Delegates Take Action on Issues Related to Mental Health

Solitary confinement for incarcerated people with mental illness: The House approved policy to support limiting the use of solitary confinement of any length, with rare exceptions, for incarcerated people with mental illness in adult correctional facilities. The resolution further encourages appropriate stakeholders to explore, develop, and implement alternatives to solitary confinement for incarcerated people in all correctional facilities.

State licensing board inquiries about mental health treatment: The AMA approved policy encouraging state licensing boards to “require disclosure of physical or mental health conditions only when a physician is suffering from any condition that currently impairs his/her judgment or that would otherwise adversely affect his/her ability to practice medicine in a competent, ethical, and professional manner, or when the physician presents a public health danger.” The policy advocates using the language recommended by the Federation of State Medical Boards that reads: “Are you currently suffering from any condition that impairs your judgment or that would otherwise adversely affect your ability to practice medicine in a competent, ethical, and professional manner?”

Best practices in treating opioid use disorder: Delegates asked the AMA’s Task Force on Reducing Opioid Deaths to work with the American Hospital Association and other relevant organizations to identify best practices being used by hospitals and others to treat opioid use disorder as a chronic disease, including initiating or providing opioid agonist or partial agonist therapy in inpatient, obstetric, and emergency department settings; providing cognitive-behavior therapy as well as other counseling as appropriate; establishing appropriate discharge plans; and participating in communitywide systems of care for patients and families affected by this chronic medical disease.

Physician-assisted suicide/physician-assisted death: A report from the Council on Ethical and Judicial Affairs (CEJA) on physician-assisted suicide was not approved but was sent back to the council for further work. The report stated that existing AMA policy against the practice of physician-assisted suicide should not be changed, but it said there were “irreducible differences” of opinion about what constituted compassionate, ethical care at the end of life and that existing AMA medical ethics offered room for physicians to participate in jurisdictions where the practice was legal. The report was the object of extensive and impassioned debate in reference committee hearings, with physicians offering opinions on both sides—sometimes including personal anecdotes of experiences with family members at the end of life. On the floor of the House, delegates voted to send the report back for further revision.

Separation of migrant children from their caregivers: Delegates approved a resolution opposing the practice of separating migrant children from caregivers in the absence of immediate physical or emotional threats to the child’s well-being. The resolution was in response to widespread coverage in early June of the administration’s policy of “zero tolerance” for families apprehended trying to cross the border. After enormous backlash, the administration rescinded the policy in an executive order signed on June 20. Speaking at the time on behalf of the Academy of Child and Adolescent Psychiatry, David Fassler, M.D., told the House, “We are well aware that sudden separations from one or both parents increase the risk of anxiety, depression, and posttraumatic stress disorder. This is especially true for children fleeing war, violence, and chaos in their home countries. The academy is on record opposing any policy or legislation that separates children and families in these stressful situations. As the academy’s president, Dr. Karen Wagner, recently said, ‘It is our responsibility as physicians to put an end to the idea and practice of separating vulnerable children from their families, including high-risk immigrant children.’ ” ■