APA Council Reports

The Council and its components developed the “Resource Document on How Psychiatrists Can Talk with Patients and Their Families About Race and Racism,” which the APA approved. It was developed following discussions with Cheryl Wills, M.D., Chair, APA Presidential Task Force on Addressing Structural Racism Throughout Psychiatry on how the Council could support the work of the Task Force. This document involves several of the Council’s workgroups and members, including APA/APAF Fellows. It incorporates background information, guidelines for clinical work, questions for starting a dialogue with patients about race and racism, tools for assessing experiences of racial groups and discrimination, clinical vignettes, and resources for providers, children, and their families. Several Council members also developed a Psychiatric News article highlighting the importance of the Resource Document.

The Council and its components also developed and supported the development of the following position statements, which the APA approved:

The Council and its components developed and supported the update and development of the following position statements and resource document which were in the approval process at the writing of this report:

The Council developed the “Resource Document on Approaches to Youth in Mental Health Crisis” to complement the “Position Statement on Police Interactions with Children and Adolescents in Mental Health Crisis.” The Resource Document overviews contemporary models for approaching youth in a mental health crisis with a practical, solution-oriented focus and emphasizes de-escalation and rapid linkage to clinical evaluation services. It supports the APA goal of ensuring young people in mental health crises and their families receive support from first responders who are appropriately trained to address their needs.

The Council coordinated with AACAP to review and update the Joint AACAP/APA ADHD Parents’ Medication Guide. The guide is an initiative to have information for parents on all types of psychiatric illness medication for children and adolescents. The Council reviewed and updated the following public education webpages on the APA website: ADHD, Intellectual Disability, Autism, Disruptive and Conduct Disorders and Specific Learning Disorder.

Council members presented in ten sessions and two poster presentations during the virtual 2021 APA Annual Meeting. Presentation topics included social media, collective trauma, learning gaps, racial injustice, LGBTQ, ethics, and telepsychiatry. The Council uses social media to disseminate its work to the public and through articles in Psychiatric News.

Several components report to the Council, including the Committee on Women’s Mental Health, the Caucus on College Mental Health, and the Caucus of Psychiatrists Treating Persons with Intellectual Disabilities. In addition to coordinating with these components on the above work, along with other groups and individuals, the Council and its component members work in collaboration in the following areas:

Additionally, the Women’s Committee has been working on position statements and presentations on maternal psychiatry and collaborating with AACAP and the American College of Obstetricians and Gynecologists to set a new standard of care to evaluate depression in women during health screenings. As the APA is part of the Higher Education Mental Health Alliance, the College Mental Health Caucus works with the ten organizations represented in the alliance to create guides on college mental health issues to educate campus partners.

The Council also recently reviewed and updated its workgroups to focus on the following topics within Child and Adolescent Psychiatry:

The Council continues to discuss current developments impacting these and other areas and identifies opportunities for collaboration and partnership.

As the development of mentorships and sponsorship programs and opportunities expands across the organization, the Council is available to provide input and guidance following a successful mentorship program in the Council pairing the APA/APAF Fellows on the Council with Council members. The mentorship program involves mentors and mentees reviewing a mentorship guide outlining expectations and approaches, mentees identifying three goals to accomplish with the support of mentors, both mentors and mentees signing an agreement to stay connected, and an opportunity for mentors and mentees to share feedback, through a survey every 3-months, about their experiences and areas for improvement.

In collaboration with the Council on Addictions, the Council undertook an extensive revision of the position statement on “Substance Use in Older Adults.” The revised statement was approved by the Joint Reference Committee (JRC) and the APA Assembly and is awaiting final approval from the APA Board of Trustees.

The Council was tasked to review and provide input on the existing Position Statement on the Role of Psychiatrists in Assessing Driving Ability to determine if it should be retained, revised, or retired. After a thorough review of the document, the Council agreed to retain the statement. Council requested that these additional councils – Ethics, Psychiatry and Law, Quality Care, Government Relations and Advocacy, also review the position statement for their input before submission to the JRC for approval.

The Council was asked by the Research Council to provide feedback on the use of Emotional Support Animals in psychiatric populations. Council noted that there is currently no formal certification process to qualify an individual for use of an animal as an ESA, and suggested that the statement could offer recommendations to individual clinicians who receive requests to authorize ESAs.

The Council has long been a strong advocate for reducing geographic restrictions on Medicare reimbursement for telepsychiatry in order to increase older adults’ access to mental health services. It has been very gratifying to see the constructive adaptation of regulations governing telepsychiatry in the setting of the COVID-19 pandemic.

It has been particularly helpful that Medicare and many other payers have been willing to reimburse for audio-only clinical encounters. This has made it feasible for psychiatrists to continue to treat older adults who are seeking to avoid contagion by staying home and who do not have the equipment and/or know-how to use audio-visual platforms. The Council is grateful that the APA has been and remains a strong advocate for these and other telehealth policy reforms that enhance access to care for elderly Americans in need of mental health treatment.

In 2019, a group of leading geriatric psychiatrists, including several Council members, submitted a proposal to the CMS requesting a revision of existing codes and the creation of new codes for specific conditions that occur in association with dementia. The National Minority Quality Forum Executive Summary: 8.F Page 4 of 5 spearheaded this effort on behalf of psychiatrists and neurologists, asking for enhanced specificity in coding to capture the severity of dementia and the particular noncognitive behavioral and psychological symptoms of dementia for which they are providing treatment. Dr. Maureen Nash reported about the March 2021 meeting where she presented the proposal with neurologists. The presentation was well received by the coders present at the meeting, as well as APA and AAN representatives. Dr. Michael First, APA liaison to the ICD harmonization process, also supported the proposal. More updates are forthcoming for the council members.

During the 2019 Fall Component Meeting, the Council discussed the interface of geriatric psychiatry with community psychiatry. A new Fellow on the Council suggested that the Council reach out to trainees interested in community psychiatry to highlight the opportunities at this interface so that they might consider training in geriatric psychiatry. Several Council members have worked at and written about this interface and offered to work on the project. Council published its first article on this topic in Psychiatric News.

The COVID-19 pandemic is having a profound impact on older adults, particularly those with mental illness. Inspired by the experience of having published “Culture, Heritage, and Diversity in Older Adult Mental Health Care” (American Psychiatric Association Press, 2019), the Council has pulled together the lessons of the current pandemic this year and developed a volume on pandemic preparedness for older adults. Drs. Robert Roca, Micheline Dugue and Maria Llorente, are the editors of the book. Final drafts of all chapters were submitted by the authors, and editors reviewed them. All chapters have now been finalized and sent to APPI Press for formatting and publishing.

During the 2020 Fall Component Meeting, Dr. Cheryl Wills informed the Council about the work that the APA Taskforce on Structural Racism was doing. Dr. Wills provided the background on the task force's development and presented the taskforce's goals and objectives. She invited the Council to join the efforts and contribute to the cause. The Council’s 2020 Chair, Dr. Roca discussed the potential idea of developing a document on how to talk about racism with patients who are older adults. Council took that year to draft a resource on The Impact of Racism in Older Adults. A working group (Drs. Dahl, Roca, Llorente and Ali) was formed to brainstorm different ideas and decide on the content and outline of a proposed document. The work group aims to develop the draft document before the 2021 Fall Component Meeting.

Dr. Maria Llorente is representing the Council on the workgroup that is charged to develop a mentorship toolkit for the APA. Other components of the workgroup include Committee on Women’s Mental Health, Council on Medical Education and Lifelong Learning (CMELL), Caucus on Leadership and Entrepreneurship, Council on Minority Mental Health and Health Disparities, and Council on Research. Dr. Llorente reported that the program was initiated by the women’s committee and was inspired by the shortage of mentorship opportunities for women residents and psychiatrists, as well as individuals from minority groups. The toolkit covers topics such as introduction to mentoring, role of mentors and mentees, administrative mentoring, mentoring in research, mentoring women, ethnically diverse and underrepresented minority psychiatrists in medicine. The JRC has reviewed the toolkit and is pleased with the product.

The workgroup will meet to finalize the toolkit by the September Components meeting.

The Committee on Integrated Care, developed a guide on The Role of Psychiatrists in the Equitable Distribution of the COVID-19 Vaccine, along with an article published in Psychiatric News to highlight a case study on successfully vaccinating people with serious mental illness in an inpatient psychiatric unit. APA used the document to advocate, both at the federal and state levels, the need to prioritize vaccinating people with mental illness and substance use disorders. The Committee worked with members of the APA Committee on Psychiatric Dimensions of Disaster, Council on Communications, Council on Minority Mental Health and Health Disparities, and Council on Healthcare Systems and Financing to develop the document.

Lastly, a workgroup was formed to develop guidance on how to bill add-on codes for smoking cessation. Seventy-five percent of individuals with either addictions or mental illness smoke cigarettes, compared with 22% of the general population. Nearly half of all cigarettes consumed in the United States are by individuals with a psychiatric disorder. Smoking is the single most preventable cause of premature death and disability in our country.

Following successful advocacy to reduce burdensome documentation and increase reimbursement, members of the Committee have been focused on developing educational resources on the recent changes to the outpatient evaluation and management (E/M) codes that went into effect January 1, 2021. In addition, members of the Committee have continued in their roles as APA representatives to the AMA reimbursement related committees—the AMA CPT Editorial Panel and the AMA/Specialty Society RVS Update Committee (RUC). This effort has included advising and advocating for changes to E/M codes used in other settings including inpatient and nursing facility services; and reviewing CPT coding proposals related to digital health. The Committee has weighed in on issues related to coverage for telehealth services and continues to support the Practice Management Helpline by responding to CPT coding and documentation queries.

The Committee submitted revised the existing position statement on Core Principles for Alternative Payment Models to reflect the need for models to address health equity. Members provided feedback on the advocacy efforts directed to ensure appropriate coverage and reimbursement for psychiatric services during the COVID-19 Public Health Emergency (PHE). This included providing feedback and support to member volunteers who wrote an article on the financing of psychiatric services during the PHE. In addition, members continue to monitor emerging alternative payment models and participate in discussions with the Council on Quality Care and the Administration on the impact on access to care of proposed episode-based cost measures under MIPS.

The Committee on Telepsychiatry, chaired by continued to add resources to its Telepsychiatry Toolkit. Over the past year, the Committee has focused on developing new content for the Toolkit in response to the COVID-19 Public Health Emergency, as well as video interviews with Committee members detailing their experiences using telepsychiatry.

COVID-19 ushered in broad changes to the regulatory and legislative landscape around telehealth, and the Committee worked with APA staff to respond to these changes at the federal and state levels, advocating for continued flexibilities around telehealth practice (e.g., licensure, electronic prescribing via telehealth, audio-only telepsychiatry) and reimbursement. Additionally, the Committee worked with APA's Department of State Government Relations to develop model telehealth legislation. As a result, this model legislation has been adopted in part or in whole by 26 states as of July 2021.

The Committee also worked with members of APA's College Mental Health Caucus to publish College Mental Health, Telepsychiatry: Best Practices, Policy Considerations, & COVID-19, offering guidance on licensure, prescribing, billing, and other issues to psychiatrists on practicing telepsychiatry with college students.

The Council met with the leadership of the World Association for Cultural Psychiatry (WACP), including WACP President, Dr. Roberto Lewis-Fernandez, and Dr. Francis Lu to discuss APA supporting the recently developed WACP statement addressing the impact of COVID-19 on the mental and physical health and economic well-being of vulnerable populations around the world, as well as calling on governments to address the mental health and social impacts of the pandemic. The WACP Statement on COVID-19 and Vulnerable Populations overlapped in content and intent with the APA Guidance Document on COVID-19 and the APA Board of Trustees approved a commendation of the WACP Statement on COVID-19 and Vulnerable Populations which is available from the WACP website.

The Council met with APA President, Dr. Jeffrey Geller, to discuss a proposal to change the Council name and charge, incorporating population health into the charge and name. The Council and the Caucus reviewed and updated the proposal and the Joint Reference Committee conducted a survey of the Council’s activities receiving feedback from other APA components. The APA Board of Trustees approved changing the name of the Council on International Psychiatry to the Council on International Psychiatry and Global Health and incorporated language to bring global perspectives of individual, family, culture, and population-based approaches for understanding mental health, well-being and the treatment and prevention of psychiatric illnesses to the mission of the APA. The updated charge also emphasizes a focus on international membership, developing partnerships with national and international organizations, supporting the transformation of psychiatric education to a global setting and promoting human rights advocacy. To see the full charge of the Council, go to the APA website under “Councils.”

Council and Caucus members presented as part of the 2021 APA Annual Meeting in the following sessions in the virtual program and/or the APA OnDemand product:

World Psychiatric Association (WPA) leadership, in coordination with APA leadership, were also accepted to present “WPA’s and APA’s Response to the COVID-19 Pandemic–Parts 1 and 2.”

During the Annual Meeting, the Council met virtually with the leadership of the following international psychiatric organizations to discuss the mental health impact of COVID-19 and identify potential opportunities for collaboration and partnership as well as areas of focus for consideration by the Council.

The Council also met with psychiatrists part of the African Global Mental Health Institute and the APA International Poster Engagement Program including Dr. Anusha Lachman of Stellenbosch University in South Africa and Dr. Marlon Edu Saavedra Delgado of the Mexican Psychiatric Association.

The 2021 APA International Poster Engagement Program, coordinated by the Council, was conducted virtually, due to the APA Annual Meeting being virtual, and included 17 submissions from the following 12 countries:

The program focuses on expanding networks, professional enrichment, and bilateral learning. Participants include medical students, residents, and early career psychiatrists accepted to present their research during the APA Annual Meeting international poster sessions. Program reviewers consist of Council and Caucus members to provide feedback on the format, layout, scientific content, method, analysis, communication, and presentation of their research poster. The Council hopes to continue to increase the number of participants in the program next year and conduct the program in-person during the 2022 APA Annual Meeting.

Council members supported the update of the APA Global Mental Health webpage which includes global mental health resources to support education and training on global mental health topics for medical students, residents, and psychiatrists. It includes a link the “Resource Document on Developing a Global Mental Health Curriculum in Psychiatry Residency Programs” developed by the Council last year as well as other resources relevant to COVID-19 and global mental health from various international institutes and organizations. The webpage can be accessed at www.psychiatry.org/globalmentalhealth.

Under the previous Caucus Chair, Dr. Samuel Okpaku, the Caucus on Global Mental Health and Psychiatry, continued an advisory group of past Caucus Chairs including Drs. Milton Wainberg, Eliot Sorel, Khurshid, Vincenzo Di Nicola, Gabrielle Ivbijaro, and Geetha Jayaram. It was decided that the tenure of the Caucus Chair will be two years and that the advisory group will become the leadership of the Caucus. The 2021 election of the new Caucus Chair included Dr. Marsal Sanches and Dr. David Baron with Dr. Baron receiving the majority of votes to become the new Caucus Chair. Dr. Baron has begun coordinating with the past Caucus Chairs and the Council to identify priorities for the Caucus during his term as Chair.

In October 2020, Dr. Afzal Javed, a consultant psychiatrist at the United Kingdom National Health Service (NHS) and Honorary Chairman of the Pakistan Psychiatric Research Center, assumed the role of WPA President, launching the WPA 2020–2023 Action Plan. Dr. Danuta Wasserman of the Karolinska Institute in Sweden was elected as WPA President-Elect along with the following Council members who were elected to the WPA Executive Committee and Board:

The Council continues to stay connected with WPA on its activities through its representatives and work together with its leadership and components on various topics, including developing policy and guidance on the use of psychiatric institutions for the commitment of political dissenters.

At its December 2020 meeting, upon recommendation by the Council, the APA Board of Trustees approved awarding the 2021 APA Chester M. Pierce Human Rights Award to the following individuals:

The Board of Trustees also approved having the award be presented to either an individual or organization in alternating years. The 2022 award will be presented to an organization promoting the human rights of populations with mental health needs. Dr. Michelle Durham was appointed as the new Chair of the Chester M. Pierce Human Rights Award Nominating Committee and additional appointments to the Committee are being finalized.

Additionally, in April 2021 a work group of members including Council and Caucus members began working with the APA Foundation on an endowment campaign to fund the award. While award recipients have been recognized with a plaque at the APA Annual Meeting, an endowment would provide award recipients with an APA Annual Meeting lectureship, honorarium, and related expenses. The campaign seeks to secure $100,000 in pledge commitments by September 2021. To learn more about Dr. Chester Pierce, including the multiple roles he held throughout his career impacting health disparities and global mental health, go to the APA website under “Awards” and review his bio.

The Council Workgroup on Climate Change and Mental Health was charged with looking at the current state of knowledge on the subject and determine if it was sufficient to create a curriculum and, if it was, what CMELL’s role should be. After reviewing the literature and consulting with the subject matter experts, the Workgroup recommended that the development of curricula at the UME, GME, and CME levels is best done by experts in the field rather than members of CMELL given that this is a highly specialized area with evolving knowledge.

The Workgroup determined that CMELL can best fulfill its role by the following actions:

As a follow-up, the Council sent official letters to APA Scientific Program, ADMSEP, AADPRT, AAP, AACDP, and AMA, encouraging further work and education in the area of climate change and mental health.

The Council developed a position statement that psychiatry residents and fellows should be supervised in medical diagnosis and treatment by physicians, board certified or eligible, and not solely by advanced practice providers. The skills of the clinician supervising residents and fellows must be consistent with the care being supervised. In the process of developing this position statement, the Council reviewed the language of the Accreditation Council for Graduate Medical Education (ACGME) Psychiatry Requirements and reached out to the ACGME For clarification of the existing requirements. The Council is currently working on the revised position statement based on the Board of Trustees’ feedback.

The Council has been collaborating with Committee on Women’s Mental Health, Caucus on Leadership and Entrepreneurship, Council on Minority Mental Health and Health Disparities, Council on Geriatric Psychiatry, and Council on Research to develop a toolkit for mentorship across a psychiatrist’s career. The product draft was submitted to the Joint Reference Committee (JRC), and the JRC commended the workgroup on this cross-collaborative effort. The multi-Council workgroup is submitting the revised draft back to the JRC based on its official feedback.

The Council convened a workgroup to assist the APA leadership in developing an assessment and response to the American Board of Medical Specialties (ABMS) Draft Standards for Continuing Certification. The ABMS released the draft standards on April 21, 2021, with the call for comment ending on July 8, 2021. The workgroup examined each of the 20 recommendations but also all the standards as a whole. The workgroup identified two main issues (cost and lack of evidence) associated with the revised standards.

This same workgroup led the Council’s effort to develop survey questions designed to collect information on APA members’ attitudes and beliefs about the current ABPN Maintenance of Certification (MOC) process. The survey was sent to a stratified sample of APA members in collaboration with Division of Research. The survey results are to be published in Psychiatric News.

The Council collaborated with the Council on Children, Adolescent, and Their Families, who has developed a training document on how to have discussion about race relations with patients and families. The Council assisted in the dissemination of the resource document to our allied education groups (ADMSEP, AADPRT, AAP, AACDP).

As a convening body for Allied Psychiatry Education groups, the Council is continuing to monitor and discuss the impact and the opportunities in psychiatric education at all levels due to COVID-19.

Dr. Vincenzo Di Nicola and Dr. Andrei Novac brought a request to the Council to support a proposal for a new APA Caucus on Medical Humanities in Psychiatry. The medical humanities in psychiatry are an important complement to psychiatry’s basic sciences and clinical mission yet they do not have a clear voice at the APA. This Caucus would be a great opportunity to provide a space for them at the APA. Given the relevance of humanities in various stages of training, especially around soft skills, it would be a good fit to house this new Caucus under the wing of CMELL. This action was approved to move forward.

Dr. Mark Rappaport brought a request to the Council to consider American Society of Clinical Psychopharmacology (ASCP) to join CMELL as an affiliate organization. ASCP has one of their major missions as education with seven different editions of curriculum being used by many programs across the country. Since 1992, they have also had a training program to train investigators. ASCP is committed to midlevel career advancement as well. The Journal of Clinical Psychiatry is the journal of ASCP, with the focus on education, not only for medical students and residents but also for academics. Given this, this collaboration would contribute well to the missions of both the Council and ASCP. This action was approved to move forward.

The Council initiates nominations for APA’s 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.

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 groups both within the profession and APA.

The following Positions Statements were developed by CMMH/HD and approved by APA Board of Trustees from 2020 to 2021:

The following Position Statement was sent to the CMMH/HD for review in 2021:

The Council on Minority Mental Health and Health Disparities reviewed the third pillar of APA’s strategic plan and suggested revisions to expand the third pillar. The JRC reviewed and approved the revisions.

The Council on Minority Mental Health and Health Disparities produced the CME Module Racism in Black Mental Health. The learning module prepares contemporary psychiatrists to practice with an antiracism framework in the care of all patients, especially African Americans.

The Council on Minority Mental Health and Health Disparities reviewed and approved the APA’s endorsement of AB Sexual Orientation and Gender Identity Data Collection Pilot Project to collect data on violent deaths from data sources, including, but not limited to, death certificates, law enforcement reports, and coroner or medical examiner reports.

The CMMH/HD reviewed and approved the draft letter by the APA to regarding a recent Department of Homeland Security proposed rule establishing a fixed time period of admission and an extension of stay procedures for individuals in F, J and I status.

The Council on Minority Mental Health and Health Disparities reviewed and approved the Position Statement on Rapid Onset Gender Dysphoria.

The Council on Minority Mental Health served on a workgroup with Council on Quality Care, Council on Children and Their Families to identify PS’s that relate directly to the issue of mental healthcare for immigrant detainees and consolidate statements that can be combined. The consolidation is complete and will be presented to the June JRC.

After reviewing the document from the Council on Minority Mental Health and Health Disparities voted to approve support of the Group for the Advancement of Psychiatry (GAP) 2020 publication Faith Communities and the Well-Being of LGBT Youth commendation. The publication serves as a resource for faith communities to educate their members about the heightened risks for serious mental health consequences faced by LGBT youth and ways to mitigate those risks.

The use of nonemergency involuntary medication is a clinical and legal process by which a psychiatric patient is administered medication after they have declined acceptance of prescribed medication for the ongoing treatment of a serious mental illness despite adequate efforts to encourage voluntary acceptance of the medications. Psychiatrists who work in jail settings will encounter patients for whom the administration of nonemergency involuntary medication is clinically indicated for the stabilization of their serious mental illness. The Council on Psychiatry and Law created this resource document to guide psychiatrists in decision-making about nonemergency involuntary psychiatric medication administration in U.S. jails by providing background information and highlighting issues for consideration. This resource document was approved by the Joint Reference Committee in October 2020 and is available at https://www.psychiatry.org/psychiatrists/search-directories-databases/library-and-archive/resource-documents.

Mental health courts (MHCs) are one of a range of “problem-solving courts” operated on the premise that the criminal law can be used to therapeutic ends to the benefit of both individual defendants and society as a whole. Other examples of problem-solving courts include drug courts, homelessness courts, veterans’ treatment courts, and domestic violence courts. Many psychiatrists are unfamiliar with MHCs despite their rapid expansion in recent years. The Council on Psychiatry and Law created this resource document to describe the concepts behind and operations of MHCs and review their role and effectiveness. This resource document was approved by the Joint Reference Committee in October 2020 and is available at https://www.psychiatry.org/psychiatrists/search-directories-databases/library-and-archive/resource-documents.

In the context of the ongoing opioid overdose crisis, psychiatrists must be aware of the full range of policy, organizational, and public health strategies impacting the lives of people who use drugs. The Council on Psychiatry and Law and the Council on Addiction Psychiatry collaborated to create this resource document aiming to inform psychiatrists about one such strategy: Safe Consumption Facilities (SCFs, also known as “supervised consumption sites”), an approach that has long been a feature of harm reduction efforts in certain countries and that has attracted increasing attention in the United States. This resource document was approved by the Joint Reference Committee in February 2021 and is available at https://www.psychiatry.org/psychiatrists/search-directories-databases/library-and-archive/resource-documents.

Police responses to calls for behavioral health crises have been known to result in tragic outcomes, including injury or death. The concept of “excited delirium” (also referred to as “excited delirium syndrome (ExDs)”) has been invoked in a number of cases to explain or justify injury or death to individuals in police custody, and the term excited delirium is disproportionately applied to Black men in police custody. The Council on Psychiatry and Law drafted a position statement asserting that acute medical conditions, including delirium, always require an appropriate medical response; therefore, it is the position of the APA that the term “excited delirium” (ExDs) is too nonspecific to meaningfully describe and convey information about a person. “Excited delirium” should not be used until a clear set of diagnostic criteria are validated. This position statement was approved by the APA Board of Trustees in December 2020.

Since 1996, several states have enacted legislation that allows courts to require orchiectomy (i.e., surgical removal of the testicles) or treatment with antiandrogen medications as a condition of release from incarceration for individuals who have been convicted of certain sex offenses. The Council drafted a Position Statement opposing laws that require orchiectomy or treatment with antiandrogen medications as a condition of release from incarceration. The position statement asserts that orchiectomy or treatment with antiandrogen medications is appropriate only in cases where a psychiatrist has diagnosed a paraphilic disorder for which such treatment is indicated and where the patient has provided informed consent (https://www.psychiatry.org/home/policy-finder?k=ORCHIECTOMY).

The Committee on Judicial Action, chaired by Dr. Reena Kapoor, 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. APA has recently joined briefs in the following cases:

SisterSong Women of Color Reproductive Justice Collective, et al., v. Brian Kemp, asserting that the Georgia House Bill 481 effectively eviscerates the constitutional right to abortion; Bristol Regional Women's Center, P.C., et al., v. Herbert H. Slatery III, et al., claiming that the mandatory waiting period of Tennessee Code Ann. § 39–15–202(a)-(h) was correctly held unconstitutional because it impermissibly obstructs patients’ ability to access abortion care safely and in a timely manner according to their treating physician’s best medical judgment; Planned Parenthood South Atlantic and Julie Edwards, v. Thomas Clark Phillip, Jr., stating that South Carolina’s attempt to exclude Planned Parenthood South Atlantic from its Medicaid program would be detrimental to public health; and Brandt v. Rutledge, advocating against House Bill 1570 that prohibits health care providers from treating patients at risk of or suffering from gender dysphoria with gender-affirming care. Additionally, the Committee wrote its own amicus brief in the case of David Wit, et al., v. United Behavioral Health, explaining that managed care organizations tightly control access to psychiatric care by applying 'medical necessity' criteria that are inconsistent with generally accepted standards of care.

The Council continues to work on an array of topics, including correctional and telepsychiatry issues, discriminatory policies preventing access to housing and employment, medical euthanasia, racism and social determinants of health and inequities, restrictions on patient access to personal items while psychiatrically hospitalized, college and university mental health, and the public health and safety consequences of legalizing cannabis, and child civil commitment laws. Additionally, the Council frequently cross-collaborates with other APA components, including the Councils on Addiction Psychiatry, Mental Health and Health Disparities, Quality Care, Children, Adolescents and Their Families, and Research. The Isaac Ray Award Committee and Manfred S. Guttmacher Award Committee each report to the Council. The Isaac Ray Award recognizes a person who has made outstanding contributions to forensic psychiatry or the psychiatric aspects of jurisprudence; it was awarded to Dr. Roy O'Shaughnessy in 2021. The Manfred S. Guttmacher Award recognizes an outstanding contribution to the literature of forensic psychiatry; it was awarded to Drs. Debra Pinals and Lisa Callahan for their articles Challenges to Reforming the Competence to Stand Trial and Competence Restoration System and Evaluation and Restoration of Competence to Stand Trial: Intercepting the Forensic System Using the Sequential Intercept Model, both published in Psychiatric Services. Both committees are in the process of selecting 2022 award recipients. Additionally, the Council on Psychiatry and Law and Committee on Judicial Action will hold a joint session in September focused on transgender issues in civil and criminal settings.

The Committee on Mental Health Information Technology, chaired by Dr. John Torous, continues to provide feedback to APA staff on letters to the Administration on federal regulations pertaining to digital health. Over the past year, they have responded to proposed rules and requests for information on electronic prescribing; interoperability and the Physician Fee Schedule; and other technology-focused proposed rules. Most recently, the CMHIT responded to a call to submit supplementary information to the Agency for Healthcare Research and Quality’s (AHRQ’s) Evidence-based Practice Centers’ (EPC) Program’s review of the evidence for its current work on technical brief, “Evaluation of Mental Health Applications.” APA submitted a letter highlighting our App Evaluation Model for inclusion into AHRQ's work on creating a framework for evaluating mental health mobile applications.

The CMHIT continues to work on gathering information on how third parties–especially payers–collect and use patient data. They have reviewed past APA policy, past and current AMA policy, as well as the relevant literature in order to develop the Position Statement as well as a Resource Document on the topic. Before moving forward, CMHIT will discuss how any Position Statement would intersect with future changes to Part 2.

The Committee on Mental Health IT has recently started meeting jointly with the Committee on Telepsychiatry for their monthly calls. As the use of technology in clinical practice continues to evolve, both Committees recognized the benefit of meeting jointly in order to continue to identify areas of potential overlap between the two groups. Together, they will develop member resources for psychiatry.org, while remaining separate Committees under two different Councils.

The Committee also continues to provide guidance to APA App Advisor on its activities. The App Advisor group is currently writing a “Best Practices in Mental mHealth” guidance/resource document, which will be reviewed by the full CMHIT as a resource document later this year. Drs. John Torous, Darlene King, Nicole Benson, Steven Chan, and Julia Tartaglia, all members of CMHIT, are also on App Advisor, and are facilitating this effort.

Finally, the CMHIT continues to monitor the degree to which the Office of the National Coordinator for Health Information Technology (ONC)'s Final Rule on Interoperability and Information Blocking affects psychiatric practices. Members of this Committee joined with members from other Components to create an Intra-Component Working Group on the ONC Final Rule. Together, they developed key advocacy priorities for APA highlighting the concerns of psychiatry regarding provisions of Information Blocking and its 8 Exceptions. APA staff continue to use these talking points in advocacy meetings with the ONC and its new National Coordinator, and its Chief Medical Officer. The ONC has offered to work with APA in developing resources and other guidance on helping psychiatrists comply with the Rule.

The Committee continues to focus on developing evidence-based practice guidelines to assist psychiatrists and others with clinical decision-making and the care of patients. There are currently three Guideline Writing Groups.

The first writing group, chaired by Dr. Victor Reus, is developing an updated 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, is in the late phases of developing a guideline for the treatment of eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, night eating syndrome, avoidant/restrictive food intake disorder [ARFID]) based on an expert survey and a systematic review completed by the APA with Doctor Evidence, a systematic review company. This guideline will be available for public comment soon. This writing group will begin work on a delirium guideline, based on a systematic review by the Pacific Northwest Evidence-based Practice Center, after the eating disorders guideline is finalized.

A third writing group, chaired by Dr. George Keepers, will begin work shortly on a revised and updated guideline for the treatment of borderline personality disorder based on a systematic review by RTI-UNC Evidence-based Practice Center.

The Committee is considering treatment resistant depression as an upcoming topic, but learned that the VA is currently undertaking a review of major depressive disorder and when completed, the Committee will assess for use as the basis of an APA guideline. Considering this, the committee chose to wait for this systematic review, and instead will move ahead with a systematic review on generalized anxiety disorder.

In 2020, the Committee, working with Guideline Central, produced its first pocket guides for schizophrenia and will be producing guides for future topics. In 2021 the Committee is exploring making guidelines computable and allowing for topics and recommendations to be searchable, embedding the guidelines into EHRs, and eventually developing electronic clinical decision support tools.

The Committee began reviewing other guidelines and materials for inclusion on the web page and has two VA guidelines and one ASAM guideline as well as several resource documents posted. We will continue to review materials that may be appropriate for inclusion. If you know of a practice guideline or other document you think would be helpful for APA membership, please send information to [email protected].

The CQPM focuses on matters related to nationally implemented quality measures that impact psychiatrists and their patients, as well as psychiatric quality measures that may be used by other health care providers who diagnose and treat individuals with mental and/or substance use disorders.

With support from CQPM members, the APA has begun the process of identifying and prioritizing topics for quality measurement. This has provided the CQPM with a strategy on which to base APA comments for developers of quality measures (e.g., Mathematica, RAND, NCQA, etc.); the National Quality Forum; and federal and state policy makers and quality program administrators who rely on quality measures as tools to operationalize the goals and strategies set forth by national and state regulations. This prioritization effort will also aid in the drafting of APA’s comments during future public comment periods for CMS quality programs (Medicare and Medicaid). This includes CMS’s Inpatient Psychiatric Facility Quality Reporting Program, the Long-Term Care Hospital Quality Reporting Program, the Merit-based Incentive Payment System (MIPS), and other programs.

The CQPM has also been providing input and guidance on APA’s measure development efforts, which are being conducted under a cooperative agreement with the Centers for Medicare & Medicaid Services. Under the oversight and guidance of the Council on Quality, the CQPM will be working on activities to inform and educate APA members about measurement-based care and use of related measures in their own practices.

The Council oversees the work of the following workgroups:

Members of the Council on Quality Care, with support from its component groups, continue to serve in leadership and advisory roles with external quality measurement groups, including the National Quality Forum and the Core Quality Measures Collaborative. 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 the APA an authoritative voice in the national quality enterprise.

The Council continues to help guide and support the refinement and scaling of APA’s Mental Health Registry, PsychPRO, including the review of PsychPRO’s Research Guidelines that govern the use of PsychPRO data by researchers and other external entities. Recent Registry activity includes an evaluation of registry processes to meet Phase II objectives and goals. PsychPRO has proved a valuable tool for APA membership who require quality data reporting services to comply with CMS’ Merit-based Incentive Payment System (or MIPS) Program. This was a Phase I proof of concept, which resulted in participation, from across the country, of about 200 practices and 1000 clinicians, including data for 300k unique patients and 4+million encounters. PsychPRO’s technical infrastructure also proved successful in supporting several federal grants, which helped to develop quality data acquisition processes and framing common data elements for a robust data repository.

PsychPRO, as a registry of the future, is envisioned to provide quality data and information for APA to have a greater voice advocating for the profession and advancing the psychiatric care landscape. Informatics expertise and a next-generation registry platform are planned to empower the APA to advance healthcare through data science. As such, for Phase II, the PsychPRO registry aims to migrate to a next-generation registry solution that allows for flexibility and scalability, and will enhance clinician and patient engagement, to create a high quality data enclave for the purposes of quality measurement-based care as well as clinical research and development of learning healthcare systems and networks. PsychPRO is currently undergoing this transition with a new software vendor, which is planned through to the end of 2021. Onboarding of new users has already begun and transition of current users will begin 2022.

For more information about the Registry, please go to www.psychiatry.org/psychiatrists/registry

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 extreme heat in the northwestern US, multiple mass shootings, and the large condo collapse in Miami, Florida. Committee members have led special webinars on disaster psychiatry topics and participated in interviews through major media outlets. The Committee has been engaged in supporting APA’s response to the COVID-19 pandemic and written numerous guidance documents, including recent and timely guidance on cultivating preparedness for future public health emergencies, effective communication with the public during public health emergencies, and the role of psychiatrists in distributing the COVID-19 vaccines.

Chair: Charles Nemeroff, M.D., Ph.D.; This Workgroup, chaired by Charles B. Nemeroff, M.D., Ph.D., completed two manuscripts on biomarkers to guide interventions in autism spectrum disorder, and cannabinoids and THC in psychiatry. In addition, the Work Group has three manuscripts nearing completion on ecological momentary assessment in clinical research, neuroimaging biomarkers in psychiatry, and technology in mental health. The Work Group is developing papers on several topics including the treatment of posttraumatic stress disorder (PTSD), ketamine, and the use of pharmacogenomics in prescribing antidepressants.

Chair: Jonathan Alpert, M.D., Ph.D. The Work Group completed a commentary on climate change and psychiatric workforce needs and a manuscript on gaps in research on climate change and mental health. The Work Group plans to develop further papers related to mental health impacts of climate change as well as on topics including suicidality and suicide safety planning, integrated care for individuals with serious mental illness, and gun violence. Additionally, the Work Group put on a 2-part symposium on Climate Change and Mental Health during the virtual APA Annual Meeting.

Chair: Paul S. Appelbaum, M.D.; Vice‐Chairs: Kenneth Kendler, M.D. and Ellen Leibenluft, M.D. The DSM Steering Committee, its Subcommittee on Minor Changes, and its five Review Committees have been working on several dimensions of the DSM since the last report in October 2020. This year's major focus has been the development of DSM‐5‐TR, involving a thorough revision of the text and inclusion of the changes made to DSM‐5 since its publication in 2013. The addition of prolonged grief disorder under the trauma- and stressor-related disorders, which was approved by the APA Assembly and Board of Trustees, has been one of the most prominent changes to the DSM. Other notable changes include the addition of olfactory reference disorder (olfactory reference syndrome) under other specified obsessive-compulsive and related disorder, elimination of extraneous specifiers in persistent depressive disorder, modifications of the specifiers for bipolar and depressive disorders, and reconciliation of discordant versions of criterion A in substance/medication-induced bipolar and related disorder and bipolar and related disorder due to another medical condition, all also approved by the APA Assembly and Board. An Ethnoracial Equity and Inclusion Work Group was created, including experts with a diversity of backgrounds and expertise, to review the DSM-5-TR text to identify and address issues related to race, ethnicity, and geographic origin. The Work Group’s goals included ensuring that notations of differences in prevalence rates or presentations by race, ethnicity, or geographic origin do not suggest essentializing differences between groups, and that adequate emphasis is given to the impact of environmental factors such as racism and discrimination. The Work Group also updated language that may have reflected outdated or noninclusive terminology. A number of proposals for the addition, deletion, or modification of diagnostic criteria were received and reviewed by the Steering Committee, with requests made for modification or submission of additional data by the proposers. The Steering Committee expects to receive revised versions of these proposals in the coming year.