Reports to the Membership

Last June, in Dobbs v Jackson Women’s Health Org., the Supreme Court overturned Roe’s protection for reproductive rights. The APA joined the Group of 6 and more than 70 health care organizations in statements opposing the Dobbs decision. APA will continue to engage with our physician colleagues at the national level on legislation or policy proposals that interfere into the patient-physician relationship and will assist DBs that seek to advocate for or against various state proposals that interfere into the provision of evidence-based medical care.

On June 22, the House overwhelmingly passed H.R. 7666, the Restoring Hope for Mental Health and Well-Being Act of 2022, by a vote of 402 to 20. The legislation includes several provisions APA has prioritized, including: language from APA’s legislation to encourage update of the Collaborative Care Model; federal grants to states to enhance parity enforcement; elimination of the federal opt-out for nonfederal governmental health plans from requirements of the Mental Health Parity and Addiction Equity Act (MPHAEA); a boost in authorized funding for crisis services including the launch of the 9-8-8 Lifeline; and reauthorized funding for maternal mental health and substance use disorder screening programs. Additionally, the package extends the funding authorization for Project AWARE and reauthorizes the Minority Fellowship Program at $25 million for Fiscal Years 2023 to Fiscal Year 2027. In support of the bill, President Brendel testified before the Committee in April 2022, and 300 APA members engaged with their legislators via APA’s grassroots engagements asking them to support the bill.

On June 23, the House passed the Support the Resilience of Our Nation’s Great (STRONG) Veterans Act, a comprehensive mental health package aimed at increasing the Department of Veterans Affairs’ capacity to address veteran suicides and expand access to mental health resources. The omnibus package rolls together 22 bills, including provisions to improve mental health outreach to Native American veterans and minoritized veterans, bolster VA’s outreach to justice-involved veterans, and expand Vet Center eligibility to student veterans. The package includes several measures for which APA has advocated, including an expansion of eligibility to participate in the VA’s Governors’ Challenge veteran suicide prevention program, a requirement that the VA carry out the “Solid Start Program” to respond to the needs of veterans who have recently separated from the Armed Forces, as well as an expansion of access to the Peer Support Program of the VA. The package is expected to receive consideration in the Senate this fall.

The Inflation Reduction Act, H.R. 5376 was passed in August 2022. The long-awaited reconciliation package includes significant tax incentives for clean energy technologies along with modifications to the tax code meant to reduce the federal budget deficit. The bill also allowed Medicare to negotiate prescription drug prices and extended the expanded Affordable Care Act insurance premium assistance program through 2025.

In late December, the 117th Congress passed H.R. 2617, the Consolidated Appropriations Act of 2023 (CAA), which included numerous legislative priorities for the APA, including significant funding of critical MH and SUD programs. Below is a summary of APA’s legislative priorities passed in the CAA. APA is engaged in follow-up actions on many of these items in the new Congress:

The CAA increased appropriations for a series of APA-supported programs and included other key policy and funding items on which we continue to advocate:

APA and our physician partner organizations supported the “Improving Seniors Access to Timely Care Act,” H.R. 3173, which was designed to reduce denials by Medicare Advantage plans via prior authorization. Although that bill passed the House in September with overwhelming bipartisan support, a subsequent cost estimate of $16.2 billion over 10 years was issued by the Congressional Budget Office (CBO) and prevented enactment in 2022. Efforts to persuade CBO that its cost estimate was incorrect are ongoing.

APA submitted comments on episode-based cost measures being developed by CMS for use in the MIPS program. The measures under development include one focused on Major Depressive Disorder and another focused-on Psychoses and Related Conditions. CMS is conducting field testing of the measures. As part of this process, clinicians or clinician groups who have been attributed at least 20 episodes under any of the measures will receive a cost report for their review and feedback. APA supported APA-developed quality measures related to functioning, suicide safety planning, and reduction in suicidal thoughts and behaviors, as well as measures related to screening for social determinants of health. However, we did not support proposed cost-measures for the MIPS program, repeating our concerns about the patient population and attribution methodology. These cost-measures, if not applied appropriately, could have unintended consequences by emphasizing cost-reduction which could place patients at risk and have the potential to exacerbate problems with access to care.

APA submitted comments supporting a CMS proposal that plan applicants be required to demonstrate that they comply with network adequacy standards before CMS will approve an application for a new or expanded Medicare Advantage (MA) plan. APA also provided CMS with requested information regarding building an adequate network of behavioral health providers including easing administrative burdens, improving reimbursement rates, use of telehealth and wider adoption of the Collaborative Care Model. APA also supported efforts to improve health equity by requiring all Special Need Plans to include one or more standardized questions on the topics of housing stability, food security, and access to transportation as part of their Health Risk Assessments.

APA joined two coalition letters to CMS raising concerns and urging them not to move forward with the previously finalized changes to split or share visits. The group proposed an alternative policy, which would allow physicians or qualified health professionals to bill split or share visits based on time or medical decision-making. The letters requested CMS to seek further input from stakeholders to ensure that the revised policy does not have any unintended consequences for patients or physician-led team-based care.

HEDIS, a set of measures assessing health plan performance across a range of domains related to health care quality and patient experience, is updated by the National Committee for Quality Assurance (NCQA) annually. This year, APA provided feedback to NCQA on measures addressing social risk screening and intervention, deprescribing of benzodiazepines in older adults, as well as an NCQA proposal to expand race and ethnicity stratification to select HEDIS measures.

On April 4, 2022, CMS released its proposed rule regarding 2023 policies for the Inpatient Psychiatric Facility Quality Reporting (IPFQR) program. APA submitted comments on the proposed rule, supporting positive payment updates and providing input on future payment methodologies and billing policies. In addition, APA provided feedback on a CMS Request for Information regarding approaches to the collection of data on social disparities that impact health.

The Federal Trade Commission solicited comments on the business practices of pharmacy benefit managers and their impact on patients and their physicians. APA submitted comments highlighting the administrative burdens that contribute to physician burnout and reduce clinical time available for patient care and quantity requirements that pose dangers to some patients. APA also addressed changes to prescription-tiering that apply to inexpensive generics and other medications that are widely used to treat psychiatric conditions, cannot be quickly or easily changed, and result in increased costs to patients and/or disruptions to their care.

In a May 2022 letter to Department of Labor (DOL) Secretary Martin Walsh, APA urged the administration to employ its new powers to investigate and sanction plans that are noncompliant with the Mental Health Parity and Addiction Equity Act. APA highlighted the DOL’s report to Congress that not a single health plan had submitted a compliant parity analysis and the Government Accountability Office’s report that consumers continue to be unable to access mental health care. APA will be meeting with the DOL regarding this letter and member complaints in the near future.

APA, the American Psychological Association, and the National Association of Social Workers met with CMS to express member concerns about the administrative burden of the good faith estimate requirements and to seek clarification of the regulations. APA anticipates ongoing meetings with CMS as the agency refines guidance and releases additional regulations and will update the membership accordingly.

In August 2022, APA responded to a federal request for information on the Medicare Advantage program, in which CMS sought input on approaches to advancing health equity and ensuring that MA enrolees have access to high-quality care. APA’s comments provided input on capturing data related to social determinants of health, guidance on MA marketing activities, the use of telehealth to improve patient outcomes and enhancing network access to behavioral health services. In addition, APA urged CMS to incentivize the collaborative care model and the adoption of measurement-based care as part of the MA program.

CMS requested information on promoting equity and efficiency in CMS programs. APA recommended CMS ensure that measurement of disparities is based on reliable, accurate, and actionable data that allows providers to implement concrete solutions and to reduce burden and increase incentives for psychiatrists to expand their practices accepting more Medicare patients. APA also urged CMS to make flexibilities permanent following the public health emergency, meeting beneficiaries' needs and increasing access.

On August 31, APA responded to the CMS Proposed Rule on Conditions of Participation (COP) for Rural Emergency Hospitals (REH) and Critical Access Hospital COP Updates. APA supports expanding health care access in rural communities while encouraging CMS to further support access to mental health and substance use treatment through these facilities. The APA report “The Psychiatric Bed Crisis in the U.S.” was highlighted to urge CMS to reconsider an exemption for patients needing inpatient psychiatric care until a bed in a facility that most meets the needs of a patient is available. APA also used this opportunity to encourage the coverage and reimbursement of mental health and substance use outpatient treatment services out of the REH to increase the availability of quality services in rural health communities.

In September, APA submitted comments on the CMS proposed rule on the 2023 Physician Fee Schedule and Quality Payment Programs. Our comments focused on ensuring access to mental health and substance use disorder treatment through continuing support for coverage and appropriate reimbursement of services, including those provided via telehealth (including audio-only). On November 1, 2022, CMS released the final CY 2023 Physician Fee Schedule, effective January 1, 2023. CMS adopted several of APA’s recommendations in the final rule, including maintaining audio-only billing capabilities for Medicare mental health services, allowing initiation of buprenorphine via telehealth, increasing payment for evaluation and management services in facility settings (hospital, nursing facility) and services provided in the home/residence, and expanding the definition of a “high-priority measure” in the QPP to include health equity-related quality measures.

On October 3, APA responded to the US Department of Health and Human Services proposed rule Nondiscrimination in Health Programs and Activities, supporting the Agency’s commitment to clarify and broaden nondiscrimination protections to include sexual orientation and gender identity in access to covered health programs and activities, including pregnancy or related conditions. The proposed rule also includes nondiscrimination in the delivery of health programs and activities through telehealth services, including but not limited to, Limited English Proficiency individuals and individuals with disabilities. APA previously responded to changes to Section 1,557 and will continue to support vulnerable populations’ access to and coverage of mental health, substance use, and other health care services.

APA’s comments to SAMHSA’s Request for Information on Possible Agency Actions Regarding Mental Health and Substance Use Wellbeing in the Context of Climate Change and Health Equity address pressing issues the Agency faces while developing priorities. APA recommended priorities for SAMHSA to ensure behavioral health equity across all populations, but with a focus on those most vulnerable to climate change and natural disasters. As a leader on the mental health impacts of climate change and natural disasters, APA has offered support to partner with SAMHSA to address the inequities in care as the intensity and frequency of climate events increase.

Comments submitted by APA to the U.S. Preventive Services Task Force supported the recommendations of screening for depression, suicide risk, and anxiety in conjunction with brief interventions, as opposed to screening alone. This includes screening for individuals over the age of 65. APA expressed concern about the potential negative interpretation of statements regarding the use of pharmacologic agents during the perinatal period, which are safe and effective treatment options.

APA, along with its partners working to amend 42 CFR Part 2 (confidentiality of substance use disorder patient records) met with the United States Office of Management and Budget to share recommendations about changes to the rule. The recommendations include administrative simplification, language to address the conflict with Part 2’s disclosure, segregation of a patient’s Part 2 data from the rest of a HIPAA database, and rules for the revocation of consent. APA continues to monitor the Federal Register for the release of the rule.

APA responded to a request for comments from the Food and Drug Administration (FDA) supporting FDA’s efforts to increase access to Naloxone, the opioid overdose reversal agent, by making it available as an over-the-counter medication. APA applauds this effort to help reduce overdose mortality, while suggesting several strategies to help mitigate any unintended consequences to changing Naloxone from a prescription to a nonprescription product, such as providing adequate end-user education, adding intranasal naloxone to the list of FDA Essential Medications, and encouraging collaborations with CMS to keep costs low.

CMS requested information on the creation of a national directory of health care providers and services. CMS would like to alleviate burdens and improve the state of provider directories through a CMS developed and maintained, Application Programming Interface (API)-enabled national directory. APA responded by recommending frequent updates to keep information updated and accurate but also to take into account that psychiatrists may work in multiple settings, accepting new patients may change more frequently than on an annual basis, and participation in networks can vary. Moreover, APA suggested that information such as participation in a Collaborative Care model can help patients select a primary care provider in order to access the care necessary when searching for a physician.

APA submitted comments to the Drug Enforcement Agency (DEA) on a package of proposed rules around telemedicine prescribing of controlled substances. If finalized, these rules would modify longstanding regulation to slightly increase flexibility of DEA-registered practitioners to prescribe controlled substances without having seen the patient in person first after the end of the COVID-19 PHE. In response to the buprenorphine rule, which addresses the prescribing of buprenorphine for opioid use disorder, APA recommended that the DEA remove in-person visit requirements for buprenorphine, at a minimum for the duration of the opioid public health emergency. In response to the telemedicine rule, which addresses the prescribing of Schedules III–V nonnarcotic controlled substances, APA recommended significant revisions to the final rule to maintain access to clinically indicated treatment. APA shared its recommendations widely, including with other medical societies and stakeholders and with each District Branch, to increase the reach of these recommendations.

APA joined the American Academy of Child and Adolescent Psychiatry (AACAP) in a letter to the DEA highlighting the crisis of the widespread shortage of prescribed stimulants. AACAP and APA requested information from the DEA about their actions to address the shortage and requested a meeting to discuss potential solutions as soon as possible. AACAP and APA also shared case studies of the effect of this shortage on our members and their patients to demonstrate to DEA the importance of mitigating and communicating its cause and solutions to the public.

APA sent a letter CMS urging action in the 2024 Medicare Physician Fee Schedule and other pertinent rulemaking to maintain critical access to mental health care through telehealth as the COVID-19 PHE comes to an end. These recommendations included: 1) maintaining standardized coding for telehealth rather than delineating CPT codes by modality; 2) maintaining reimbursement for telehealth services at the same rate as in-person care; 3) permanently removing in-person visit requirements for mental health care; and 4) maintaining the virtual supervision of residents delivering telehealth services. CMS has taken significant strides toward maintaining access to telehealth services for Medicare beneficiaries, and these steps would help codify remaining areas of opportunity for clinicians to deliver high-quality, technology-enabled mental health care.

APA commented on a proposed rule to modify regulations governing Medicare Advantage, the Medicare Prescription Drug Benefit (Part D), Medicare cost plans, and Programs of All-Inclusive Care for the Elderly (PACE). APA supported many of the proposals, including when and how MA plans develop and use coverage criteria and utilization management policies to ensure that MA enrolees receive the same access to medically necessary care they would receive in Traditional Medicare. APA supported proposals that would streamline prior authorization requirements, including adding continuity of care requirements and reducing disruption in ongoing care for beneficiaries by requiring that when an enrollee is granted prior authorization approval it will remain valid for the full course of treatment. APA also supported marketing proposals intended to protect MA and Part D enrollees and people shopping for Medicare coverage, advance health equities and improve access to behavioral health care.

APA President Rebecca Brendel and the Administration met for a roundtable with Secretary of Labor Marty Walsh and Acting Assistant Secretary Ali Khawar to discuss what areas need focused parity enforcement and how to address workforce shortages and employee/workplace mental health. Dr. Brendel highlighted APA members’ concerns regarding facility concurrent reviews, retroactive reviews and claw-back in the outpatient setting, and reimbursement rates. Dr. Brendel also discussed the collaborative care model and the evidence supporting the model’s ability to be a workforce multiplier, improve outcomes and contribute to physicians’ satisfaction, and pointed out that access to mental health is not only a health issue but a significant economic issue. Both Secretaries emphasized that parity enforcement remains a high priority for the Department, as does the mental health well-being of the nation’s labor force.

In July 2022, APA led a group of over 40 stakeholder organizations in sending a letter of support to the Senate HELP Committee asking for Collaborative Care Language to be included in the Committee’s anticipated health program reauthorization package. The letter specifically asked the HELP Committee to include Title Ill, Section 301 from the House-passed H.R. 7666, the Restoring Hope for Mental Health and Well-Being Act of 2022 The letter to Senate HELP in support of this provision represents the broad stakeholder interest in Collaborative Care, including from the physician community, employer groups, insurers, mental health advocates, and many others. This legislative initiative was ultimately passed as part of the Consolidated Appropriations Act described above.

Across the United States, there is interest in reforming prior authorization to increase patient care to patients and reduce regulatory burdens on physicians. Based on member feedback about how prior authorization limits timely access to treatment, APA developed legislation to reform the process. During the State Advocacy Conference in October, APA shared its new state model legislation on prior authorization The model language would prohibit prior authorization in certain circumstances, including for generic prescription drugs, on any drugs prescribed without interruption for 6 months, and on any long-acting injectable medication. The language also requires a physician in the same specialty as the prescriber to make a denial of coverage. APA staff have now shared the model legislation and supporting materials with all district branches, 25 of which appeared interested in pursuing some version of the model legislation in 2023 and future legislative session. Maryland, Massachusetts, Montana, and New Jersey have introduced versions of APA’s model prior authorization reform legislation. While Maryland’s legislation received several hearings, it did not meet the legislative deadline to move forward. However, Maryland DB’s work on this legislation has further solidified its relationship with Maryland’s medical society, and both organizations are excited to pursue this legislation again in the future. Other states, such as Mississippi, Texas, and North Dakota, supported different variations of prior authorization legislation. Mississippi passed “gold card” legislation through the legislature only to be vetoed by Governor Reeves. While this is frustrating, APA and district branches are resolved to keep working together to reform prior authorization.

APA continues to work closely with district branches that face legislation reducing physician involvement in patient care. As of mid-2023, APA had worked with at least 25 district branches to oppose nurse practitioner, physician assistant, and psychologist prescribing legislation that would either decrease or altogether remove physicians from patient care. At the beginning of 2022, APA developed resources for states that are likely to see psychologist-prescribing legislation. On October 27, 2022, APA President Rebecca Brendel, MD, JD, joined a panel hosted by the CATO Institute entitled, “Can Prescribing Psychologists Help Solve the National Mental Health Crisis?” The panel discussed whether lawmakers should expand psychologists’ scope of practice to allow them to prescribe medication. Dr. Brendel discussed the lack of data on the safety and efficacy of psychologists prescribing and encouraged support for access improvements like telemedicine and the collaborative care model.

While district branches have been able to defeat many unsafe prescribing bills the past few years, 2023 has been a challenging year. In the 2023 legislative session, there have been hundreds of scope of practice bills introduced in the states, including psychologist prescribing legislation, legislation authorizing nurse practitioners to be the sole practitioner involved in committing patients, nurse practitioner and physician assistant independent practice, and pharmacist prescribing. The challenge is further compounded by our nation’s mental health crisis, with legislators desperate to pass anything that seems like an option for increasing access to care, even if that includes psychologist prescribing.

Despite years of work by district branches to build important relationships with state legislators, psychology prescribing legislation was introduced in 12 states—Arizona, Colorado, Hawaii, Illinois, Iowa, New Mexico, New York, Oklahoma, Pennsylvania, Texas, Vermont, and Washington. By the end of March, legislation had been enacted in one new state, Colorado, and modified existing authority in another, New Mexico. Unfortunately, support from the governor increased the challenges faced by the Colorado DB and contributed to a modified version of that proposal being enacted. However, the Colorado DB was able to secure a significant amendment requiring written physician sign-off before a prescription from a psychologist may be filled. That amendment was the direct result of action taken by a strong legislative champion the DB has cultivated over a period of years.

It is not yet clear whether other states will enact new, or expand existing, authority for psychologists to prescribe, but APA has worked with DBs so far this year to defeat such legislation in several states, including Hawaii, Oklahoma, and Washington, and continues to assist where legislation remains active.

APA continues to help District Branches find safe ways to increase access to care, such as the collaborative care model (CoCM). In both Montana and Pennsylvania, previous sponsors of psychologist prescribing legislation opted to support CoCM instead. In the summer of 2022, Pennsylvania legislation was signed into law allocating funding for primary care providers interested in expanding CoCM after APA/DB/UPenn advocacy, and Colorado also passed a similar funding law for CoCM and integrated care within Colorado. By the end of 2022, legislation supporting coverage for the psychiatric CoCM codes had been signed into law in a total of seven states: Connecticut, Illinois, Louisiana, Massachusetts, Montana, New Jersey, and Texas (Texas addressed only Medicaid). In 2023 so far, legislation supporting CoCM has been introduced in Arizona, Arkansas, Maryland, Minnesota, Nevada, Oklahoma, South Dakota, North Dakota (state hospital only), and Wyoming. These district branches are working closely with APA staff on strategy in all these states. Unfortunately, South Dakota’s bill was defeated in Committee by a vote of 7–6 because the insurers opposed a new mandate in the state, but the district branch will still work to educate legislators and others about the model and its positive implications for patients. The Wyoming and North Dakota bills have been signed into law, with the measures in the remaining states still pending as of the end of March 2023.

APA’s State Advocacy Conference took place on October 15–16 in Minneapolis, Minnesota. The State Advocacy Conference included social media training and panels on gun access reform, 988 and the crisis continuum of care, scope of practice and patient safety, and legislation to promote access through the collaborative care model, and the Prior Authorization Reform legislation. APA’s request of DBs, areas and councils to identify new members to participate resulted in many new faces and the opportunity to engage new members in advocacy. The Division of Government Relations is continuing to encourage attendees to engage in advocacy and further hone their advocacy skills and confidence.

The DSM Steering Committee received eight new proposals since May 2022. Four of these were referred to the proposers with a request for more data and information. One proposal requested the addition of “Parental Alienation” to the section “Other Conditions that May Be a Focus of Clinical Attention.” The proposal was reviewed by the DSM Steering Committee and is currently being reviewed by the Neurodevelopmental Review Committee. Another proposal requested the addition of “Developmental Visual-Spatial Disorder (nonverbal learning disability)” in the DSM in the Chapter “Conditions for Further Study.” Both DSM Steering Committee and Neurodevelopmental Review Committee reviewed it and provided feedback to the proposers who are now collecting the additional data requested. A proposal to add “Postpartum Psychosis” within the Bipolar and Related Disorders chapter was reviewed by the DSM Steering Committee and sent to the Serious Mental Disorders Review Committee for evaluation. Additionally, a proposal to add Suicide Crises Syndrome to the DSM is currently being reviewed by the Internalizing Disorders Review Committee.

The DSM Steering Committee is also collaborating with the Council on Geriatric Psychiatry to discuss Major and Mild Neurocognitive disorders within the DSM. The workgroup on Personality Disorders continued to meet to discuss the best approach to review significant proposals for the diagnosis of personality disorders, including the current categorical approach, the ICD-11 system, the Alternate Model of Personality Disorder (AMPD) currently in section III of the DSM, and a revised proposal for personality disorder classification.

The DSM Steering Committee is evaluating procedures for the addition or changes of the Assessment measures on the DSM website. The discussion was initiated by receiving a proposal to add Military Cultural Formulation Interview (CFI) to the website, as well as by request by the PROMIS group to update their measures hosted on the DSM website.

In addition, the department of Research is working closely with other departments in the APA to advance knowledge of the DSM. For example, the Divisions of Research and Education collaborated to develop the webinar: “Emerging Topics in Psychiatry—DSM-5-TR: What You Need to Know.”

Three APAF Special Topics Small Grants of up to $25,000 were awarded to Drs. Felicia Boakye-Dankwah, William Coe, and German Velez. These current APAF Fellows continue to conduct their research related to the impact of structural racism/racial discrimination on a) patients with mental and substance use disorders, b) the psychiatric workforce (including early career psychiatrists), and/or c) the practice of psychiatry. The grant period ended on September 29, 2022, for 1-year proposed projects, and will end on September 29, 2023, for 2-year proposed projects. The Division of Research continues to monitor research activities being carried out under the supervision and guidance of a mentor at their primary institution.

The 2022 Psychiatric Research Fellowship was awarded to Dr. Kevin Xu; his fellowship began on July 1, 2022, and will conclude on June 30, 2024. His mentored research examines area-based determinants of substance use disorders, treatment initiation, and drug-related poisonings in pregnancy. As Dr. Xu’s project is awaiting APA’s IRB approval to start the data analysis phase, he continues to meet with his Division of Research mentors on regular basis. Dr. Uzoamaka (Stephanie) Asonye (2021–2023) is in the data analysis phase of her project. Dr. Asonye’s research focuses on the management of agitation in hospital-based settings and differences in management practices based on race.

The 2023 Research Colloquium will be held on May 20–21, 2023, at the APA Annual Meeting in San Francisco. 48 mentees have been invited to this Colloquium including five international mentees. Recruitment of senior research mentors and statistical mentors is underway. Presentations on day one will cover grantsmanship, negotiating an academic psychiatrist-scientist career, negotiating a leadership career that enables active involvement in research, mentorship, and work-life balance. Day 1 also includes a presentation on developing a research proposal and identifying appropriate study design(s). This presentation is followed by a workshop during which mentees at each table work together to identify a topic of clinical and/or public health importance, identify gaps in research, and identify study designs that can be used to address the research topic of interest. Day 2 consists of didactic Lunch and Learn sessions, small group breakout sessions, and poster sessions. The Colloquium is partially funded by an R-13 grant from the National Institute on Drug Abuse (NIDA) for $25,000 per year from 2020 to 2022. The Division of Research applied to renew the Colloquium’s funding from NIDA. ACNP also provides $20,000 per year to partially fund the Colloquium. The APAF continues to fund the program at $125,000 in 2023. Funding from the Medical Technology Enterprise Consortium (MTEC) continues to support research focused on military and veteran mental health including traumatic brain injury, PTSD, and suicide. The Society on Biological Psychiatry (SOBP) reviewed and approved our application for $20,000 per year for 2 years to fund a 12-month Colloquium Booster Session at their Annual Meeting. The funding will be in effect for the 2023 Colloquium cohort.

The AMNet team continues to support participating practices in adapting to the new platforms, TetherAll and BHWorks. The team continues working on adding train-ing and educational resources to help AMNet participants.

The third AMNet Collaborative newsletter is being developed that will cover the updates on the new platforms, TetherAll, and BHWorks. The article “Patient Engagement and Adaptations to Delivery of Care for Opioid Use Disorder during COVID-19 In Outpatient Practices” has been revised to be resubmitted to Psychiatric Services. Another manuscript, “Clinical Utility and Feasibility of Deploying AMNet Measures into Addiction Medicine Practice Settings: AMNet Beta Test,” is currently being drafted.

In the final phase of this initiative, the research team has completed the data collection through focus groups and surveys conducted among practitioners and pregnant persons. The team is conducting data analysis, which will inform the deliverables of the final toolkit. The toolkit will include white papers, webinars, and factsheets for behavioral health providers and pregnant persons. The research team is working with APA Marketing and Communications to strategize the toolkit layout and its promotion at the 2023 Annual Meeting. The team is also working to present the project findings at the Presidential Symposium on Identifying and Addressing Treatment and Training Gaps in Perinatal Mental Health, which will occur on May 23, 2023. The review of the literature is almost complete. The panel members have submitted their manuscripts which will be edited and turned into four white papers on 1) epidemiology, etiology, and outcomes, 2) clinical care, 3) training, and 4) special populations. 2020 Mom, a national nonprofit focused on closing gaps in maternal mental health care through education, advocacy, and collaboration, has provided funding to conduct a nonbehavioral health provider survey that aims to understand the family physicians, OB/GYNs, physician assistants, and midwives’ experiences and barriers to treating pregnant persons with mental and substance use disorders. The survey is being piloted among advisory panel members before it is circulated among the nonbehavioral health providers in the next 2 weeks.

The CMS Quality Measures Development Grant ended on September 13, 2021, however the review process for the measures to become part of CMS’s MIPs program has been ongoing. Three of the five measures that were developed from this initiative were approved by CMS to go through NQF’s Measure Application Partnership (MAP) review process to decide approval for inclusion in CMS’s MIPS program. Starting in December 2022, APA worked with CMS to finetune the measure specification. In addition, APA attended the mandatory NQF MAP Health Equity Advisor Group, Rural Health Advisory Group, and Clinician Workgroup meetings to address questions or concerns from the public as well as the review groups on the reliability, validity, and clinical utility of three measures. Following these meetings, the three quality measures received 90%–100% approval from the NQF Clinician Workgroup. CMS will consider the MAP review’s feedback over the next few months to decide whether the three measures will move forward and be part of the rulemaking process. We are still awaiting the final decision.

APA Group Chats are a professional development series for APA administrative staff, focused on diversity, equity, inclusion, belonging and antiracism (DEIBA). The conversations are prompted by a variety of in-person experiences that include, but not limited to thought leaders, exercises, literary works, cultural events, and community service. During this time frame, APA hosted the following.

APA has secured the services of a consulting group, the Arredondo Consulting Group, who specializes in addressing DEIBA in organizations. An initial step of the consulting group was to gain insight into the experiences and perspectives of APA administrative staff. One of the recurrent themes that emerged from this qualitative approach to data gathering was a desire for a neutral individual who could assist staff in the resolution of conflicts or concerns. After a competitive bid process, the staff selected an ombuds who is engaged with APA.

APA executed a mental health webinar and podcasts series that examined inequities through an interdisciplinary lens leveraging innovative frameworks. This webinar series is a continuation of the APA Fireside Chats discussions where strategies and opportunities to improve the mental health of historically marginalized and minoritized communities are examined. Topics included:

APA organized five sessions for the APA annual meeting in support of the theme: “Innovate, Collaborate, Motivate: Charting the Future of Mental Health.” Sessions include:

In honor of Bebe Moore Campbell National Minority Mental Health Awareness Month, APA established the MOORE Equity in Mental Health Initiative. Through this program, APA celebrates every July with a series of community-wide events focused on promoting mental health equity for young people of color Events included:

APA continues to focus on diversifying the psychiatric workforce. As such, APA participated in the Black Men in Medicine Strategy Summit and the Summit on Men of Color in the Health Professions. APA also hosted Howard University’s Medical Psychiatry Residents and Students Interested in Psychiatry Group at the APA Headquarters. APA is actively supporting the recruiting efforts of the APA/APAF workforce program by presenting at the Latino Medical Student Association Residency Fair, exhibiting at the Association of American Medical Colleges’ Annual Meeting. In addition, Dr. James shared information about the program during her presentation at the Black Psychiatrists of America Spring Meeting, at the Northwestern University’s Department of Psychiatry and Behavioral Sciences. Virginia Tarlow, M.D., Grand Rounds on the “Social Determinants of Health Nonmedical Factors That Influence Mental Health Outcomes,” and at the Colorado Psychiatric Society on “What Does Equity Mean and How Do Social Determinants of Health Affect Mental Health Equity?” APA will continue to engage with APA members and organizations to increase the number of diverse candidates. APA also expanded outreach efforts for the APA/APAF SAMHSA MFP program with visits to programs in seven states. These efforts yielded a robust pool of diverse candidates from communities underrepresented in psychiatry.

APA organized and supported the APA President’s Listening Sessions with each M/UR Caucus. The focus of these listening sessions was to obtain feedback and input on the utility of “M/UR” as a designation in APA, suggestions and recommendations on “self-identification” (i.e., names proposed by members of the seven M/UR groups), and feedback on priority issues that APA is not addressing under the current nomenclature.

APA is launching this series to bring together interdisciplinary experts in perinatal mental health, reproductive health, and research to discuss ways to leverage innovative frameworks to address mental health care inequities among Black, Indigenous women, and birthing people of color. Initial offerings will include:

. APA is planning the implementation of the Future of Psychiatry Task Force’s recommendations that the Board of Trustees adopted in March 2023. Central to achieving the goals of ensuring the future of psychiatry is PsychPRO, APA’s national mental health registry. PsychPRO is designed to support the mission of improving the quality of care and quality of life for all patients with mental health and substance use disorders, through data driven programs and initiatives that facilitate and underpin the processes associated with a learning health care system at the local and national level. PsychPRO supports several pillars of the APA and is a key aspect in helping to shape the future of the field.

Highlights since May 2022 include:

The 2023 Annual Meeting will be held in San Francisco, CA, May 20–24. The program will include over 600 scientific sessions, 1,000 posters, and 22 paid courses, including six Master Courses. This year’s program will include several special tracks, including the return of the popular clinical updates track, as well as a track for residents, fellows, and medical students, and for international medical graduates. Four plenary sessions will bring in high-profile keynote speakers from around the country, including critically acclaimed actress Ashley Judd, who will be presenting at the Opening Session; best-selling author Heather McGhee, who will be presenting at the new Emerging Voices; journalist Beth Macy, journalist and author of Dope Sick, who will be presenting the 2023 William C. Menninger Convocation Lecture; and David and Christena Huntsman, who will be presenting the new Changing the Conversation plenary. For those who cannot attend in-person, there will be a live, interactive, virtual steaming option for learners to have access to selected sessions in real time. Both in-person and virtual attendees will be able to earn up to 43 AMA PRA Category 1 credits.

The research track for the 2023 Annual Meeting is presented by the National Institute for Alcohol Abuse and Alcoholism and will include sessions on treating alcohol use disorders in women, managing AUD and other co-occurring disorders, and a lecture from NIAAA director, Dr. George Koob, on changing the conversation around alcohol in the United States.

Additional session highlights include “Presidential Workgroup on the Future of Psychiatry” by Drs. Robert Trestman, Carol Alter, Erik Vanderlip, and Shabana Khan; “Give It Your Best Shot: Learning How to Administer Long-Acting Injectable Antipsychotics” by Drs. Donna Rolin, Robert Cotes, and Megan Ehret; “America’s Overdose Crisis Amidst the Covid-19 Pandemic: What Are We Learning?” by Dr. NIDA director Nora Volkow; “Where We Are and Where We Must Go: Evidence Driven Substance Use Disorder Treatment” by Dr. Sarah Wakeman (part of APA’s Frontiers of Science Lecture Series); and “Breaking the Glass Closet: Challenges and Opportunities for LGBTQ+ individuals in a Minority Culture of Psychiatry and Leadership” by Drs. Pratik Bahekar and Kenneth Ashley, providing that there is something for everyone at the Annual Meeting in San Francisco.

The APA launched the 2023 Annual Meeting Self-Assessment in Psychiatry, which is a series of 100 questions that will help physicians self-assess current knowledge in major topics in psychiatry, providing feedback that can be used as the subsequent basis for focused CME, lifelong learning, and/or professional development. Learners will be able to earn up to 8 AMA PRA Category 1 credits and MOC Part II. The self-assessment is free to APA members and will be available until December 2023. (Table 1.)

The Mental Health Services Conference (MHSC) was held in person in Washington, DC on October 13–14, 2022. The 2-day program created a collaborative and multidisciplinary experience for attendees to share their ideas and engage in team-based care discussions with colleagues across disciplines. Conference attendance was 583, and met the goal of creating an intimate, collaborative, knowledge-exchange event. The two luncheon plenary sessions, sponsored by the APA Foundation, were highly rated by attendees, as was the CEO plenary on day 2, featuring a recorded fireside chat between Assistant Secretary for Mental Health and Substance Use Dr. Miriam Delphin-Rittmon and Dr. Saul Levin.

A self-assessment was provided as part of the Mental Health Services Conference this year for anyone delivering mental health services, particularly those serving on a multidisciplinary mental health care team. Learners were provided with a series of 50 questions that will help mental health professionals self-assess current knowledge in major topics in psychiatry, providing feedback that can be used as the subsequent basis for focused CME/CE, lifelong learning, and/or professional development.

The 2023 Mental Health Services Conference will be held on October 12–14 at the Capital Hilton in Washington, DC. The Scientific Program Committee is currently in the process of planning the program with consideration of the comments and feedback received from attendees last year. Building on the successes of the conference in 2022, we will have a leadership track for residents, fellows and early career psychiatrists; additional breakouts and networking opportunities; and sessions featuring robust conversations and actionable takeaways for all members of the care team. Registration for the conference is now open.

SMI Adviser. A $14.6 million dollar SAMHSA-funded initiative implemented by APA, currently in Year five of funding. SAMHSA has notified APA that it will provide a sixth year of funding, without competition. Recent data and accomplishments include:

In partnership with the SPRC, APA executed six webinars that focused on a variety of topics related to suicide prevention. To ensure the topics and format are relevant for future resources, the SPRC will facilitate needs assessments and explore different content delivery methods. The APA continues to offer SPRC developed enduring activities via the APA Learning Center as the collaborators assess data to determine the future deliverables.

In collaboration with Morehouse’s African American Behavioral Health Center of Excellence, the APA continues to develop the Striving for Excellence webinar series. The second grant year concluded on September 29, 2022, and in that year, APA conducted 12 webinars and began the process of developing self-paced learning modules. We are in the third year of the grant partnership and working to create 12 webinars and two self-paced learning modules. The information provided in the series will help to increase behavioral health systems’ capacity to provide outreach, engage, retain and effectively care for African American/Black care seekers.

APA started a No Cost Extension in July 2022 after completing the third year of the grant. Under the PCSS grant, the APA produces and administers live webinars to train providers on the evidence-based prevention and treatment of opioid-use disorders.

In Grant Year 3, the OL team supported the development of six webinars on the topics: “Preventing Suicide in People with SUD; HIV and SUD—Intertwined Epidemics,” “Opioid Use in Women,” “Hepatitis C in People with SUD,” “Dual Diagnoses—Major Depression and SUD,” and “Youth and Adolescent Overdoses.” Additionally, the OL team delivered an in-person “Buprenorphine Waiver Training” in New Orleans, as well as an additional “Buprenorphine Waiver Training” at the AACAP Annual Meeting in Toronto. In 2023, the OL team is producing six webinars on the following topics: The Connection Between Mental Health and Opioid Use Disorders; SUD Screening in Primary Care; SUD in Late Life; SUD Care in Rural Areas; and Opioid Prevention via Housing First.

APA is a subawardee to AAAP on this SAMHSA-funded program. Previously, the APA was charged with delivering six virtual learning collaboratives focused on applying evidence-based practices in prevention, treatment, and recovery of opioid use disorders. In the second grant year, which started at the end of October 2021, APA delivered two 8-week trainings on the topics of Telepsychiatry for OUD and Integrated Care for People with Comorbid SUD/Mental Health Conditions. The third grant year started at the end of October 2022. This grant year, APA is switching focus on deliverables to include webinars as there is a need for shorter form, adult learning. The APA team will produce three Virtual Learning Collaboratives and three one-hour webinars. In addition, representatives from the APA will attend an ORN Summit in May to discuss priorities and brainstorm next steps for the grant.

The APA developed a five-module course on Tobacco Cessation. The course offers MOC Part 2 credits through the self-assessment activity. Both the Tobacco Cessation eLearning module and self-assessment are free of charge and available to APA members and nonmembers in the APA Learning Center for up to 3 years from the launch date.

NTI is a research initiative, funded through a 5-year agreement between the Children’s Bureau, and the Center for Adoption Support and Education (C.A.S.E.) working alongside the University of Maryland School of Social Work, Institute for Innovation and Implementation. NTI developed, piloted, and evaluated two state-of-the-art, standardized, web-based trainings to build the capacity of the child welfare and mental health workforce in all states, tribes and territories, to better understand and address the mental health needs of children, youth and their families moving toward or having achieved permanency through adoption and guardianship. APA will host the NTI content and will provide 25 credits of Continuing Education credits for various professions, including physicians, social workers, psychologists, and nurses in compliance with the requirements of the relevant accreditation entities through its Learning Management System for 3 years.

The APA has developed educational content for CME credit (36 hours of CME including 16 hours of self-assessment for MOC) and made the education credits available without charge to APA members and ABPN Diplomates.

The APA Joint Accreditation application was approved on December 12, 2022, and APA is now a provider of interprofessional continuing education. Joint Accreditation for Interprofessional Continuing Education offers organizations the opportunity to simultaneously serve multiple professions, including physicians, nurses, psychologists, social workers, and other health care professionals, through a single, unified application process, structure, and set of accreditation standards. Joint Accreditation for physicians, psychologists, nurses, and social workers allows the APA to position the organization as a strategic partner in health care improvement initiatives and collaborative care. Interprofessional education and team-based care is a critical component of health care improvement, with evidence demonstrating that interprofessional continuing education improves health care professionals’ performance and patient outcomes.

APA accredited more than 80 CME activities in 2022 as part of the Joint Provider Program, in partnership with over 70 District Branches, allied groups, and external mental health organizations. Over 30 CME applications have been submitted for accreditation in Q1 of 2023.

“Physician Burnout and Well-Being,” a 3-credit enduring course, which involves self-paced material as well as engaging testimonials, was launched in June 2022. This course is meant to educate physicians to recognize the symptoms of burnout, develop risk mitigation strategies, and apply intervention techniques for preventing burnout in practice.

APA launched a CME accredited webinar series, APA Emerging Topics, which focuses on hot topics in psychiatry. These are 90-minute zoom webinars, with 60 minutes reserved for the presentation followed by a 30-minute Q&A. The live webinar is a free member benefit, and the recording will be made available on the Learning Center at an additional cost for nonmembers. These learning opportunities include 1.5 AMA PRA Category 1 Credits and occur bimonthly. The series is scheduled to continue through August 2023.

Disasters and Mental Health: Helping your Patients Deal with Adverse Effects of Climate Change, Pandemics and Mass Violence is scheduled to launch in April 2023. This course will walk the learners through the fundamentals as well as interventions in disasters. This asynchronous didactic portion of the course will cover topics such as the basic concepts in disaster and preventive psychiatry, psychological and behavioral effects of disasters, risk, and vulnerability to disasters, psychological first aid, risk and crisis communication, leadership consultation and preparedness for disasters.

In late spring and early summer APA’s Learning Management System (LMS) has begun its transition to the Oasis platform, which includes a new Continuing Education Management System (CEMS). CEMS was developed to ensure APA is compliant with Joint Accreditation/ACCME standards, while also improving the user experience when submitting applications for CME/CE accreditation. By hosting CEMS within the LMS, the Division of Education hopes to see an increase of efficiency in building courses once the applications for CME/CE credits are approved, as well as improved functionality of reporting, updated dashboards for administrators, and an enhanced user-experience for the front-end users who are submitting the applications.

The Book Acquisitions team continues to acquire titles of interest to our audience of psychiatrists and mental health professionals. APA released 26 books in 2022, including the DSM-5-TR and related titles, and is on track to publish 23 titles in 2023. In addition, the team is tracking an additional 78 projects for publication over the next 3 years. The team met with over 35 authors at the 2022 APA annual meeting, generating ideas for new projects and touching base with authors on ongoing projects.

The American Journal of Psychiatry (AJP) saw its impact factor score, a bibliometric calculation that describes the level of importance a journal’s published output has on the scientific literature, rise to 19.242. This Impact Factor score ranks AJP among the highest, not just in the category of psychiatry, but also among all the more than 21,000 indexed journals in scientific, technical, engineering, and medical publishing, where AJP’s 19.242 is ahead of 99% of the rest of the publishing world. Psychiatric Services also saw its impact factor rise to above four, which puts it in the top tier of publications in psychiatry.

Both AJP and PS have been pursuing efforts to improve how research is conducted, analyzed, and reported by adding checklists in the submission process to ascertain the level at which research involving human participants was conducted with an eye toward inclusiveness and equity. The editors of Psychiatric Services are reporting on these efforts at the 2023 APA Annual Meeting.

The American Journal of Psychotherapy continues its return to prominence now that it is part of the APA Publishing portfolio. A recent issue was dedicated to the object relations work of Otto Kernberg, and a special presentation copy will be given to Dr. Kernberg at an APA reception in San Francisco.

Focus published issues devoted to 1) novel neurotherapeutics, 2) children’s mental health, 3) innovations in psychotherapy and mental health service delivery, and 4) borderline and other personality disorders, with the last issue forming the basis of a live interactivity event conducted during APA’s Annual Meeting.

APA successfully completed significant revisions to two reprints of DSM-5-TR, including a major update of the diagnostic codes for neurocognitive disorders. DSM-5-TR continues to perform well, meeting budget goals and exceeding prior TR editions by substantial variance. Other titles continue to be impacted by supply chain and global logistics issues of paper availability as well as disruptions in shipping and deliveries, both domestic and international. Other books released in the past year include the fourth edition of the APA Practice Guideline for the Treatment of Patients with Eating Disorders; the second edition of Gabbard’s Textbook of Psychotherapeutic Treatments; Otto Kernberg’s Hatred, Emptiness, and Hope; and Ezra Griffith’s Race and Excellence: My Dialogue With Chester Pierce.

PsychiatryOnline and journal subscription sales are all strong and re are tracking to budget set at $2.8M year-to-date. JobCentral, our job search and career planning platform for Psychiatrists has had a strong first quarter and has launched a new dashboard which provides job seekers with statistical information surrounding job searches.

Over the past year, digital publishing implemented a CME feature to the journal product line on PsychiatryOnline. The DSM-5-TR was published on PsychiatryOnline.org as well as all updates and remains the version of record. PsychiatryOnline remains strong as the online leader in psychiatric research and experiences a high volume of monthly visitors. The podcast Psychiatry Unbound continues to host current thought leaders from our book editors and has a steady growth in listeners. Additionally, A new DSM-5-TR app is slated to be released, on both iOS and Android, in early May.

In 2022, APA was highly successful in its efforts to extend its voice to the public and other external stakeholders. APA responded to a record 467 media requests (+10% vs. 2021) and earned more than 76,000 media mentions (+68%), reaching an estimated combined audience of nearly 354 billion people, with a media value of nearly $667 million. This includes several national TV and radio networks and top-tier newspapers. In addition, APA’s patient and families’ webpages had 16,833,000 unique viewers, while APA has added more than 220,000 followers to our social media channels during this time, pushing our footprint to well over 1 million. The momentum established in 2022 continued into 2023, with outreach through February seeing 11,887 media mentions, reaching an estimated combined audience of more than 45 billion; patient and families ‘website unique pageviews of more than 2.9 million; and more than 21,000 new social media followers. APA is also launching a speaker’s bureau of member experts before the 2023 Annual Meeting.

APA continues to increase its library of animated explainer videos on mental health disorders to provide education succinctly and creatively via social media. We have added videos on the following topics (in both English and Spanish): anxiety, SUD, OCD, impacts of climate change on mental health, PTSD, depression, “what is a psychiatrist,” suicide/self-harm, ADHD, warning signs of mental illness, eating disorders, and gambling disorder. Collectively, our animated videos have been viewed more than 350,000 times. Videos in the queue for development in the coming months include autism spectrum disorder and burnout.

APA saw continued success raising public awareness and obtaining media attention through the release of its Healthy Minds monthly and annual public opinion polls. Topics and themes covered since May 2022 include mental health in the workplace, summer mental health, mental health in relation to the justice system, the midterm elections, seasonal change, holiday mental health, nutrition and mental health, 2023 New Year’s Resolutions, the impact of current traumatic events, pets and mental health, and school mental health.

APA launched its online resource www.LaSaludMental.org in September in conjunction with the start of Hispanic Heritage Month, and outreach to Spanish-language media continues to earn placements in outlets across the country. In addition, an APA Foundation series of Spanish radio public service announcements citing LaSaludMental.org as a resource were distributed to more than 650 Spanish-language stations across the country in September and November 2022. Through February 2023, these PSAs have aired more than 1,500 times, reaching an estimated audience of more than 6 million. Two new sections for LaSaludMental.org covering ADHD and PTSD are under development and are scheduled to be released in the Spring of 2023.

At the end of 2022, APA increased its membership to 38,073 members. This number is 2.8% higher than the previous year’s total of 37,037 members, as the Association saw growth across medical student, resident-fellow, general and international member categories.

Memberships increased or were flat in 56% percent of district branches from 2021 to 2022, while 44% percent saw slight decreases. Medical student membership (globally) increased 14.5% from the end of 2021 to 4,802 worldwide.

Resignations decreased 37% in calendar year 2022 to 60 resignations, versus 95 resignations in 2021. Nearly half did not specify a reason, 22% indicated retirement, 10% said financial reasons/dues are too high, and 3% (two members) stated philosophical differences.

The budget for dues revenue for 2022 was $8.6M. Year-end dues revenue is estimated at $8.9M at the time of writing. The Administration also continues to implement the new Retired and Semi-Retired membership categories. 101 members have opted-in to retired status and 185 have opted-in to semiretired status.