substance 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 peers and mentors.

This year, Drs. Wilson Compton, Nina Kraguljac, John Krystal, Carolyn Rodriguez, and Ned Kalin from the Council on Research and its components will serve as mentors in the program. Additionally, biostatisticians/methodologists will participate to provide a valuable perspective often unavailable to young researchers. The Work Group hopes to continue its efforts to include a panel of statistical and methodological mentors to help senior psychiatric researchers in the mentorship of Colloquium awardees.

APA Past President (2016–2017) Maria Oquendo, M.D., Ph.D. and Bernardo Ng, M.D., past chair of the APA’s Council on International Psychiatry, continue to lead the effort to expand the Research Colloquium to include more international ERC psychiatrists. Eleven international mentees from Argentina (2), Brazil (2), Colombia (1), Japan (1), and France (2), Mexico (1), the Netherlands (1), and Nigeria (1) were invited to attend this year’s Colloquium. International mentees are selected and sponsored by their institution, country’s psychiatric association or branch of SOBP, or are self-funded.

Lastly, the Colloquium continues to be jointly funded by the APA Foundation (APAF), the American College of Neuropsychopharmacology and the Society of Biological Psychiatry, and the National Institute on Drug Abuse (NIDA). A renewal grant application for the Colloquium, with Dr. Diana Clarke, Deputy Director of Research and Staff Liaison for the Council on Research at the APA and Scientific Coordinator of the Colloquium, as the principal investigator, was successfully funded for 3 years.

The Award for Research in Psychiatry, the highest award for research given by the APA, was presented to Maurizio Fava, M.D., Psychiatrist-in-Chief of the Massachusetts General Hospital (MGH), director, Division of Clinical Research of the MGH Research Institute, executive director of the Clinical Trials Network and Institute, (MGH), associate dean for clinical and translational research and the Slater Family Professor of Psychiatry at Harvard Medical School. Dr. Fava is a world leader in the field of depression. 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 awarded to Milton Wainberg, M.D. Dr. Milton Mainberg is the Founding Chair of the Caucus of Global Mental Health and Psychiatry of the American Psychiatric Association, a Professor of Clinical Psychiatry at Columbia University/New York State Psychiatric Institute, Director of the NIMH-funded Columbia University Global Mental Health Implementation Science T32-Post Doctoral Fellowship, and NIMH/Fogarty International-funded Portuguese-speaking African countries Mental Health Implementation Research Training Program. Several other prominent researchers were recognized this year for their outstanding contributions to psychiatry and psychiatric research: Melissa Arbuckle, M.D., Ph.D. received the APAF/American Association of Chairs of Departments of Psychiatry Research Mentorship Award; Vilma Gabbay received the Blanche F. Ittleson Award for Research in Child and Adolescent Psychiatry; and the mentor/mentee team of Robert Sweet, M.D. and his trainee, Brandon McKinney, M.D. received the Kempf Fund Award for Research Development in Psychobiological Psychiatry. Christina Mangurian, M.D. past chair of the Council on Minority Health and Health Disparities, received the 2020 APA Health Services Research Senior Scholar Award, and Samuel T. Wilkinson, M.D. received the 2020 APA Health Services Research Early Career Award.

This year, the APAF awarded 7 non-renewable small research grants to APA/APAF fellows to study the Impact of COVID-19 on a) patients with mental and substance use disorders, b) the psychiatric workforce (including early career psychiatrists), and/or c) the practice of psychiatry. The review committee for these small grants was chaired by Dr. Jonathan Alpert, chair of the Council on Research and included 4 other APA members. The 7 successful APA/APAF fellows included Drs. Anees Bahji, Sebastian Cisneros, Devin Cromartie, Juliet Edgcomb, Youngjung Kim, Michael Mensah, and Tina Thomas. Drs. Anees Bahji and Youngjung Kim, were past awardees of the Research Colloquium for Junior Psychiatrists Investigators.

Chair: Joshua Morganstein, M.D.; The Committee on Psychiatric Dimensions of Disaster coordinated with the APA Communications Department to reach out to the district branches and state associations affected by recent tragic events, including, but not limited to, wildfires in California, earthquakes in Puerto Rico, and mass shootings in Canada. Committee members led special webinars on disaster psychiatry topics and participated in interviews through major media outlets, such as CNN, CNBC, and The Washington Post. The Committee has been engaged in supporting APA’s response to the COVID-19 pandemic and written a number of pandemic-related guidance documents, including on essential procedures, redeployment of psychiatrists to other roles in medicine, and exposure to COVID-related death, among others.

Chair: Charles Nemeroff, M.D., Ph.D.; This Workgroup, chaired by Charles B. Nemeroff, M.D., Ph.D., generated five manuscripts, which were reviewed and approved by the Joint Reference Committee (JRC) and Board of Trustees (BOT), and were submitted for publication. These manuscripts are as follows: “Amyloid and Tau in Alzheimer’s Disease: Biomarkers or Molecular Targets for Therapy,” “A Review of the Evidence for Using Hormonal Strategies in the Treatment of Depression,” “The Use of Social Media in Recruiting Participants for Mental Health Research Purposes: A Systematic Review and Best Practices Report”, “Biomarkers of Schizophrenia,” and “Big Data and Machine Learning: A Primer for Psychiatrists.” The Workgroup provided an overview of current initiatives, including biomarkers of Autism Spectrum Disorder, ecological momentary assessment, cannabinoids and THC in psychiatry, and the neuropsychiatric sequelae from COVID-19. Draft manuscripts on these topics will be submitted for critique and approval by the Council on Research, JRC, and BOT in upcoming meeting.

Chair: Jonathan Alpert, M.D., Ph.D. The primary focus of the Health Services and Health Disparities Work Group has been the effects of climate change on mental illness and psychiatric service needs. The Work Group provided an overview of recent initiatives, including a systematic review and the use of Behavioral Risk Factor Surveillance System (BRFSS) and social media data to predict psychiatric service needs and utilization related to climate change and mental health. The Work Group is interested in issues of access to mental health care, workforce development, and patient-reported outcomes. Additionally, the Work Group is interested in the topics of gun violence, LGBTQ health research methodology, SMI and integrated care, and other areas of societal interest where they could identify gaps in research and potential research questions.