Reports to the Membership

Report of the Secretary

Maria A. Oquendo, M.D.

It is my constitutional duty and personal privilege as Secretary of the American Psychiatric Association to report to the membership on the actions taken by your Board of Trustees over the past year. The official actions of the Board are summarized in the appended documents. Following are some of the highlights.

APA Strategic Initiatives

The Board at its March 2015 Meeting adopted a 5-year strategic plan for the APA that focuses on the integration of psychiatry into all care settings and support for our members in this transition, education, research, and diversity. The Board said its goal was to determine how best to meet the challenges and opportunities ahead, internally and externally, and have a multiyear focus. The adopted plan was informed by the most extensive all-member survey in APA’s recent history, which drew over 2,200 member responses.

The Strategic Initiatives are:

• Advancing the integration of psychiatry in the evolving health care delivery system by:

  	a.	Advocating for the central role of psychiatry in all care settings and working to ensure full implementation and robust enforcement of mental health parity.
  	b.	Meeting the educational needs of members throughout their careers and providing assistance to them in the changing practice environment and as new technologies emerge.
  	c.	Building the psychiatric workforce, developing and advocating for equitable reimbursement models, and safeguarding the practice of psychiatric medicine.

• Supporting research to advance treatment and the best possible clinical care, as well as to inform credible quality standards; advocating for increased research funding by:

  	a.	Leading the development, refinement and evaluation of appropriate quality measures.
  	b.	Conducting, supporting and encouraging research, including data analysis and registries to inform the APA, its members and society about current and future best practices of mental health delivery and clinical care.
  	c.	Leading advocacy to increase funding from public and private sources to advance the understanding, prevention, treatment and ultimate cure of mental illness.

• Educating members, patients, families, the public, and other practitioners about mental disorders and evidence-based treatment options

• Supporting and increasing diversity within the APA; serving the needs of evolving, diverse, underrepresented and underserved patient populations; and working to end disparities in mental health care

These strategies will be achieved through increased advocacy, effective communication, strengthened member services, a well-structured organization and association, and collaboration with other medical as well as mental health organizations.

Maintenance of Certification (MOC)–Part IV: Improvement in Medical Practice

In keeping with a formal request from the Assembly Executive Committee, Dr. Boyer brought forward a motion about part IV of the American Board of Psychiatry and Neurology (ABPN) MOC requirement.

At the March 2014 Board of Trustees Meeting, the Board, acting on the recommendation of the Assembly Executive Committee, and representing over 36,000 psychiatrists, voted to support the elimination of part IV of MOC.

Therefore, the Board of Trustees recommends to the ABPN that they lobby and advocate the American Board of Medical Specialties to eliminate part IV of the MOC, that the APA reaffirms its commitment to lifelong learning and quality improvement and support for the highest scientific and ethical standards of medical practice and that the APA will establish a joint Board and Assembly Work Group with the charge to evaluate the broad issue of MOC for psychiatry and its relationship to maintenance of state licensure and other accrediting bodies. The goal of the work group is to return timely reports to the Board and Assembly, including recommendations, if appropriate, for any positions the APA should take regarding any and all parts of MOC.

Following the Board vote, Drs. Summergrad and Levin sent a letter to ABPN President and CEO Larry Faulkner expressing the Board’s concern.

Practice Guidelines for Psychiatric Evaluation of Adults

The Board approved the Practice Guidelines for Psychiatric Evaluation of Adults at its December 2014 Meeting. The Guidelines were passed by the APA Assembly at its November 2014 meeting. The Guidelines are composed of the following sections:

• Guideline 1–Review of Psychiatric Symptoms, Trauma History, and Psychiatric Treatment History as Part of the Initial Psychiatric Evaluation

• Guideline 2–Substance Use Assessment

• Guideline 3–Assessment of Suicide Risk

• Guideline 4–Assessment of Risk for Aggressive Behaviors

• Guideline 5–Assessment of Cultural Factors

• Guideline 6–Assessment of Medical Health

• Guideline 7–Quantitative Assessment

• Guideline 8–Involvement of the Patient in Treatment Decision-Making

• Guideline 9–Documentation of the Psychiatric Evaluation

Position Statements

Position statements can be found on the American Psychiatric Association’s website: www.psychiatry.org in the “Learn Section,” Library & Archives under APA documents. The APA Board of Trustees addressed several position statements throughout the year. Five new position statements were approved, 20 position statements were reaffirmed, and seven position statements were retired.

New Position Statements.

• The APA Board of Trustees approved the proposed Position Statement: Psychotherapy as an Essential Skill of Psychiatrists at its July 2014 meeting.

• The APA Board of Trustees approved the proposed Position Statement: Prior Authorizations for Psychotropic Medications at its July 2014 meeting.

• The APA Board of Trustees approved the proposed Position Statement: The Need to Monitor and Assess the Public Health and Safety Consequences of Legalizing Marijuana at its July 2014 meeting.

• The APA Board of Trustees approved the proposed Position Statement: Residency Training Needs in Addiction Psychiatry for the General Psychiatrist at its December 2014 meeting.

• The APA Board of Trustees approved the proposed Position Statement: Firearm Access, Acts of Violence and Relationship to Mental Illness and Mental Health Services at its December 2014 meeting.

Reaffirmed Position Statements.

• The APA Board of Trustees reaffirmed and retained the 1997 Position Statement: Relationship between Treatment and Self Help at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2008 Position Statement: Elder Abuse, Neglect and Exploitation at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2009 Position Statement: Discriminatory Disability Insurance Coverage at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2009 Position Statement: Psychiatrists Practicing in Managed Care: Rights and Regulations at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2008 Position Statement: State Mental Health Services with a revised title: Leadership of State Mental Health Services at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2004 Position Statement: Universal Access to Healthcare at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2007 Position Statement: Federal Exemption from the Institutions for Mental Diseases (IMD) Exclusion at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2009 Position Statement: Abortion and Women’s Reproductive Health Rights at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2009 Position Statement: Xenophobia, Immigration and Mental Health at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2007 Position Statement: Peer Review of Expert Testimony at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2007 Position Statement: Joint Resolution against Torture at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2000 Position Statement: Moratorium on Capital Punishment in the United States at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 1997 Position Statement: Discrimination against Persons with Previous Psychiatric Treatment at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2007 Position Statement: Insanity Defense at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2006 Position Statement: Psychiatric Participation in the Interrogation of Detainees at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2005 Position Statement: Death Sentences for Persons with Dementia or Traumatic Brain Injury at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2005 Position Statement: Mentally Ill Prisoners on Death Row at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2004 Position Statement: Diminished Responsibility in Capital Sentencing at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 1995 Position Statement: Endorsement of the Patient-Physician Covenant at its December 2014 meeting.

• The APA Board of Trustees reaffirmed and retained the 2009 Position Statement: Provision of Psychotherapy for Psychiatric Residents at its December 2014 meeting.

Retired Position Statements.

• The APA Board of Trustees approved the retirement of the 2004 Position Statement: Mental Health & Substance Abuse and Aging: Three Resolutions at its December 2014 meeting.

• The APA Board of Trustees approved the retirement of the 2002 Position Statement: Access to Comprehensive Psychiatric Assessment and Integrated Care at its December 2014 meeting.

• The APA Board of Trustees approved the retirement of the 1999 Position Statement: Psychotherapy and Managed Care at its December 2014 meeting.

• The APA Board of Trustees approved the retirement of the 1995 Position Statement: Proposed Guidelines for Handling the Transfer of Provider Networks at its December 2014 meeting.

• The APA Board of Trustees approved the retirement of the 2002 Position Statement on Endorsement of Medical Professionalism in the New Millennium: A Physician Charter at its December 2014 meeting.

• The APA Board of Trustees approved the retirement of the 1975 Position Statement on Desegregation of Hospitals for the Mentally Ill and Retarded at its December 2014 meeting.

• The APA Board of Trustees approved the retirement of the 2001 Position Statement on Juvenile Death Sentences at its December 2014 meeting.

Report of the Treasurer

Frank Brown, M.D.

The figures below for the 12 months ended December 31, 2014, are audited.

APA’s net income from unrestricted activities was $4.460 million compared with a budgeted loss of $258,000. Investment income was $4.363 million.

Because of a change in actuarial rates, there was a onetime adjustment to expenses of $2.849 million, and income tax expense was $263,261.

Temporarily restricted activity showed a loss of $125,195.

In total, APA's net income was $5.586 million.

APF was budgeted to have a loss from operations of $3.5 million, but its actual loss was $2.768 million. Investment income was $3.738 million. Temporarily restricted activity had a loss of $26,880, and other income was $39,430, resulting in a net of income over expenses for APF of $982,730.

APA's net assets are now $78.731 million, and APF's are $60.953 million.

Report of the CEO and Medical Director

Saul Levin, M.D., M.P.A.

The APA has had a robust and successful year in implementing programs on strategic issues, membership, and partnerships. After a thorough internal organizational analysis, I have completed the internal reorganization of APA.

In addition, the APA Ad Hoc Work Group on Strategic Planning, including the APA Administration, developed the priorities of a 5-year strategic plan, which was passed at the March 2015 Board meeting. Many of the issues highlighted here are related to the initiatives in the strategic plan.

Ad Hoc Work Group on Healthcare Reform

The Board Ad Hoc Work Group on Healthcare Reform examined issues and opportunities for psychiatry in the era of new healthcare systems deliveries. The report makes recommendations in six areas of APA activities. It includes the development of initiatives and resources by components and the Administration for the purpose of educating federal and state policy makers, regulatory agencies, and payers regarding the role of psychiatrists in organized systems of care.

The work group will meet during the September 2015 Component Meetings to review the Administration implementation plan and consider each of the recommendations as contained within the ad hoc work group report. The work group will report back to the Board of Trustees at its October 2015 meeting.

Research Review Ad Hoc Work Group

The Research Review Ad Hoc Work Group determined appropriate scope and priority areas for research of the APA as appropriate to the fields of psychiatric medicine and mental healthcare and as a professional society given its size and within its resource capacity. The work group considered six primary objectives for the Research office: 1) shaping the research agenda, 2) increasing research capacity, 3) addressing practice needs, 4) improving practice quality, 5) improving care delivery, and 6) addressing the value of psychiatry.

The work group selected shaping the research agenda as the primary objective for the office, which means to shape the agenda policies, priorities, and activities of research funders across the spectrum. The APA through the Division of Research is addressing the needs of psychiatrists, patients, care givers, and other stakeholders in the research agenda.

Ad Hoc Work Group on Education and Training

The Ad Hoc Work Group on Education and Training presented a comprehensive report that was approved by the Board of Trustees. The report includes several overarching recommendations including: 1) The APA must take a leadership role in advocating for the necessary changes in residency education to prepare the psychiatrists of the future to meet the public health needs of Americans with psychiatric illness. 2) The APA should vigorously advocate for maintaining and increasing funding for graduate medical education, including funding for training in innovative care delivery systems. 3) General psychiatry training programs remain 4 years in length. This is more than warranted due to the need to learn the greater volume of clinical knowledge in the areas of neuroscience, ethnic/social diversity and systems of integrated healthcare that are required of a generalist psychiatrist. 4) The areas that must be covered during the 4 years of general psychiatry training include psychosomatic medicine, geriatric medicine, child and adolescent psychiatry, forensic psychiatry, and substance abuse/addiction. Increased clinical exposure to these areas during general residency training will be required to ensure that generalist practitioners will be able to meet the clinical demands of the future. 5) The increase in clinically applicable neuroscience knowledge has created a need for residency curricular development.

The report renews the APA commitment to an educational advocacy agenda that focuses on supporting GME funding and maintaining psychiatry’s designation as a primary care specialty.

APA Branding

The Board of Trustees approved the adoption of a new brand for the APA at its December meeting. The Board noted many competing marks, fonts, and colors evident in APA’s then-current approach to branding and voted unanimously to support a rebranding initiative. The newly adopted brand (Figure 1) will help the APA and related entities move forward in conveying a consistent look and message and demonstrate clear value to members. The APA Administration is in the process of rolling out the new brand to our many audiences. The Benjamin Rush mark will continue to serve as the seal of the APA for certain formal documents and events. The APA successfully launched its new brand on May 16, at the Opening Session of the 2015 Annual Meeting.

Veterans Suicide Prevention and VA Workforce

On February 12, President Obama signed the Clay Hunt Suicide Prevention for American Veterans (SAV) Act into law. The SAV Act will increase access to much-needed mental healthcare for America’s veterans by improving the ability of the Veterans Health Administration to attract and retain psychiatrists. The legislation was named in honor of Clay Hunt, an Iraq and Afghanistan War veteran and suicide prevention advocate who tragically took his own life in 2011.

APA was very supportive of this measure and instrumental in its passage. The legislation would establish a pilot project encouraging more psychiatrists to choose a career with the VHA by offering medical school loan repayments on par with other government agencies and private practices. Both Immediate Past President Paul Summergrad, M.D., and I were present for the White House bill signing ceremony.

Partnerships

Over the last year, the APA has formed and strengthened numerous partnerships with our allied professional and consumer organizations. Partnership is an essential component of the work we do in our programmatic and advocacy activities. Some specific activities include:

• Collaboration with the National Association of Social Workers (NASW) at the 2014 Institute on Psychiatric Services (IPS) meeting, to create our first “Social Workers” track. The presentations were taped and will be promoted on both APA and NASW websites.

• Consumer advocacy groups reviewed and provided feedback on APA’s “Understanding Mental Disorders–Your Guide to DSM-5.” We conducted two focus groups with parents of children with mental illness, caretakers, peer counselors, and persons with lived experience, and they provided feedback on the content and usefulness of the book. The National Alliance on Mental Illness (NAMI), Anxiety and Depression Association of America (ADAA), Depression and Bipolar Support Alliance, and Mental Health America (MHA) provided testimonials for the book.

• The APA continues to work on quality measurement maintenance projects with: 1) the American Academy of Addition Psychiatry (AAAP) on measurement development for substance use disorders; and 2) the American Academy of Neurology (AAN) on measurement development for dementia.

• The Division of Diversity and Health Equity (DDHE) is working on diversity initiatives, such as creating a repository of diversity and cross-cultural articles, books, and references; highlighting the importance of diversity and multicultural interests and supporting members and the DB/SAs with related educational opportunities during the second annual APA Diversity Mental Health Month (DMHM) on “Culturally Appropriate Care”; and partnering with the American Association of Medical Colleges (AAMC) for the first “Conversations about Diversity and Health Equity” that was held at the Annual Meeting and facilitated by AAMC’s Chief Diversity Officer, Marc Nivet, Ed.D.

• The APA co-hosted a joint congressional briefing with the American College of Neuropsychopharmacology (ACNP) and the American Brain Coalition to encourage increased funding for the National Institute of Mental Health (NIMH), National Institute on Drug Abuse (NIDA), and National Institute on Alcohol Abuse and Alcoholism (NIAAA) research funding.

• A joint paper on firearms was published in February in the Annals of Internal Medicine (http://annals.org/article.aspx?articleid=2151828). The APA worked with the American College of Surgeons, American Congress of Obstetricians and Gynecologists, American Academy of Family Physicians, American College of Emergency Physicians, American Public Health Association, American Bar Association, American Academy of Pediatrics, and the American College of Physicians.

The APA Administration met with the American Association of Community Psychiatrists (AACP), the Academy of Psychosomatic Medicine (APM), the American Association of Directors of Psychiatry Residency Training (AADPRT), the American Board of Psychiatry and Neurology (ABPN), the American Medical Association (AMA), Morehouse School of Medicine, Research!America, ecoAmerica, the Council of Medical Specialty Societies (CMSS), the American College of Neuropsychopharmacology (ACNP), NAMI, Mental Health America (MHA), the American Brain Coalition, the American Psychiatric Nurses Association (APNA), and the Kennedy Forum, just to name a few, regarding future collaborative initiatives.

International Update

In July 2014, the APA application to become a nongovernmental organization with Special Consultative Status to the United Nations was approved. This action stemmed from an Assembly Action Paper approved by the Board and provides the APA the opportunity to join over 4,000 nongovernmental organizations working with the economic and social branch of the United Nations in the development of international policy and working together to raise awareness on various issues.

Mental Health Parity

After years of advocacy with the Department of Health and Human Services (HHS) on expanding mental health parity to our most vulnerable population and expressing the need for full disclosure from insurance plans, Centers for Medicare and Medicaid Services (CMS) released its proposed rule on how the Mental Health Parity Act applies to the majority of Medicaid plans and the Children's Health Insurance Program (CHIP). The rule broadly extends the parity requirements to the 50 plus different Medicaid systems with a wide diversity of treatment of MH/SUD benefits, including those that have carved out mental health benefits in unique ways. This creates greater consistency between the commercial and Medicaid markets and would help ensure that beneficiaries who receive services through Medicaid or CHIP will have access to mental health and substance use disorder benefits. States are required to make publically available their documentation for Mental Health Parity and Addiction Equity Act (MHPAEA) compliance requirements as well as include this in their contracts with third parties. The APA reviewed the proposed rule in detail and submitted comments.

Medicare Sustainable Growth Rate (SGR)

The flawed Medicare Sustainable Growth Rate (SGR) was a budget cap that was passed into law in 1997 as an attempt to control federal spending on physician services. Since 2003, Congress routinely delayed devastating cuts that would have jeopardized beneficiary access to psychiatric services in the Medicare program through “patches” to scheduled SGR reductions, causing significant instability and administrative burden for physician practices. In March and April 2015, Congressional leadership conducted breakthrough negotiations based on recent bipartisan work to bring an end to the flawed Medicare SGR formula once and for all. They have laid the groundwork for significant changes to Medicare physician reimbursement over the next decade and beyond with the passage of H.R. 2, the Medicare Access and CHIP Reauthorization Act (MACRA).

The APA proactively lobbied on repeal and replacement of SGR for over a decade with the assistance of thousands of APA members, and passage of H.R. 2 is a historic action that will stabilize payment and improve access to psychiatric care for Medicare beneficiaries.

Comprehensive Mental Health Reform

The APA sent a strong letter in support of the bipartisan comprehensive mental health reform legislation known as the “Helping Families in Mental Health Crisis Act.” This legislation, also known as the Murphy-Johnson Bill, was recently reintroduced in the U.S. House of Representatives. It builds on last year’s bill, which was already widely considered the most pro-psychiatry legislation to be introduced in many years and which was unanimously supported by the Board in December 2014. The new version of the bill contains very helpful new language on parity enforcement and on increasing the psychiatric workforce, as well as other changes to some of the provisions in last year’s bill.

The next steps in the comprehensive reform debate will include Reps. Murphy and Johnson working with the leadership of the House Energy & Commerce Committee to move the bill toward a Committee vote, while they also continue to collaborate with Senators Chris Murphy (D-CT) and Bill Cassidy, M.D. (R-LA) on the quickly developing Senate version. The APA will remain deeply engaged in lobbying both bodies as they work toward possible votes in Committee followed by House and possible Senate Floor votes in the coming months or beyond.

I want to especially thank the Board, which has made many vital decisions over the past year and has worked to elevate the APA. I also want to thank the Assembly Executive Committee, Assembly, and all of the DB/SAs and their leadership (elected leadership and executive directors) for their concerted effort to engage membership and make a noticeably positive impact on patients and our members.

I look forward to another year of the APA growing and strengthening its position in the healthcare discussion. I also look forward to our continued journey together.

Report of the Speaker

Jenny L. Boyer, M.D., J.D., Ph.D.

Since our meeting in November, your Assembly leadership has accomplished several significant tasks.

The first was to request an increase in funding from the APA Finance and Budget Committee for the Assembly. This was successful and subsequently approved by the BOT. Your Speaker argued for state voice, member recruitment, and diversity in her presentations to the Finance and Budget Committee. This will enable the Assembly to fund the new representation as part of the reorganization to Assembly meetings.

A specific plan of reorganization was agreed upon by the AEC, and that plan will be considered by the Assembly at the May meeting. The proposed plan enables each state to have at least two representatives funded for the November meeting as well as an overall increase in diverse membership for our district branches. The overall guiding principles were inclusivity, diversity, and effectiveness. Diversity will be a high priority for new representatives who are nominated or appointed. Diversity is broadly defined to include ethnicity, gender, age, interest area, foreign medical graduate education, etc.

Another task for the Speaker, and others from the Assembly, was to argue for any passed referendum, regardless of the percentage of membership that voted, to be placed as a discussion item on the BOT agenda. This was approved by the BOT and addressed the concern of the Assembly that items of importance to the membership were not to be ignored. This has too often occurred because the vote of the membership for a Referendum was usually only 20%, not the 40% required.

Still another task of Assembly leadership was to represent member voice in the development of the new Strategic Plan for APA. Clearly, member concerns about parity and fair reimbursement, training for the changing health care environment, diversity, and MOC have been integrated into the plan. It is hoped that the reorganization of the Assembly and the future action papers will reflect consideration of the APA Strategic Plan. In this way, the BOT, the Assembly, and APA staff and components will work together on common goals.

In February 2015, the Speaker and the Chair of the Assembly Work Group on MOC, Dr. Batterson, were invited to attend a meeting of ABPN in order to express member concerns about MOC. Subsequently, the Speaker recommended the AEC move to eliminate part IV of the MOC. The AEC passed the motion overwhelmingly. The motion, though, was amended to include a task force for the BOT and Assembly, and unanimously passed the BOT. A letter was then sent by the President and CEO of APA to ABPN requesting that ABPN advocate to ABMS to eliminate part IV of the MOC. This action by the BOT was in response to the Assembly’s longstanding efforts to make the voice of members heard. The Speaker has invited the head of the ABMS, Dr. Lois Nora, to address the May Assembly, and she has graciously accepted.

The following Assembly work groups have met by conference call or exchanged e-mail in order to accomplish specific charges: Access to Care, Dr. Joseph Mawhinney; Communications, Dr. Jacob Behrens; Legislative, Dr. John Bailey; Long Range Planning, Dr. Melinda Young; Mentorship, Dr. Ludmila De Faria; MOC, Dr. Bob Batterson; Assembly/Foundation Initiative (formerly Public Affairs), Dr. Jeff Borenstein; Metrics, Dr. Glenn Martin, and DSM 5, chair to be determined.

In the JRC, our Recorder, Dr. Anzia, and our Speaker-Elect, Dr. Martin, have worked with our President-Elect to develop a clearer set of guidelines for accountability and how the Councils and authors of action papers should communicate with each other. They are developing methods to accomplish this. We are trying to be more efficient in completion of the standard work of coordinating passed action papers with the Components and APA staff. We have been working on the implementation of new ways to communicate our work in the Assembly in a timely way, such as asking APA staff to send information about passed action papers via Twitter to members while the Assembly is still in session.

We continue to plan for the May Assembly in Toronto, including the orientation of new Assembly members before the meeting.

I thank Allison Moraske and Margaret Dewar for their exemplary dedication to the Assembly. I thank Drs. Paul Summergrad and Reneé Binder for their commitment to member voice. I thank Drs. Glenn Martin, Dan Anzia, and Saul Levin for their teamwork. I thank Drs. Scott Benson and Melinda Young for their continuing mentorship. I thank Dr. Gary Weinstein for his expert guidance and for reducing my personal anxiety. I thank Dr. Harold Ginzburg for his patience with the Speaker.

Report of the Speaker-Elect

Glenn Martin, M.D.

It has been a great pleasure to be part of the 2014–2105 leadership team of the Assembly of the APA with Speaker Dr. Jenny Boyer and Recorder Dr. Dan Anzia.

As Dr. Boyer’s Speaker’s report spells out well, much has been accomplished this year. By the end of the May meeting, we will have hopefully agreed to a structural reorganization of the Assembly to better promote the strategic vision of the APA. We will have vetted dozens of action papers and either approved, modified, or retired a multitude of position papers. We will have moved to better integrate the component chairs into the Assembly’s reference committee process and beefed up the functioning of the Assembly representatives on the components. The end result will be to better communicate and coordinate between two of the largest structures in the APA, outside of the Board of Trustees, administration, and publishing.

In addition, while serving on the Board of Trustees, Dr. Boyer and I were instrumental in getting the Board to agree to place in the Operations Manual the procedure to replace area trustees, should it become necessary again. In addition, the Board has agreed to take up at a future Board meeting any resolution voted upon by the membership which passed by majority but did not achieve the required percentage of all eligible voters necessary to have been considered “passed.” And, of course it was a motion from the Assembly’s Executive Committee taken up by the Board that resulted in the official position of the APA opposing Performance in Practice (PIP) as currently implemented in the ABPN recertification process.

As Speaker-Elect, I served as Vice-Chair of the Joint Reference Committee (JRC) chaired by our President-elect Renée Binder. I am pleased to say the JRC has beefed up its efforts to provide oversight to the components which operationally report to the JRC. We have worked to review and coordinate the various work products of the Assembly and components to bring some continuity of structure and function to the position statements adopted by the Board of Trustees. The JRC has also markedly improved its internal tracking and follow-up with a clear expectation that items referred to components are returned in a timely manner to avoid action items, reports, and positions being lost in black holes.

Looking toward 2015–2016, I think the Assembly will continue to work in cooperation with the JRC and the President to develop best structures and processes for the Assembly to work with the components, so that each inform each other as to priorities, interests, and work products. The focus of much of the internal restructuring this year had to do with the district branches and state associations, and in this coming year more attention will be paid to the MUR and affiliated organizations and sections. The seven areas are recognized as an important organizing structure for the states and the Assembly, but a clear funding stream to support and enhance their functions has to be clarified. Technology to support the full year nature of the Assembly and the smooth running of its meetings (e.g., electronic voting and wireless access) will also have to be addressed with gusto.

So, I thank the Assembly for giving me the opportunity to serve this past year as your Speaker-Elect, and I am very much looking forward to the great things we will accomplish together this coming year.

Report of the Committee on Bylaws

Rebecca W. Brendel, M.D., J.D.

Members: Edyth P. Harvey, M.D., Christopher Pelic, M.D., Eric Martin Plakun, M.D., Rudra Prakash, M.D., J.D., Sidney H. Weissman, M.D.; Administration: Margaret Dewar, Chiharu Tobita.

At the December 2014 Board of Trustees meeting, the Board voted to ask the Bylaws Committee to draft language concerning replacement of area trustees should unforeseen in-term vacancies occur. The Board instructed that the proposed changes be consistent with the APA Bylaws and the past practice of the Board of Trustees. The approved final language was placed in the APA Operations (Ops) Manual. The updated Ops manual can be accessed on the APA website in the Association Governance section.

In summary, the new outlined procedures provide that, in the event of a vacancy in the position of Area Trustee, the Executive Committee of the Board of Trustees shall ask the area council from which there is a vacancy to submit three names of members in good standing from the area for consideration as a replacement and then submit no fewer than two members to the Board for consideration. The Board of Trustees shall then select one candidate to serve the remainder of the vacant area trustee term no later than its next scheduled meeting.

In the next upcoming year, the Bylaws Committee will meet during the Fall Component Meeting in September 2015 and carefully review the APA Bylaws for any inconsistency in the language.

Report of the Membership Committee

Rahn Kennedy Bailey, M.D., DFAPA

Membership Activity in 2014.

• New Medical Student Members totaled 1,368.

• New and reinstating Resident-Fellow Members totaled 1,625.

• New and reinstating General Members totaled 1,544.

• New and reinstating International Members totaled 673.

• Resident-Fellow Members advancing to General Member status total 944.

• District Branch transfers totaled 892.

There were significant recruitment and retention activities in 2014, and the total membership is growing. Membership gains were higher in 2014 than the previous year in all membership categories except Resident-Fellow Members. Membership losses offset some of the gains. The net result of all membership activity was the third year of membership growth with an overall increase of 3.9% (1,371 members) from January 2014 (35,003 total) to January 2015 (36,374 total).The total number of members in dues-paying categories increased by 2.3% during the same time period.

The committee agreed to use $150K of the $180K approved for the District Branch Grant process for expedited grant requests for initiatives. A total of 55 grant requests were awarded in the amount of $2,727 for membership recruitment and retention initiatives (N=20), healthcare reform educational sessions (N=15), CME event (N=12), and other educational sessions (N=8). There were seven submissions for innovative grants; four were awarded for $5K each and one for $10K.

Two years ago, the Membership office formalized an initiative to provide district branch/state associations (DB/SAs) a variety of APA print resources to display at their local meetings. Membership contacts DB/SA staff in advance to learn about the meeting dates and assembles a schedule. The Membership contact then contacts each DB in advance of the meeting to find out which resources they’d like to have for the upcoming meeting. In 2014, nearly 40 DB/SAs were sent materials such as membership applications and brochures, flyers on member benefits, educational opportunities, etc.

The Membership Committee sponsored a special meeting for district branch membership chairs during the Annual Meeting for a third year. Representatives from 38 DB/SAs attended, including 28 staff and 20 members. Information was shared about upcoming membership promotions by the national office and how the DB/SAs can get involved. Most of the meeting was an open forum for attendees to discuss and share ideas about membership recruitment and retention. A summary of the meeting will be posted on the DB Membership Chairs listserv.

For the second year, the Membership Committee and BOT WG on International Psychiatrists cohosted a New International Member Welcome Reception on Monday morning during the Annual Meeting. There was a very good turnout with well over 100 people from at least 25 countries in attendance, including several Presidents of International Psychiatry organizations. Drs. Summergrad, Levin, Amiel, Riba, and McIntyre all gave welcoming remarks. The reception was very much appreciated by the new international members/fellows/distinguished fellows in attendance.

The idea of allowing international members to pay one fee to cover their lifetime of membership was introduced a few years ago for the Membership Committee to explore. The lump sum dues rates for U.S. and Canadian members are determined by a complex set of factors using actuarial and other data that vary from one country to another. The Membership Committee agreed to move forward with a recommendation to the Board of Trustees that a lump sum dues option be offered to international members and suggested that the Finance & Budget Committee recommend proposed amounts for approval. The Board approved the action item, and promotion of the new program began in 2015.

The Membership Committee considered a series of ideas to streamline the dues payment policies that, if implemented, would improve membership processing, create more clarity for members, and remove barriers for those who want to reinstate. Overall, the Committee anticipates that with the establishment of a reasonable final dues payment deadline and a process that no longer requires the management of dues amnesty, there will be improvements in member retention. The following recommendations were approved by the Board of Trustees for implementation in 2016.

1. Dues Payment Deadline: Change from June 30 to March 31:

   	a.	Rejoining During the Administrative Reinstatement Period: Continue with current policy.
   	b.	Rejoining After Administrative Reinstatement Period: Pay only future dues to reinstate (no requirement to pay dues for the first quarter).

2. New and Reinstating Members: Collect dues in advance prior to enrollment or reinstatement instead of billing them later.

3. Dues Amnesty: Continue program with changes.

   	a.	Extend to the 750 (approximately) psychiatrists who have been granted amnesty, but were later dropped for nonpayment, with the understanding that reinstating members will never need amnesty again because if dues are not paid by March 31, they will be dropped without a dues obligation to reinstate in the future;
   	b.	extend dues amnesty to former members who belonged to one of the six DBs that do not offer amnesty and therefore had not been eligible for APA dues amnesty; and
   	c.	allow former members from the six DBs that do not offer amnesty to reinstate into a different district branch (if they live or work in a new DB jurisdiction), even if dues are owed to the former DB because it does not offer amnesty.

The APA Membership Department finalized logistics with the 71 psychiatry residency training programs that qualified for the 100% Club in 2014–2015. All qualified programs have received their confirmations, certificates or plaques, and special gifts for each resident (platinum and gold level). Membership is also working with Psychiatric News and APA Headlines to promote the 100% Club programs in APA publications and newsletters throughout the year.

The Rebate Program is being expanded in 2015 to include residents/fellows and international psychiatrists, in addition to fully trained U.S./Canadian psychiatrists who pay the Full-Program or Resident Non-Member Annual Meeting registration fee. Membership applications must be completed on-site at the Annual Meeting to be eligible for the Rebate Program. Promotion will begin after the Advanced Registration deadline in mid-April.

Membership is updating a series of house ads to run on a space-available basis in Psychiatric News educating members and nonmembers alike to the benefits of membership. The ads focus on specific APA resources relating to Annual Meeting member registration discounts, research, practice management, educational and CME opportunities, and advocacy.

The International Membership Ambassador program is continuing in 2015 with members from several countries agreeing to recruit their colleagues for APA membership. The Membership Department is working with members from Argentina, Australia, Brazil, India, Japan, the Netherlands, Spain, and the United Kingdom.

Membership staff exhibited at the Royal College of Psychiatrists’ (RCP) annual International Congress in London on June 24–27, World Psychiatric Association’s (WPA) World Congress of Psychiatry on September 14–18, in Madrid, American Academy of Child & Adolescent Psychiatry Annual Meeting in San Diego on October 20–24, and the APA Institute of Psychiatric Services meeting in San Francisco on October 30–November 2.

Throughout the year, the Membership Department continued to send recruitment mailings and e-mail blasts to nonmembers who attended the 2014 APA Annual Meeting in New York City, lapsed members 5 years or less promoting APA dues amnesty, medical student members of AMSA, and others.

In 2014, 1,057 applications for fellowship and 282 for international fellowship were approved. Additionally, 128 distinguished fellowship and one international distinguished fellowship nomination were approved.

Report of the Committee of Tellers

Hind Benjelloun, M.D.

Members: Bruce A. Hershfield, M.D., William B. Lawson, M.D., Ph.D.;

Administration: Margaret Dewar, Chiharu Tobita.

At the March Board meeting, the Board of Trustees approved the final results of the 2015 APA National Election as reported by the Committee of Tellers below.

Eligible voting members in the 2015 Election received either an electronic or paper ballot. Voting members with an e-mail address listed in the membership database received an electronic ballot on January 2, while voting members without an e-mail address listed in the membership database received a paper ballot. As in the past two elections, voting members were able to utilize an alternative voting method by accessing their ballot through the APA homepage or the APA Election website after entering their membership username and password.

The election management firm, the Survey & Ballot (SBS), managed the distribution and tallying of ballots while providing technical support to voting members. According to a survey provided at the end of the electronic ballot asking voters to rate their “level of satisfaction with the web voting process,” approximately 95% rated their experience as “satisfied” or “very satisfied.”

Voter turnout increased slightly from 19% in 2014 to 21% in the 2015 Election. A total of 5,761 of 30,450 eligible voters participated. Of the voters submitting ballots, 89% voted electronically compared with 81% last year.

Report of the Elections Committee

Barry K. Herman, M.D., M.M.M.

Members: Tanya N. Alim, M.D., Josepha A. Cheong, M.D., Robert E. Kelly Jr., M.D.; Administration: Margaret C. Dewar, Chiharu Tobita.

Campaigning in the 2015 APA Election began with the announcement of candidates on October 31, 2014 and ended with the voting deadline on February 2, 2015. The voting period started on January 2 at 5:00 a.m. (Eastern Standard Time) and ended on February 2 at 11:59 p.m. (Eastern Standard Time).

The Committee met with the candidates via conference calls to review the Election Guidelines in the beginning of the campaign period starting with the announcement of the final slate by November 1. The Elections Committee was available for questions or concerns from candidates, their supporters, and the APA membership and provided clarification to the APA Election Guidelines when it was needed.

This year, the Committee proposed the following amendments to the APA Election Guidelines and the APA Operations (Ops) Manual, which were approved by the Board of Trustees at the March 2015 meeting:

• Voting members can nominate by petition and submit signatures to the Department of Association Governance by November 15. According to the Ops Manual, there is no specific requirement of the format of the signatures. The Elections Committee therefore endorsed and introduced an electronic petition signature submission system (available at https://www.ipetitions.com/start-petition). This petition system will serve as an alternate format to the cumbersome process of paper signature submissions.

• According to the Ops Manual, the Elections and Tellers Committees are prohibited from actively supporting or endorsing any candidate. The Elections Committee recommended that further restriction be set and applied to the Nominating Committee and the Board of Trustees.

• Many violations of Section B.1. (“signing campaign communications”) in the APA Election Guidelines have occurred during past elections when many candidates and supporters signed their campaign materials/messages with their APA/Area/DB organization titles. The Elections Committee voted to approve deleting this section from the current guidelines and allow candidates and supporters to sign their campaign communications with their APA/Area/DB organization titles.

• During the 2015 Election, a few candidates distributed campaign materials with statement of support/endorsement for their fellow candidates. The Elections Committee examined the difference between expressing “mutual support” versus “campaigning together” and asked whether a distinction needed to be made in the Election Guidelines. The Elections Committee voted to approve the amendment to the Election Guidelines to clarify the difference between “mutual support” and “campaigning together.”