APA’s Government, Policy, and Advocacy Update (December 2022)

Earlier this year, the U.S. Preventive Services Task Force (USPSTF) released draft recommendations around screening for depression and suicide risk in patients over age 18. In its draft, USPSTF recommended screening adults, including pregnant and postpartum adults, for depression. Further, they concluded that current evidence is insufficient to assess the balance of risks and benefits of screening for suicide in adults.

APA provided comments, signed by APA CEO and Medical Director Saul Levin, M.D., M.P.A. APA strongly encouraged USPSTF to expand the depression screening recommendation to include screening with a brief evidence-based intervention and/or referral when indicated as opposed to screening alone.

Further, APA urged USPSTF to recommend targeted suicide screening, such as for individuals who screen positive for depression. This would be “a more balanced and reasonable recommendation” than not screening for suicide risk at all. “This is especially important in groups at high risk for suicide, such as individuals over the age of 65,” the comments stated.

Finally, APA raised concerns with USPSTF’s statements regarding pharmacologic agents taken by individuals who are pregnant or postpartum, suggesting that they could be interpreted as a recommendation against medications for depression in this population. “[I]t may reinforce the already reflexive tendency on the part of many clinicians to discontinue (or avoid) psychotropic medications during pregnancy for those individuals who might need and benefit from them,” the comments stated. APA attached a more detailed response to this aspect of the USPSTF recommendations in its comments, developed by APA’s Committee on Women’s Mental Health.

October marked the one-year anniversary of three organizations—the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association—declaring a national state of emergency on children’s mental health. APA joined the Sound the Alarm for Kids initiative last year, and this year, to commemorate the anniversary, APA and over 130 organizations sent a letter to President Joe Biden, urging him to declare a national emergency for the youth mental health crisis.

“While much has been done by the federal government to address the crisis, the mental health of our nation’s youth continues to deteriorate,” the letter stated. It points to increasing rates of suicide among children (especially Black boys and girls under age 12), increasing number of emergency department visits for suspected youth suicide attempts and diagnoses of anxiety, depression, and behavioral or conduct issues. It also noted the challenges imposed by systemic inequities such as racism, homophobia, transphobia, economic inequality, and under-resourced schools.

“Issuing a National Emergency Declaration would galvanize existing critical funding streams and support to help ensure that all children and adolescents can access the full continuum of mental and behavioral health care from promotion and prevention to early identification and treatment, especially in times of crisis,” the letter continued. “Of particular note, we need a robust and comprehensive mental health workforce strategy that prioritizes recruitment of underrepresented populations and ensures trained pediatric mental health and primary care professionals are adequately paid for the services they provide.” ■