APA Council Reports

Ludmila Barbosa De Faria, M.D., Chairperson

The Committee on Women’s Mental Health continues to take the lead on issues relating to women’s mental health across the lifespan. Specifically, the Committee has led several components in the creation of a toolkit on mentorship across the psychiatrists’ career, which will be added to the APA website over the next few months. Members of the Committee submitted an APA blog entry on Texas’ controversial abortion law and a Psychiatric News article on the effects of COVID-19 on women’s careers. The group has reviewed numerous position statements as part of APA’s 5-year review process, notably revising the position statement on intimate partner violence (formerly domestic violence against women). Looking ahead, the Committee will collaborate with the National Center on Domestic Violence, Trauma, and Mental Health on intersecting areas, including maintaining access to care while protecting privacy, especially in situations of domestic violence the criminalization of SUD, particularly in the perinatal population.

Recently, as a response to the Supreme Court’s Dobbs v. Jackson ruling overturning Roe v. Wade, the Committee has mobilized to draft an APA blog. Members of the committee were also interviewed by Psychiatric News on the issue. Dr. Ludmila De Faria, the Committee Chair, and Dr. Nancy Byatt, a committee member, participated in a reproductive rights and mental health Twitter chat hosted by APA. The Committee will be working on a fact sheet on reproductive rights and mental health as a member resource and continues to brainstorm ideas to educate the public on this important and timely topic, through op-eds, resources, and social media outreach.

In collaboration with the Council on Addictions, the Council is in the process of completing an extensive revision of the position statement on substance use in older adults. The revised statement will be submitted to the Joint Reference Committee.

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, and in consultation with several other councils—Ethics, Psychiatry and the Law, Quality Care, Government Relations and Advocacy, and legal counsel—the Council agreed to recommend that the statement be retired. This recommendation will be submitted to the Joint Reference Committee for approval.

The COVID-19 pandemic has continued to impact older adults profoundly and selectively, particularly those with mental illness. To provide guidance to clinicians currently working with older adults, the Council completed a book, Geriatric Mental Health Care: Lessons from a Pandemic in time for this year’s annual meeting and which is currently available thru the APA Bookstore. In addition, three Council members, Drs. Roca, Dugue and Llorente coauthored a review article, “Special Report: Lessons from a Pandemic—How Geriatric Psychiatrists Adapted to Meet the Needs of a Vulnerable Population,” published in Psychiatric News July 20, 2022.

As part of the COVID-19 adaptations, being able to offer continuity of care to seniors via audio-only services has been critical and served to keep our most vulnerable patients safer. In addition, psychiatrists were also able to continue to provide services to rural elderly with limited or no Internet availability, as well as those who do not have the equipment to use audio-visual platforms. It has been particularly helpful that Medicare and many other payers have been willing to reimburse for audio-only clinical encounters. The Council is grateful that the APA has been and remains a strong advocate for continued insurance and Medicare coverage of these audio only visits to expand access to care for elderly Americans in need of mental health treatment.

The Council welcomed a new fellow to serve as liaison from the Council on Children, Adolescents, and their Families. The Council discussed the interface of geriatric and child psychiatry from several perspectives, including the management of aging persons with intellectual disabilities and grandparent/child relationships (kinship care). The Councils are exploring opportunities to collaborate on future joint projects.

A final draft of this resource document, “The Impact of Racism on Older African American Adults,” was reviewed by the Council of Minority Mental and Health Disparities (CMMHD), approved with no further comments, and confirmed by the Geriatric Council at its meeting at the APA Annual Meeting. The final document will now be submitted to the JRC for approval to become an official resource document during its October meeting.

Members of the Council voiced concerns regarding a recent article published in Annals of Long-Term Care that advocated for abrupt discontinuation of antidepressants in that setting, with very short term follow up. Several Council members are actively working on a review article to serve as guidance for clinicians to assess antidepressant use in long-term care, make determinations as to when it is appropriate to discontinue these medications, and offer recommendations on gradual reductions, as well as long-term follow up to quickly identify recurrent depressive symptoms.

Dr. Roane, a member of the Council, volunteered to serve as a mentor as part of this program.

Dr. Nash is representing the Council and the APA as this workgroup updates the dementia quality measures.

The Harford-Jeste Award was presented to Dr. Brendan Yarns during the APA annual meeting in collaboration with the AAGP Presidential session. The Jack Weinberg recipient, Dr. Kristen Wilkins, was honored in the APA Convocation Book.

Benjamin Druss, M.D., Chairperson

The Committee on Integrated Care developed guidance on the payment for treatment of smoking cessation during outpatient psychiatric visits, which highlights the impact smoking has on those with mental illness or addictions and illustrates, through the use of case examples, options available for billing for smoking cessation services. 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. The Committee reviewed the position statement on the role of psychiatrists in reducing physical health disparities in patients with mental illness and is giving consideration to updating the information and converting it into a member resource document. The Committee has established two workgroups that will develop resources for APA members related to the integration of physical and medical care, as well as development of patient-facing information related to integrated/coordinated/collaborative care.

Gregory Harris, M.D., M.P.H., Chairperson

The Committee has been focused on developing additional educational resources on E/M code selection criteria and documentation following an increase in audits by private payers. Educational resources will be updated to include 2023 changes to code selection criteria and documentation of services provided in facility settings as well as residential care. 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 set to take effect in January 2023; 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.

Laurence Miller, M.D., Chairperson

Members of the Committee contributed to an article, “The Impact of COVID-19 on Financing of Psychiatric Services” in the March 2022 edition of Psychiatric Clinics. Members of the committee worked collaboratively with members from the Council on Quality Care to provide expertise to CMS regarding concerns about the MIPS episode-based cost measures under development. The Committee has been monitoring the 988 implementation and is in process of developing a position statement related to advocacy for sustainable sources of funding.

Shabana Khan, M.D., Chairperson

The Committee on Telehealth continues to provide feedback to APA staff on letters to the Administration regarding the changing federal regulations pertaining to telehealth. The Committee has continued to meet jointly with the Committee on Mental Health IT for their monthly calls. As the use of technology in clinical practice continues to evolve, both Committees recognized the benefit of meeting jointly to continue to identify areas of potential overlap between the two groups. Together, they developed online member resources and a resource document on telehealth services in the context of intimate partner violence (IPV) addressing potential risks to safety and security. Finally, the Committee is collaborating with ATA to develop a best practices in videoconferencing-based document available in fall 2022.

During the 2022 APA Annual Meeting in New Orleans, La., the Council met in-person to discuss immigrant and refugee mental health. This included a discussion on 1) the mental health impact of displacement due to conflict and violence on individuals and families, 2) identifying what groups are the most impacted by displacement, and 3) how organizations can better support mental health treatment and care of displaced persons. The Council invited representatives from the World Psychiatric Association, the European Psychiatric Association, and the Royal College of Psychiatrists to participate in the discussion. The topic was also raised by the Joint Reference Committee after meeting with other APA councils developing resources on specific immigrant and refugee groups, and following APA’s responses to migration issues and refugee resettlement in the U.S. The Council on International Psychiatry and Global Health is coordinating with the APA Office of International Affairs to review APA’s existing resources intersecting areas relevant to migration and mental health to determine if there’s an opportunity for collaboration with other Councils and allied organizations to ensure such resources are inclusive of all displaced populations.

Upon recommendation by the Council on International Psychiatry and Global Health and the Chester M. Pierce Human Rights Award Nominating Committee, the APA Board of Trustees approved the recipient of the 2022 APA/APAF Chester M. Pierce Human Rights Award as Grégoire Ahongbonon, founder of Association Saint-Camilles-de-Lillis. Saint-Camilles provides mental health services and support to the mentally ill and their families via treatment and recovery centers across the Ivory Coast, Benin, and Togo. As the inaugural recipient of the newly endowed Chester M. Pierce Human Rights Award, Mr. Ahongbonon received funding to travel to the 2022 APA Annual Meeting to present the lecture “Person-Oriented Psychiatry: Changing the Way People with Mental Illness are Viewed and Treated in West Africa,” and met with various groups and components during the conference, including the Council on International Psychiatry and Global Health, to discuss their work. As the award is now endowed, it will move under the APA Foundation for future selection and approval. More information about Dr. Chester M. Pierce can be found on the APA website.

Following the establishment of the Joint Reference Committee Workgroup on Addressing Unique Needs of International Medical Graduate (IMG) Members and Members of International Origin, the Council on International Psychiatry and Global Health was invited to identify two representatives to serve on the workgroup which met for the first time at the 2022 APA Annual Meeting. The workgroup is comprised of IMG members and will review issues impacting IMGs and psychiatrists of international origin to determine how to best address them through education, advocacy, and other resources.

The Caucus on Global Mental Health and Psychiatry has established several workgroups, including an advisory group of past caucus chairs, which meets regularly to help guide the work of the Caucus. Additionally, workgroups have been established to address mentorship opportunities for international residents and trainees, global mental health education and resources, primary care collaboration, and climate change. The Caucus met in-person during the 2022 APA Annual Meeting and continues to work toward the development of educational resources and programs through its workgroups. The Caucus is also working closely with members and components of the World Psychiatric Association as appropriate.

The 2022 APA International Poster Engagement Program included 12 submissions from the following countries: Bangladesh, Canada, Egypt, Pakistan, South Korea, Tunisia, and the United States. The program is coordinated by the Council on International Psychiatry and Global Health and focuses on expanding networks, professional enrichment, and bilateral learning with participants being typically comprised of medical students, residents, and early career psychiatrists accepted to present their research during the APA Annual Meeting international poster sessions. Program reviewers consist of members of the Council on International Psychiatry and Global Health and the Caucus on Global Mental Health and Psychiatry to provide feedback on the format, layout, scientific content, method, analysis, communication, and presentation of their research poster. Individuals had the opportunity to participate in the program in-person at the 2022 APA Annual Meeting or virtually. Participants who attended the 2022 APA Annual Meeting in-person were invited to share their research at the Council’s in-person meeting.

The following are a selection of sessions relevant to international psychiatry and global mental health that were part of 2022 APA Annual Meeting program:

The Council on Research and the Committee 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.

CMELL was charged with reviewing an action paper that highlighted the prevalence of mental health issues in correctional populations, the shortage of trained psychiatrists in the correctional setting, and the fact that psychiatrists will increasingly encounter patients with a history of incarceration. The author proposed that “the APA representative member of the ACGME Psychiatric Review Committee advocate to require a correctional experience in the general psychiatry residency. This may include either didactic instructions or a clinical rotation in a jail or prison.” With respect to the resolution that the APA advocate for prison psychiatry, the Council clarified that the APA nominates members to serve on the Psychiatric Review Committee of the ACGME, but that these members do not represent the APA. The Council recommended that the author of the action paper contact ACGME directly and submit feedback when there is an open call period for comments on the revision of residency requirements.

The council was charged with reviewing an action paper that wanted the APA to recognize the National Board of Physicians and Surgeons (NBPAS) as an alternative pathway for maintaining certification based on lifelong learning. APA currently lists both NBPAS and ABPN as pathways to Maintenance of Certification (https://www.psychiatry.org/psychiatrists/education/certification-and-licensure). The action paper also requested that a psychiatrist representative from NBPAS join CMELL as corresponding member. The Council is interested in learning more about how NPBAS can support APA members through the board recertification process and has invited a psychiatrist from the organization to speak to CMELL members before voting on the action paper.

CMELL submitted comments on ACGME Common Program Requirements, strongly recommending keeping wording regarding diversity as it now exists. The comments stated that adoption of the CPR revision will make it more difficult for medical schools to fulfil this LCME accreditation standard “to achieve mission-appropriate diversity outcomes among its students, faculty, senior administrative staff, and other relevant members of its academic community,” since LCME and ACGME accreditation standards will not be aligned. Alignment fosters synergistic and more efficient and transparent recruitment and retention of critically needed “faculty, senior administrative staff, and other relevant members of its academic community” for both GME and UGME.

The Innovation Committee, which reports to the Council, brought back the Mental Health Innovation Zone, rebranded as the Mental Health Innovation Exchange. The event, which took place on August 18–19, 2022, is APA’s showcase and catalyst for advancing technologies in psychiatry, dedicated to answering the question “what’s next in mental health technology?” The event was delivered virtually in 2022, as a reintroduction of the program which has not taken place since 2019 due to the global pandemic. The committee will begin work on planning for the 2023 event, which is to be included as part of the APA Annual Meeting in San Francisco.

The Committee on Physician Burnout and Wellbeing Committee completed survey on burnout and depression among 1,500 psychiatrists. The completed data analysis demonstrating that lack of control over schedule, being female, and discrimination are associated with an increased risk of burnout and depression among psychiatrists. The Committee is in the final steps for publishing the data from their survey. Badr Ratnakaran, M.D., also created an online educational program, “Physician Burnout & Wellbeing,” which is available for free.

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 following position statement was approved: “The APA commits to ensuring that psychiatry residents and fellows are supervised by psychiatrists in conducting psychiatric diagnostic evaluations, managing psychiatric emergencies, and managing psychiatric conditions with medications and not solely by advanced practice providers.”

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 was approved by the Joint Reference Committee (JRC), and the JRC commended the workgroup on this cross-collaborative effort.

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 is a great opportunity to provide a space for them. 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.

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

The following positions statements and resource documents were sent to the CMMH/HD for review in 2022:

Dr. Walter Wilson, Chairperson of the Council on Minority Mental Health and Health Disparities, represented mental health parity workgroup of the National Association of Insurance Commissioners (NAIC) on the mental health and racial structural barriers preventing patients from receiving care, how insurance companies can help promote health equity, and what both providers and patients go through when trying to join an insurance network.

CMMH/HD was invited by the APA Administration to provide feedback on NIDA’s Racial Equity Action plan. The Council provided specific feedback around including structural racism education across all the organization.

The Committee on Judicial Action requested input from the Council on Minority Mental Health Disparities on an amicus brief in the case of Tyrie Washington v. State of Maryland, a case involving a young Black man’s flight from police.

An emotional support animal (ESA) is an animal of any species that is not trained to perform a specific task, but rather alleviates a person’s psychiatric disability through companionship. ESAs are different from service animals and other disability-related assistance animals. Psychiatrists may be asked to write a letter supporting a patient’s request for an ESA. Laws about ESAs vary across federal, state, and local jurisdictions. As this is an evolving area of law, it is essential for psychiatrists to stay up to date with laws in their jurisdiction. The Council on Psychiatry and Law created this resource document to provide an overview of the clinical, ethical, and legal considerations that a psychiatrist should consider when asked to write an ESA letter for a patient. This resource document was approved by the Joint Reference Committee in June 2022 and is available at https://psychiatry.org/getattachment/3d42da2a-9a4d-4479-869f-4dd1718f1815/Resource-Document-Emotional-Support-Animals.pdf.

In nearly all states, if a physician determines that hospitalization of a minor is medically indicated and their parent or guardian consents to the hospitalization, then the minor is admitted. These admissions are typically characterized as “voluntary” admissions, even though the minor may be objecting. State statutes differ as to whether a minor above a designated age should be permitted to consent to psychiatric hospitalization without parental consent. Similarly, in some states, parental consent for psychiatric admission is not sufficient if the youth is older than a certain designated age. This resource document seeks to lay out several key issues related to the rules governing the psychiatric hospitalization of minors so that psychiatrists can be better informed when rendering their judgment in particular cases. This resource document was approved by the Joint Reference Committee in January 2022 and is available at https://www.psychiatry.org/getattachment/6dd28cc3-fdf2-46a4-bb29-d2ce62bc5321/Resource-Document-Consent-for-Voluntary-Hospitalization-of-Minors.pdf.

In July 2020, APA adopted a position statement on voluntary and involuntary hospitalization of adults with mental illness, stating that when persons with mental illness who need inpatient care are unwilling to consent to voluntary admission, some form of involuntary hospitalization should be available. The Council on Psychiatry and Law drafted this position statement on civil commitment of minors to extend those principles to minors who require involuntary hospitalization. The position statement asserts that in any case in which a minor has been determined to need inpatient hospitalization, and neither the minor nor a parent or guardian has provided valid consent under state law, the minor should be admitted in accordance with the principles and procedures laid out in the position statement on voluntary and involuntary hospitalization of adults with mental illness. This position statement was approved by the APA Board of Trustees in December 2021 and is available at https://www.psychiatry.org/getattachment/5c61e4a5-4a42-46a5-9efc-aeacb0a76c25/Position-Civil-Commitment-of-Minors.pdf.

Reena Kapoor, M.D., Chairperson

The Committee on Judicial Action 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:

The Council continues to work on an array of topics, including correctional and telepsychiatry issues, discriminatory policies preventing access to housing and employment, enhancing the learning experience about jail and prison psychiatry in general psychiatry residency programs, racism and social determinants of health and inequities, restrictions on patient access to personal items while psychiatrically hospitalized, and the public health and safety consequences of legalizing cannabis. Additionally, the Council frequently cross-collaborates with other APA components, including the Councils on Addiction Psychiatry, Mental Health and Health Disparities, Medical Education and Lifelong Learning, Healthcare Systems and Financing, Quality Care, Advocacy and Government Relations, 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. Raymond F. Patterson in 2022. The Manfred S. Guttmacher Award recognizes an outstanding contribution to the literature of forensic psychiatry; it was awarded to Drs. J. Reid Meloy and Jens Hoffman for their book, The International Handbook of Threat Assessment, 2nd Edition. Both committees are in the process of selecting 2023 award recipients. Additionally, the Council on Psychiatry and Law and Committee on Judicial Action held a joint session in September focused on the ramifications of the recent Dobbs v. Jackson Women's Health Organization Supreme Court decision for the profession of psychiatry.

The Committee on Mental Health Information Technology (CMHIT), chaired by Dr. John Torous, continues to provide feedback to APA staff on letters to the Administration on federal regulations pertaining to digital health.

The Committee on Mental Health IT has continued to meet 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 in the process of writing a best practices in mental health guidance and resource document, which will be reviewed by the full CMHIT 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. The Committee also continues to expand upon the telepsychiatry toolkit on psychiatry.org.

The Committee is also developing a position statement on psychiatry and social media, which hopes to address concerns that are emerging in the media and in draft legislation. The committee hopes to have this position statement completed by next year.

The Committee has also developed a resource document on telehealth services in the context of intimate partner violence (IPV), addressing potential risks to safety and security. After Joint Reference Committee approval, a brief will be posted on psychiatry.org and the resource will be disseminated.

Finally, the Committee is collaborating with ATA to develop a best practices in videoconferencing-based document. The document is currently in its final draft stages.

The APA practice guideline for the treatment of patients with eating disorders was approved by the Assembly on March 21 and by the Board of Trustees on April 6. The guideline covers anorexia nervosa, bulimia nervosa, binge eating disorder, night eating syndrome, and avoidant/restrictive food intake disorder (ARFID). The draft was sent to the Assembly for electronic review and vote. The Assembly had 2 weeks to discuss the guideline and there were two “office hour” calls to answer any questions. The approved guideline is posted on the APA web site with the final copy set version available later this year.

The writing group that worked on eating disorders, chaired by Dr. Cathy Crone, has started work on a delirium guideline, based on a systematic review by the Pacific Northwest Evidence-Based Practice Center. The writing group chaired by Dr. George Keepers has started work 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 writing group chaired by Dr. Victor Reus will be 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.

The Committee was considering treatment resistant depression as the next topic but learned that the Department of Veterans Affairs (VA) was updating major depressive disorder. The VA shared their evidence review and the Committee is discussing if it can serve as the basis for a treatment resistant depression guideline. In the meantime, work on the generalized anxiety disorder review has continued with a completed systematic review due this summer.

The Committee now reviews other guidelines and materials for inclusion on the web page and has three VA guidelines, including the recent revision on major depressive disorder, and one ASAM guideline as well as several resource documents posted. We will continue to review other materials that may be appropriate. 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 Committee on Quality and Performance Measurement (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 is working to identify and prioritize 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 effort will also inform the Committee’s guidance regarding measures included in APA’s PsychPRO registry.

Building on APA’s recent measure development efforts, 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, with input on quality measurement and patient assessment, including SDOH. Recent registry activity includes onboarding participants to the new registry technical vendor, Arbor Metrix. Participation stands currently at just over 70 practices (including three large systems: Sheppard Pratt, Cambridge Health Alliance, and Hackensack Meridian) with approximately 750 clinicians (i.e., psychiatrists, psychologists, social workers, therapists, nurse practitioners, and physician associates). Data file specification and safe and secure data transfer processes were finalized allowing for streamlined onboarding. New data file specs and transfer processes also allow for better data quality control and mapping to the registry database infrastructure.

PsychPRO 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 health care through data science. As such, the PsychPRO registry is being built on a next-generation registry solution including collaborations with several MBC focused technologies, allows for flexibility and scalability, and will enhance clinician and patient engagement. As we continue to grow, PsychPRO will provide for a high-quality data enclave for the purposes of quality measurement-based care as well as clinical research and development of learning health care systems and networks. For more information about the registry, please go to www.psychiatry.org/psychiatrists/registry.

Joshua Morganstein, M.D, Chairperson

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 floods and tornadoes in Kentucky, and the multiple mass shootings in New York and Texas. Committee members have led special webinars on disaster psychiatry topics and participated in interviews through major media outlets. Committee members led a two-part course on disaster response during the APA Annual Meeting. The Committee has been engaged in supporting APA’s response to the U.S. withdrawal from Afghanistan and resulting refugee crisis as well as the war in Ukraine.

Elizabeth Haase, M.D., Chairperson

The Committee on Climate and Mental Health has been engaged in creating a roadmap for the climate change response of the APA. We have worked with the APA annual meeting and finance committees, given presentations, and passed an action paper that will result in a workgroup to make the APA’s practices more sustainable across the board, focused initially on greening the carbon footprint of how we hold meetings, with recommendations for how members can reduce their carbon footprint to meet 2030 targets underdevelopment. We have worked with Council on Medical Education and Lifelong Learning to establish an ongoing collaboration between our two committees for curriculum development and link the climate curriculum targets we are establishing as APA standards to other national climate health education initiatives through Group for the Advancement of Psychiatry gaps, Climate Psychiatry Alliance, Global Consortium on Climate and Health Education, and Medical Societies Consortium on Climate and Health. We have held several meetings with national leaders from the Substance Abuse and Mental Health Services Administration and the United States Department of Health and Human Services to determine what grant, community, and collaboration efforts are possible to ensure mental health needs are included in national policy efforts to combat the ill effects of climate change. The Committee has worked with the APA’s media and government relations groups on a number of press releases on APA’s response to extreme heat and other climate emergencies as well as to produce a media kit for Earth Day highlighting the impacts of climate change on social media.

Charles Nemeroff, M.D., Ph.D., Chairperson

The Diagnostic and Novel Treatments Workgroup (Biomarkers WG) completed manuscripts on schizophrenia and substance use, the neuropsychiatric sequelae of COVID-19, technology and mental health, and biomarkers of autism, which have all been submitted for publication. In addition, the workgroup is developing papers on additional topics including the treatment of posttraumatic stress disorder, ketamine, psilocybin, MDMA, an update on the use of pharmacogenomics in prescribing antidepressants, and structural racism and supporting diversity in psychiatric research (workforce issues). The Council’s Biomarkers WG chair worked in collaboration with Dr. Gregory Barber, fellow on the Ethics Committee, and Dr. Steven Siegel to describe a case report that addresses potential untoward consequences of psilocybin use. This manuscript has been accepted for publication in the American Journal of Psychiatry. The workgroup, in collaboration with the Council on Addiction Psychiatry, completed a position statement on the use of psychedelic agents for mental health.

Jonathan Alpert, M.D., Ph.D., Chairperson

The workgroup commentary on climate change and psychiatric workforce needs was published in Psychiatric Services, and its manuscript on climate change and mental health, which focused on gaps in research, was published in Lancet Planetary Health. The workgroup plans to develop papers on topics such as research on suicidality and suicide safety planning, particularly among traditionally unrepresented groups, integrated care for individuals with serious mental illness, and gun violence.

The Council has developed a manuscript, “Structural Racism in Psychiatric Research Careers: Eradicating Barriers to a More Diverse Workforce,” led by Dr. Alik Widge, that is currently under review for consideration for publication in AJP.

Paul S. Appelbaum, M.D., Chairperson; Kenneth Kendler, M.D., and Ellen Leibenluft, M.D., Vice-Chairs.

The DSM Steering Committee, its Subcommittee on Minor Changes, and its five Review Committees have been working on multiple dimensions of the DSM since the last report in October 2021. This year’s major accomplishment has been the finalization and publication of DSM-5-TR in March 2022. The text revision involved the addition of new diagnoses (prolonged grief disorder, stimulant-induced mild neurocognitive disorder, and the restoration of the diagnosis of unspecified mood disorder). In addition, it contained clarifying modifications to the criteria sets for more than 70 disorders. Symptom codes for suicidal behavior and non-suicidal self-injury, and a code for no diagnosis or condition were added to the chapter Other Conditions That May Be a Focus of Clinical Attention. Four cross-cutting review groups (Culture, Sex and Gender, Suicide, and Forensic) as well as a Workgroup on Ethnoracial Equity and Inclusion reviewed DSM-5-TR text to ensure appropriate attention to risk factors such as racism and discrimination and the use of non-stigmatizing language.

Several proposals for the addition, deletion, or modification of diagnostic criteria were received and reviewed by the DSM Steering Committee through its online portal. The addition of a symptom code for impairing emotional outbursts was approved by the Steering Committee, Neurodevelopmental Disorders Review Committee and the APA’s Assembly and Board of Trustees. The code will be added to the next editions of DSM-5-TR and is effective October 1, 2022. In addition, the DSM Steering Committee continues to harmonize the ICD-10-CM codes in the DSM with the coding updates published by the National Center for Health Statistics (NCHS) to help streamline their use by clinicians on a daily basis.