APA Council Reports

At the fall component meetings of the American Psychiatric Association in Arlington, Va., September 11–14, 2019, the APA councils heard reports from their components. Following are summaries of the activities of the councils and their components.

The Council on Addiction Psychiatry

Jill Williams, M.D., Chairperson

The Council on Addiction Psychiatry (CAP) is committed to providing psychiatric leadership in the study, prevention, and treatment of substance use disorders. The component provides recommendations to APA on training, treatment, and public policy. To facilitate effective collaboration and communication, the Council invites representatives of the White House Office of National Drug Control Policy (ONDCP), the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Disease Control (CDC) to participate in its meetings. The Council has focused on physician training on treatment of substance use disorders, prescription drug monitoring programs, accessibility and availability of services, budgetary challenges, research priorities, and opportunities for APA to contribute meaningfully to important government initiatives.

Through its active collaboration with APA’s Department of Government Relations and Department of Policy, Programs, and Partnerships, the Council has provided guidance on the Association’s legislative and regulatory advocacy efforts regarding the national opioid crisis. As the Administration has been working to implement the provisions of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act, a bill intended to address the crisis, the Council has provided guidance on APA’s response. The Council is also working on creating resources about best practices for opioid use disorder (OUD) patients during vulnerable transitions of care, such as those leaving the emergency room or the criminal justice system. Members have also helped staff respond to regulatory activities, such as the White House’s roadmap to health research and development focused on the opioid crisis, the Pain Management Best Practices Inter-Agency Task Force draft report, and the Department of Health and Human Services’ request for information regarding controlled substances.

Additionally, the Council provided guidance in APA’s response to the Food and Drug Administration’s (FDA’s) recent request for comments on cannabis-derived products, as the agency grapples with these products flooding the market and no current oversight on their safety, manufacturing, product quality, and marketing. This has become a key issue area for the Council since the passage of the 2018 Farm Bill removed hemp from the controlled substances list. Since then, the amount of cannabis-derived products has overwhelmed the market, and states have seen a push to expand the use of cannabis as medicine. The Council updated APA’s position statement that we do not endorse cannabis as medicine and is actively working on additional resources for members addressing the expanded use of cannabis products at the state level. The group will continue to provide guidance to APA staff on this emerging policy issues and consider the latest research, analyze training gaps that exist for psychiatry, and weigh in on relevant legislative proposals.

Members of the Council developed and revised several APA position statements, including “Position Statement on Assuring the Appropriate Care of Pregnant and Newly-Delivered Women with Substance Use Disorders,” “Position Statement on the Relationship Between Treatment and Mutual Support,” “Position Statements on Residency Training Needs in Addiction Psychiatry for the General Psychiatrist,” and “Position Statement on the Need to Monitor and Assess the Public Health and Safety Consequences of Legalizing Marijuana.”

APA is a partner in the SAMHSA-funded Providers’ Clinical Support System, a project developed to address the appropriate use of opioids in the treatment of chronic pain, as well as the recognition and treatment of opioid use disorder. More than a dozen medical specialty and stakeholder organizations provide free continuing medical education in support of the program. APA contributes webinars and online case vignettes that can be accessed through the association’s Learning Center and the program’s dedicated website (www.pcss-o.org). In addition, APA is a clinical site for the PCSS-MAT Implementation Program (PCSS-MIP), a pilot program funded by SAMHSA to provide technical support to health care organizations and providers for the implementation and integration of substance use disorder services, especially the use (or expansion) of medication-assisted treatment for patients with substance use disorders and in particular opioid use disorder.

The Council is also involved in a variety of training opportunities for psychiatrists and other interested clinicians. Waiver-eligible courses on office-based treatment of opioid use disorder with buprenorphine are offered at APA’s Annual Meeting and the Institute on Psychiatric Services (IPS). The waiver eligible courses were augmented by a monthly webinar series conducted by the Association as a partner organization in the PCSS network. The highly rated webinars provide free continuing medical education credit. A clinical mentoring system further enhances the training by providing opportunities for psychiatrists and other physicians to consult with members who have recognized expertise in evidence-based medication-assisted treatment of OUD. Additionally, as a partner of the Opioid Response Network, APA hosts a series of 12-week virtual learning collaboratives for psychiatrists to expand availability of medication for addiction treatment. Past topics include telepsychiatry’s role in MAT, best practices for treating adolescent patients with substance use disorders (SUDs), motivational interviewing, and treating women with SUDs.

Council members represent the Association and actively participate in the American Medical Association’s (AMA) Task Force to Reduce Opioid Abuse, which is comprised of representatives of state medical associations and medical specialty societies. The member organizations recognize that to address the epidemic of prescription drug abuse effectively, physicians should develop and implement strategies to reduce the harm caused by overprescribing of opioids and utilize evidence-based practice in treating pain and substance use disorders. Led by Dr. Patrice Harris, President of the AMA and a former member of APA’s Board of Trustees, the Task Force has undertaken initiatives to 1) address SUDs as a medical condition; 2) enhance physician training on evidence-based treatment of pain and addiction; 3) increase physicians’ use of prescription drug monitoring programs and provide guidance to policymakers about program features that will ensure provision of clinically significant information; 4) reduce the stigma of SUDs; and 5) address overdose prevention through advocacy for increased access to naloxone.

The Council on Advocacy and Government Relations

Patrick Runnels, M.D., M.B.A., Chairperson

The Council on Advocacy and Government Relations (CAGR), established in 2009 as part of the reorganization of APA councils and components, serves as the APA’s member-led coordinating body for advocacy activities involving federal and state government. Its responsibilities include anticipating advocacy-related policy needs, discussing government relations strategies, collaborating with district branches and state associations on state matters, and providing expert input to the APA Administration. The continued challenges associated with access to mental health and substance use disorder-related care continue to foster a keen focus on Capitol Hill, within the Administration, and in state governments. To help mitigate these issues, CAGR remains active in its efforts to advance the APA’s advocacy priorities.

Revising CAGR’s Charge

In 2018, CAGR established a work group to craft and propose a revised charge that clarifies, focuses, and better reflects the operations and objectives of CAGR. The work group presented draft language in the fall to the APA Joint Reference Committee (JRC) for a vote of approval. After an extensive discussion and the addition of further clarifications, the JRC unanimously voted to approve the new CAGR charge and recommend its adoption. In December 2018, the APA Board of Trustees adopted CAGR’s new charge. Throughout 2019, CAGR continues to implement its charge in a variety of ways, summarized below.

Improving advocacy coordination among councils.

CAGR’s revised charge directs CAGR to “facilitate collaboration and communication with other APA components to stay informed about advocacy issues to ensure necessary support and input.” To the extent that other councils already engage in, or have expertise to assist in, legislative advocacy on topics within their authority, CAGR sees an opportunity to augment and strengthen these advocacy efforts through strategic collaboration to share insights between CAGR members and other councils. CAGR continues to integrate its members into other Councils to advise on matters of legislative strategy, as well as to augment their efforts to add an advocacy component to the subject-matter discussions that these Councils are having. CAGR receives regular reports from its cross-council liaisons and is scheduled to have a face-to-face meeting with the Council on Healthcare Systems and Financing at the September Components meeting to discuss advocacy topics of mutual interest.

Building advocacy mentorships.

CAGR’s revised charge directs CAGR to “expand opportunities to engage APA fellows in advocacy through mentorship and/or guidance from [CAGR], APA central, DGR staff, and state government relations.” While these relationships currently exist on an informal basis, no formal mechanism exists for CAGR to oversee the nature of the advocacy training provided to mentees.

In September 2017, CAGR members presented a revised draft of a resource document—incorporating feedback from the Council on Medical Education and Lifelong Learning—illustrating the importance of incorporating advocacy training into the curriculum for psychiatric residents. This document was approved at the June 2018 JRC meeting, and CAGR continued to discuss other avenues for enhancement of advocacy mentorships. In January 2019, the Board of Trustees Executive Committee voted to approve external publication of certain portions of this resource document.

CAGR members disseminated a confidential survey in January 2019 to assess the current status of mentorships among members and fellows. CAGR analyzed and continues to use the results of this survey to inform its work in this area going forward.

Expanding dissemination of advocacy-related content to members.

CAGR has traditionally presented an advocacy training session at the APA Annual Meeting in May. CAGR continues to identify avenues to engage more members in advocacy, including publication of advocacy-related content in APA-sponsored publications such as PsychNews. In 2019, CAGR members and fellows continue to work with PsychNews staff to contribute to articles on APA’s advocacy priorities, including enforcement of mental health parity, building the mental health workforce, and modernizing the privacy protections for substance use disorder records. Each of these articles contains information as to how members can engage with their members of Congress on APA’s legislative priorities.

Federal Advocacy Conference

On March 11th and 12th, 100 APA members participated in the 2019 Federal Advocacy Conference in Washington, DC. Through this conference, APA members met with representatives from over 130 congressional offices to advocate for greater mental health parity, improved care coordination for individuals with substance use disorder, funding for mental health crisis services, and policies addressing the mental health workforce shortage. CAGR members played a pivotal role in educating other APA members about APA’s legislative priorities, as well as providing skills training on conducting meetings with legislative officials and staff.

With another State Advocacy Conference planned for next year, CAGR members began a discussion at the May Annual Meeting to determine how it can leverage its experience to augment members’ experience at this conference, and CAGR expects to continue that discussion in the coming year.

Ensuring Parity Compliance

Building on APA and CAGR’s success at educating APA members and members of Congress about the need for further MH/SUD parity legislation, APA worked to facilitate the introduction of federal parity legislation (H.R. 3165 / S. 1737) that requires insurers to “show their work” in certifying their compliance with the federal parity law. The bill requires insurers to conduct and produce comparative analyses to show that they are, in fact, complying with federal parity law.

APA also successfully included its parity legislation in the Senate Health Education Labor and Pensions (HELP) Committee’s package of legislation intended to lower the cost of health care (S. 1895, the Lower Health Care Costs Act). On June 26th, the Committee approved the bill on an overwhelmingly bipartisan basis by a vote of 20–3.

Ensuring Funding for Priority APA Programs

APA continues to advocate for adequate funding of APA’s priority MH/SUD programs, including but not limited to programs housed within the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institutes of Health (NIH), and the Health Resources and Services Administration (HRSA). In April, APA sent its annual letters to the leadership of House committees and subcommittees with jurisdiction over funding for these programs. Among several other requests, APA requested increased funding for the Community Mental Health Services Block Grant and the Minority Fellowship Program, as well as an initial investment in the Loan Repayment Program for Substance Use Disorder Treatment Workforce program enacted under last year’s opioid bill.

In light of recent mass shootings, APA also continues to advocate for public funding of research on gun violence. On February 21st, APA joined 165 other national, state, and local medical, public health, and research organizations in a letter to key members of the House and Senate, calling for $50 million in funding for the CDC to conduct public health research into firearm morbidity and mortality prevention.

Calling Attention to Trauma Inflicted Under Current Immigration Policy

APA continues to call attention to the trauma inflicted upon children under the current federal immigration policy, having released numerous statements from APA leadership on this topic. On February 27th, APA Past President Dr. Altha Stewart testified before the U.S. House of Representatives Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies. As the only physician witness, Dr. Stewart highlighted how traumatic these experiences can be for children and how exposure to “toxic stress” often leads to an increased risk of mental illness later in life. She also reiterated APA’s opposition to family separation at the border and the need for staff at detention centers to be trained in trauma-informed care.

Upholding the Affordable Care Act

APA continues to support the Affordable Care Act as a means of expanding access to affordable coverage for evidence-based MH/SUD services. On December 14th, 2018, a federal district judge issued an opinion holding the Affordable Care Act unconstitutional following Congress’ elimination of the penalty for failure to obtain health insurance. APA promptly released a statement calling for a “vigorous appeal” of the district court’s opinion “to protect access to health care for millions of Americans.”

On April 3rd, APA sent a letter expressing support for several ACA market stabilization bills advanced to the House floor by the House Energy and Commerce Committee. Among the proposals supported by APA include H.R. 1010, which invalidates the Trump Administration’s rule expanding the availability of short-term limited duration plans that are not required to comply with the ACA’s core consumer protections; H.R. 986, which would direct the Trump Administration to rescind its guidance to states that loosen the standards for the ACA’s Section 1332 “state innovation waivers”; and H.R. 1425, which creates a new reinsurance program to help offset the cost of insuring high-risk individuals and lower premium prices.

Reforming 42 CFR Part 2

On April 3rd, Reps. Earl Blumenauer (D-OR) and Markwayne Mullin (R-OK), as well as Senators Joe Manchin (D-WV) and Shelley Moore Capito (R-WV), introduced legislation (H.R. 2062 / S. 1012) intended to modernize patient privacy protections by aligning 42 CFR Part 2 with HIPAA’s standards for treatment, payment, and health care operations. Consistent with the bill the House passed last year, the reintroduced bill also amplifies consumer protections by incorporating antidiscrimination language and enhancing penalties for any breach of a patient’s privacy concerning substance use disorder records. APA continues to work with its coalition partners to educate and engage members of Congress regarding the issue and encourage passage of the legislation. APA sent an action alert urging members to call their legislator and ask him/her to support the bill.

Assessing APA Response to Drug Pricing Legislation

Congress has spent a significant amount of time this year assessing hundreds of proposals designed to address the rising prices of prescription drugs. In 2019, at least 15 committee hearings and markups have been held across seven committees to examine possible strategies to lower drug costs. Some of these hearings are more open-ended discussions around perceived problems or solutions, while other hearings are meant to discuss a specific piece or package of legislation.

Given the broad scope of the legislation introduced this year, APA staff formed a workgroup of members from both the Council on Advocacy and Government Relations (CAGR) and the Council on Healthcare Systems and Financing (CHSF), with Dr. Brian Hart from CAGR and Dr. Jennie Byrne from CHSF agreeing to co-chair this group. The goal of this workgroup is to review APA’s current policies and principles on drug pricing to see if any changes need to be made, such as new position statements or further clarification of existing positions. The workgroup will also provide feedback on how to prioritize our legislative and regulatory efforts to ensure that patients are able to access their medication.

State Updates

APA continues to partner with district branches (DBs) and state psychiatry associations across the country in responding to priority DB legislation, utilizing the experience of CAGR members where appropriate. In 2019, state-led initiatives include parity enforcement, scope of practice concerns, maintenance of certification (MOC), involuntary commitment, expanding treatment for substance abuse disorders, and adoption of integrated care models, such as collaborative care.

Expanding utilization of collaborative care model.

To offer a proactive solution to access-to-care issues raised by legislators, APA developed model legislation that would increase access to mental health care by requiring private insurers to reimburse for Collaborative Care billing codes. Legislation has been drafted for all 50 states and the District of Columbia that is designed to be budget-neutral for the state. In 2019, Illinois became the first state to adopt APA’s model legislation, and a number of other states have expressed interest in this legislation for the next legislative session.

Parity.

As another means of offering proactive solutions to ameliorate access-to-care problems, APA has also developed model legislation designed to require transparency and accountability from insurers and state regulators pertaining to compliance with federal MH/SUD parity law. APA model legislation concerning parity of coverage for MH/SUD services continues to make its way through many state legislatures. In 2019, Colorado, New Jersey, Illinois, Connecticut, Delaware, Tennessee, and the District of Columbia have all enacted APA’s model legislation, with many other states passing partial versions of this legislation.

Safe prescribing.

Ten states have seen some form of psychologist-prescribing legislation introduced this legislative session. APA has worked closely with DBs and state associations (SAs) across the country to address this legislation, and through the hard work and dedication of members, legislation in many of those states has been prevented from moving forward, and the outlook is positive for other states who are still working to ensure safe prescribing in their states.

The Committee on Advocacy and Litigation Funding (CALF)

As part of APA’s state advocacy efforts, the Committee for Advocacy and Litigation Funding (CALF), currently chaired by Dr. Bhasker Dave, reviews DB/SA grant requests for specific public affairs challenges on the state level. Due to limited budgets in many of APA’s DBs/SAs, CALF grants are heavily relied upon by states in confronting new legislative policy challenges. Once CALF approves an initial request from a DB/SA, the request is sent to voting members of CAGR to approve, and the Board of Trustees (BOT) makes the final determination to award a grant. So far this year, CALF, CAGR, and the BOT have approved CALF grants to Illinois, Kentucky, Louisiana, Rhode Island, and Texas.

The APA Political Action Committee (APAPAC)

The APA Political Action Committee (APAPAC) APAPAC is the bipartisan political voice of the APA that enables the Association to invigorate its patient and professional advocacy activities by supporting candidates for federal office. APAPAC (R. Scott Benson, M.D., D.L.F.A.P.A., Chairperson) is governed by a board of directors comprised of 14 APA members. The PAC works to ensure the election of federal candidates/incumbents who share mutual principles and goals with APA and who champion psychiatry’s position throughout the legislative process. Another role of the PAC is to educate Members of Congress as to why they should support positions vital to our patients and profession. The PAC raised over $575,000 from APA members during the 2018 election cycle. Increasing our total cycle fundraising is the APAPAC’s top priority. Although APAPAC is among the smaller physician PACs, we are poised for growth. The APAPAC Congressional Advocacy Network (CAN) is another tool we use to bring an even greater voice to psychiatry’s advocacy efforts. There are almost 200 members of the APA participating in the CAN program, which is designed to help develop, train, and energize a national network of psychiatrists who will commit to communicating and build personal relationships with members of Congress and speak on behalf of the APA on issues facing mental health.

The Council on Children, Adolescents, and their Families

Gabrielle Shapiro, M.D., Chairperson

The Council on Children, Adolescents, and Their Families works to advance the well-being and overall mental health of young people and their families. It does this by keeping psychiatric issues involving children and adolescents at the forefront of the APA policy and by assisting general psychiatrists in learning more about treating children and adolescents. Additionally, the Council serves as a convening body for allied psychiatry organizations and APA components, including the American Academy of Child and Adolescent Psychiatry (AACAP), the Caucus of College Mental Health, and the Caucus of Psychiatrists Treating Persons with Intellectual Disabilities.

Policy Development and Advocacy

Article I.

The Council is responsible for identifying areas where APA policy can drive advocacy. The Council developed and received the Board of Trustees approval of a position statement on the Separation of Immigrant Children and Families (December 2018). Additionally, the Council developed statements on the Early Recognition and Treatment of Psychotic Disorders in Youth and on Cannabis Legalization and its Impact on Children and Adolescents, which are moving through the approval process

The Council provided input on the important issues summarized below.

Update to the Department of Homeland Security (DHS) Public Charge

The Council opposed the inclusion of Medicaid and Children’s Health Insurance Plan (CHIP) and called on DHS to rescind this rule and not consider the use of public benefits programs, like Medicaid, the Supplemental Nutrition Assistance Plan (SNAP), and income-level tests in public charge determinations. The Council reinforced the APA’s position that immigrants, refugees and displaced persons be treated with dignity and respect during all stages of the migration process.

Proposed Changes to the Flores Rule

In response to DHS’ proposed changes to the regulations established by the Flores Settlement Agreement (FSA) (Apprehension, Processing, Care and Custody of Alien Minors and Unaccompanied Children Concerns), the Council highlighted the negative mental health impacts of this policy change on children and their families and recommended that the maximum period of detention for children and their parents to not exceed the current limit of 20 days. The APA recommended that DHS hold detainment centers to the maximum safety and compliance requirements and make no exemptions to these standards. The Council further recommended that in order to improve each Family Residential Center (FRC) ability to identify and treat patients with unidentified or unmet health and mental health needs, staff should be educated on the delivery of trauma-informed and culturally competent care to this displaced population.

Education and Training

Article II.

Annual Meeting and IPS programing: The Council continues to identify and support opportunities for the development of quality abstracts on child and adolescent psychiatry topics for presentations at the APA Annual Meeting and other psychiatric meetings. More than 20 sessions were sponsored by our Council at the IPS and APA Annual Meeting, and many Council members also presented at affiliate meetings and internationally.

Mentorship for APA/American Psychiatric Association Foundation (APAF) Fellows: The Council members continue to mentor the APA/APAF Fellows that are assigned to the Council. Each fellow is assigned to a senior member on the Council to receive mentorship.

The APA/APAF Child and Adolescent Psychiatry Fellowship promotes interest in a career in child and adolescent psychiatry and falls under the purview of the Council. Selected fellows receive mentorship from child and adolescent psychiatrists and leaders in the field. Council members have been matched as mentors for the2018–2020 fellows: These fellows are: Cesar Cardenas, Jr., M.D. (University of Mississippi Medical Center), Stephanie Garayalde, M.D. (University of Florida College of Medicine), Marian Rain, M.D. (University of Texas Southwestern Medical Center, Dallas), Latoya Frolov, M.D. (University of California San Francisco), Asha Martin, M.D. (New York University), James Koved, M.D. (University of Washington Medical Center), Stephanie Fosbenner, M.D. (University of Pennsylvania), Katherine Soe, M.D. (Indiana University School of Medicine), and Brandon Newsome, M.D. (Boston Medical Center)

The Council collaborates with AACAP to identify issues of common interest and create joint initiatives/products. In the past year, these products have included the APA/AACAP Medication Guide for Depression in Children and Adolescents and the APA/AACAP Medication Guide for Anxiety Disorders in Children and Adolescents.

The Council works closely with the APA College Mental Health Caucus and the caucus leadership. This year, the Council and Caucus collaborated on the College Mental Health Policy Manual for Emotional Support Animals on College Campuses and, separately, is addressing mental health issues in transitional age youth with the Higher Education Mental Health Alliance (HEMHA). In partnership with APAF’s “Typical or Troubled” Program, several Council Members who are now trained as trainers will present the programs in schools across the country. The Council will also continue to develop APAF’s “Notice, Talk, Act” program for college campuses with the College Mental Health Caucus.

The Council on Children, Adolescents and their Families has liaisons with APA’s Councils on Psychiatry and the Law, Communications, Addiction, and Advocacy and Governmental Relations.

Interest groups: The Council is comprised of a number of special interest subgroups that aim to develop educational resources and policies addressing the needs of children, adolescents, and their families. These special interest groups are: Integrated Care, Juvenile Justice, Social Media, Transitional Age Youth LGBTQIA, Immigrant and Refugees, and First Break Psychosis.

Priorities: The Council identified its priorities for the year 2019–2020 using an internal survey. The Council will focus on issues around integrated mental health, social media impact, early psychosis, school mental health, minority mental health, transitional age youths, substance abuse, impact of separation of families/risk of deportation of parents, infant mental health, and suicide prevention among minority youths.

The Council’s 2019–2020 new initiatives include:

• 1. Article III: An infomercial to help immigrant children and families overcome stigma and access mental health care

• 2. Article IV: A work group on suicide prevention in minority youth to address the increase in suicide rates among minority youth

• 3. The dangers of vaping for children and adolescents

• 4. Ways to address cyber bullying and media portrayals of mental health problems, such as youth suicide

The Council on Communications

Carol A. Bernstein, M.D., Chairperson

In the interval between the November 2018 meeting of the APA Assembly in Washington, DC and the May 2019 APA Annual Meeting in San Francisco, the Joint Reference Committee (JRC) and Board of Trustees (BOT) both voted to accept the Media Partnership Guidelines created by the Council on Communications. The guidelines are intended to help the APA review requests from media producers, filmmakers, etc., for partnership, sponsorship, and/or endorsement from APA. The Media Partnership Guidelines will now be used when requests of this nature are brought to the APA.

The Council has been engaged in an informal, reciprocal liaison effort with other APA Components for the purpose of sharing information and supporting each other’s work. So far, this effort has consisted of members designated as liaisons by their respective components joining the Council for conference calls and in-person discussions when possible (e.g., at the Annual Meeting and during the components). The Council plans to continue this initiative.

Patrick Sammon and Bennett Singer visited the Council at the APA Annual Meeting to discuss their upcoming documentary Cured, which is focused on the fight to remove homosexuality from the DSM in 1973. They hope to show the film in educational settings, such as residency training programs. The Council had a discussion on the film with the filmmakers to brainstorm ways to promote this film to residency training programs and other medical audiences. The film will be reviewed according to the APA media partnership guidelines passed by the JRC in early 2019.

The Council discussed the possibility of submitting a social media workshop for the 2020 Annual Meeting in Philadelphia to help psychiatrists become more comfortable with the expanding uses of social media both to educate the public and improve care to patients.

The Council on Consultation-Liaison Psychiatry

Jon A. Levenson, M.D., Chairperson

Maria Tiamson-Kassab, M.D., Vice Chair

The Council on Consultation-Liaison Psychiatry focuses on the psychiatric care of persons who are medically ill and/or pregnant and works at the interface of psychiatry with all other medical, obstetrical and surgical specialties. It recognizes that integration of biopsychosocial care is vital to the well-being and healing of patients and that full membership in the house of medicine is essential for our profession.

For decades, consultation-liaison psychiatry has been at the forefront of treating patients with comorbid psychiatric and physical conditions. As more psychiatrists become involved with the integration of physical and mental health care, those in consultation-liaison psychiatry may provide valuable insight and expertise. The Council serves as an important resource to the APA administration on best practices for integrating behavioral health with medical care. Most recently, the Council released a Resource Document on “Psychiatric Aspects of Infertility” that was promoted in an APA blog post, “Infertility: The Impact of Stress and Mental Health,” during National Infertility Awareness Week. The Council also developed a Resource Document on “Decisional Capacity Determinations in Consultation-Liaison Psychiatry: A Guide for the General Psychiatrist”. In addition, the Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health published the Council’s Resource Document on “Boarding of Mentally Ill Patients in Emergency Departments.” The APA is working on jointly promoting the document with American College of Emergency Physicians.

In addition, the Council developed a series of articles for Psychiatric News to help members understand the work of consultation-liaison psychiatrists following the subspecialty's name change from Psychosomatic Medicine. Published articles include: 1) “From Psychosomatic Medicine to Consultation-Liaison Psychiatry,” 2) “Psychiatric Treatment in Organ Transplant Patients,” 3) “Integrated Care,” 4) “Traumatic Brain Injury and Neuropsychiatry,” 5) “Psycho-Oncology,” 6) “Perinatal Psychiatry,” 7) “Cardiac Psychiatry,” 8) “HIV/AIDS Psychiatry,” and 9) “Pediatric Care.”

The Council on Geriatric Psychiatry

Robert P. Roca, M.D., M.P.H., M.B.A., Chairperson

The Council supports the APA in its work on behalf of older adults and the psychiatrists who care for them. To this end, the Council develops position statements and resource documents on important issues in geriatric psychiatry, thereby providing APA with background information essential for advocacy efforts and interactions with the media. The Council also works collaboratively with other professional groups to develop best practices in geriatric psychiatry, to promote research, and to provide education and training to psychiatrists, other physicians, residents, medical students, and allied mental health professionals.

Position Statements

Position statements on “Elder Abuse, Neglect, and Exploitation” and on “Sexually Transmitted Infections, including HIV, among Older Adults” were published in early 2019.

In May, the Assembly approved position statements on “The Role of Psychiatrists in Nursing Facilities” and “Disaster Response and Older Adult Mental Health Care.” Both statements are currently under review at other levels of APA leadership.

Given the climate regarding the prescribing of all psychotropic medications to older adults, the Council felt that it would be valuable to develop a position statement addressing the broader issue of the use psychotropic drugs in the elderly in all settings. The Council has partnered with the American Association of Geriatric Psychiatrists in this effort.

Joint Council Task Force on Workforce Issues

The Chair of the Council on Consultation-Liaison Psychiatry contacted the Chairs of the Council on Geriatric Psychiatry and the Council on Addiction Psychiatry to ascertain their interest in looking at ways to enhance recruitment into subspecialty fellowships. A task force was formed consisting of volunteers of these three Councils. The goal of the task force is to make recommendations for APA councils and subspecialty organizations to consider addressing subspecialty workforce challenges and general psychiatry training/education opportunities in addiction psychiatry, geriatric psychiatry, and consultation-liaison psychiatry.

The Council on Geriatric Psychiatry discussed the issue and some potential solutions. The discussion revolved around two major themes:

• 1) The importance of creating training experiences that demonstrate the appeal of working with older adults by

• • Designing rotations in which trainees work with older patients who are high functioning, as well as those who are delirious or who have dementing illnesses;

• • Including didactics about healthy aging and resiliency in residency training;

• • Providing exposure to strong interprofessional teams working with older adults, highlighting the morale, mutual support, and professional satisfaction characteristic of such teams; and

• • Providing medical students with informal early opportunities to interact with older adults.

• 2) The perception that there is no financial incentive to pursue special expertise in geriatric psychiatry and that one cannot afford to do a fellowship;

• • Training in geriatric psychiatry can pay off, as there are some very lucrative opportunities in some geographies;

• • There may be creative ways to fulfill fellowship requirements on a part-time basis while working (and being paid) as a part-time attending; and

• • “Fast tracking,” while perhaps desirable in the view of Council members, may not ever gain approval. If that is the reality, there may be merit in encouraging the creation of special geriatric psychiatry “concentrations” in the fourth year that would earn trainees a certificate of special proficiency. This may not increase the flow into fellowships but might be a way of increasing the level of geriatric psychiatry knowledge among general psychiatrists.

Response to American Psychological Association’s Practice Guidelines on Depression

The Council was asked to offer comments on the draft practice guideline from the American Psychological Association entitled “Clinical Practice Guideline for the Treatment of Depression in Children, Adolescents, and Young, Middle-aged, and Older Adults.” Council members reviewed the document and provided the following feedback:

• • The Council found the recommendations regarding medication use to be confusing. For example, the guidelines cite sources supporting the use of paroxetine and nortriptyline and then qualify those recommendations by stating that experts advise against the use of both of these agents because of anticholinergic and other side effects. In the end, the guideline appears to endorse the use of SSRIs and SNRIs but do not cite any specific evidence for the efficacy and safety of these choices or other options.

• • Part of the explanation for the lack of definitiveness noted above is that the workgroup drew from only two reviews in creating these guidelines; in the Council’s view, this is a fundamental weakness in the design of the project. A more expansive review of the literature might have broadened the recommendations to include other medications and even electroconvulsive therapy in appropriate circumstances. The Council believes that psychologists tend to be uninformed about appropriate indications for ECT and might benefit from some review of this modality in this guideline.

APPI Book: Culture, Heritage, and Diversity in Older Adult Mental Health Care

In 2004, the Committee on Ethnic Minority Elderly of the Council on Aging developed a curriculum about how to provide culturally competent care to older adults. Recently, the Council on Geriatric Psychiatry undertook a revision of the curriculum. This effort was led by Dr. Maria Llorente and involved many current and past Council members, APA/APAF Fellows, and other trainees. The result was the book Culture, Heritage and Diversity in Older Adult Mental Health Care, which was published in late 2018 by American Psychiatric Association Publishing.

Geriatric Psychiatry Awards

As in past years, the Council recommended honorees for the Jack Weinberg Award in Geriatric Psychiatry and the Hartford-Jeste Award for Future Leaders in Geriatric Psychiatry. The Jack Weinberg Award recognizes psychiatrists who have made noteworthy contributions to geriatric psychiatry as researchers, mentors, leaders and clinicians over the course of their careers. The 2019 award recipient was Dr. Iqbal “Ike” Ahmed, M.D. The Hartford-Jeste Award recognizes an early-career geriatric psychiatrist who has made significant contributions to the field of geriatric psychiatry through excellence in research, teaching, clinical practice, and community service, and has demonstrated the potential to develop into a future leader in the field. The 2018 awardee was Dr. Jennifer Gatchel. The awards were presented at the 2019 Annual Meeting in San Francisco.

The Council on Healthcare Systems and Financing

Ronald Burd, M.D., Chairperson

The Council on Healthcare Systems and Financing (CHSF) has continued its efforts to monitor and provide analysis for a number of significant issues that have an impact on the financing and delivery of, and access to, psychiatric care. These efforts include outreach to decisionmakers in both the public and private sectors. Council members have provided guidance on APA’s responses to the Administration on health care reform, quality, and payment reform. CHSF also offered input on letters to the Administration regarding the VA military package, the Proposed Rule on the 2019 Medicare Physician Fee Schedule, and the Proposed Rule on Part D and Medicare Advantage’s drug pricing changes. Similarly, the members of the Council provided feedback and reviewed APA’s advocacy on the current Administration’s efforts regarding the status of immigrants, their detainment, and the separation of families at the border. They have also advised APA staff on regulatory comments on public charge determinations and improvements to HIPAA.

CHSF has recently monitored the potential impact of health care mergers on psychiatry, including by organizing a call on this topic with American Medical Association staff. The Council also continues to monitor parity implementation at the state level, rising drug costs, the Administration’s efforts in addressing the opioid crisis, and provider burdens.

The Council currently has two existing work groups. The first is a joint group with members of the Council on Advocacy and Government Relations on drug pricing policy. The group’s goal is to determine the extent that drug pricing policy issues affect APA members’ practices and patients and to evaluate the need for the creation of APA policy. The second CHSF work group is focused on the role of psychiatry in addressing social determinants of health. The work group is currently drafting a resource document for APA members that can also be used for advocacy purposes.

Aside from these ongoing efforts, the Council has continued reviewing and revising existing APA policies referred to them by the Joint Reference Committee, as well as addressing concerns raised by the Assembly action paper process.

Committee on Integrated Care

Henry Chung, M.D., Chairperson: The Committee on Integrated Care has finalized its addendum to the Resource Document on “Risk Management and Liability Issues in Integrated Care Models,” which focuses on liability issues related to cross-state consultation for integrated care. The Council and the Board of Trustees voted to approve the addendum, and it has since been posted on APA’s website. The Committee is also developing a brief on the advantages of collaborative care for risk bearing contracts and accountable care organizations.

Committee on RBRVS, Codes and Reimbursement

Gregory Harris, M.D., M.P.H., Chairperson: Members of the Committee on RBRVS, Codes and Reimbursements have been focused on revising and updating the educational materials related to CPT coding and documentation and continue to serve as a resource on specific CPT coding questions. The group has helped to inform our advocacy efforts following CMS’ proposal to make drastic changes to the E/M coding structure. This work has now moved into the CPT and RUC arena where APA has been actively engaged, along with more than 50 other organizations. This has included participation in meetings and telephone calls with members of the Administration. In the immediate future, the Committee will be developing some resources related to coding and billing for the administration of esketamine nasal spray, which was approved, with limitations, by the FDA.

Committee on Reimbursement

Laurence Miller, M.D., Chairperson: The recently adopted Core Principles for Alternative Payment Models was developed by the Committee on Reimbursement for Psychiatric Care. Members have been identifying and gathering additional information on clinical models that could be paid for under an alternative payment model, which includes possible payment structures for substance use disorder or opioid use disorder treatment, such as MAT, coordinated specialty care for first-episode psychosis, and other payment models to address care transitions. Additionally, members of the Committee have assisted in the evaluation of a proposed episode-based cost measure for patients with psychosis. The Committee will continue to work with the Council on Quality Care to monitor that measurement development process.

Committee on Telepsychiatry

Jay Shore, M.D., M.P.H., Chairperson: The Committee on Telepsychiatry has expanded its Telepsychiatry Toolkit. Working in cooperation with the American Academy of Adolescent and Child Psychiatry (AACAP), the Committee added 18 new videos and associated literature references to the toolkit, featuring content highlighting the unique practical, legal, and regulatory implications of using telepsychiatry with patients. The Committee has also begun adding video content to APA’s regularly updated Telepsychiatry Blog. The first “vlog” entry introduces viewers to the work of the Committee and provides an overview of the use of telepsychiatry in practice. Subsequent entries provide practical examples of how to use the technology in session, offer tips on how to remain compliant with local, state, and federal regulations, and give pointers on using telepsychiatry with special populations. Members of the Committee have also rolled out their new Telepsychiatry Newsletter.

The Council on International Psychiatry

Bernardo Ng, M.D., Chairperson

K. Sonu Gaind, M.D., Vice Chair

The APA Council on International Psychiatry (Council) focuses on supporting bilateral education and development with psychiatrists from around the world through opportunities aimed at supporting and increasing international exchange and engagement. The Council also supports the development of international policy, education, and membership initiatives, recognizes organizations supporting the human rights and mental health needs of populations from around the world through the APA Chester M. Pierce Human Rights Award Nominating Committee (Committee), and engages with members through the APA Caucus on Global Mental Health and Psychiatry (Caucus). The Council Chair is Dr. Bernardo Ng, and the Vice Chair is Dr. K. Sonu Gaind; the Committee Chair is Dr. James Griffith, and the Caucus Chair is Dr. Geetha Jayaram.

Education and Professional Development

Scientific program.

Council and Caucus members continue to identify and support opportunities for the development of quality abstracts on global mental health and international topics for presentation at the APA Annual Meeting and other international psychiatric meetings. Below is a selection of sessions presented at the 2019 APA Annual Meeting in San Francisco, by Council and Caucus members:

• • “Addressing the Multiplicative Effects of Immigration on Psychiatric Training, Practice, and Care”

• • “APA Council on International Psychiatry: The Global Challenge of Mental Disorders and Non-Communicable Diseases: The Role of Integrated Care”

• • “Deportation and Detention: Addressing the Psychosocial Impact on Migrant Children and Families”

• • “Developing a Global Mental Health Program for Psychiatry Departments”

• • “Disparities in Mental Health Care Delivery to Immigrants: How Community Psychiatrists Can Close the Gap”

• • “Engaging and Partnering With Faith Communities and Spiritual Care Professionals to Revitalize Mental Health Care: An Under-recognized Innovation”

• • “Global Partnerships for Mental Health: Building Relationships and Capacity in Low-Income Settings”

• • “Increasing Access to Mental Health Care in Low- and Middle-Income Countries: Examples and Strategies From Sub-Saharan Africa”

• • “Violence Motivated by Cultural Identity: How Social Neuroscience Can Contribute to Strategies for Intervention”

In addition to these sessions, the tracks “Global, Political, and Social Issues” and “International Collaborations” reflect the breadth of issues on global mental health topics the Council and Caucus continue to monitor and discuss, including sessions that reflect collaborations with international psychiatrists and psychiatric organizations. The following is a selection of relevant sessions presented at the 2019 APA Annual Meeting with several included in the APA’s 175th Anniversary historical track:

• • “APA and Japanese Society of Psychiatry and Neurology: History and Future Visions for Collaboration”

• • “Asian-American Mental Health Treatment and Engagement: An Update on Challenges and Opportunities”

• • “Fake Views: Comparing the Royal College of Psychiatrist's Policy Development With the APA—Is There a Special Relationship?”

• • “Joint WPA-APA Council on International Psychiatry Presentation: Psychiatry’s Emerging Role in Responding to Emergencies and Adversity”

• • “Latinos in 2019”

• • “The South African Society of Psychiatrists and APA: Relations and Roles“

• • “WPA Initiatives: An Update”

While not part of the scientific program, the annual in-person meeting of the Caucus is also an opportunity for attendees to engage in dialogue on global mental health topics. Council and Caucus members also submitted abstracts for presentation at the 2019 World Psychiatric Association (WPA) International Congress in Lisbon, Portugal, August 21–24, 2019.

International presenter development.

In coordination with the APA Scientific Programs Committee (SPC) and the APA Division of Education, the Council developed a program, now in its third year, designed to connect Council members with international poster presenters at each APA Annual Meeting. The International Poster Engagement Program is managed by the Council, in coordination with APA Administration, and the program for the 2019 APA Annual Meeting was led by Dr. Jennifer Severe, Dr. Josepha Immanuel, and Dr. Uyen-Khanh Quang-Dang. The Council received submissions from participants, already accepted by the APA SPC to present at the APA Annual Meeting and thank the following individuals for their participation in the program:

• • Dr. Pedro Cabral Barata (Portugal)

• • Dr. Eugene Breen (Ireland)

• • Dr. Yoram Barak (New Zealand)

• • Dr. Melissa Chrispijn (Netherlands)

• • Dr. Johan Reutfors (Sweden)

• • Dr. Chu Wei Tsai (Taiwan)

• • Dr. Alaa Youssef (Canada)

• • Dr. Maria Beatriz Quintanilla-Madero (Mexico)

• • Dr. Lorena Del Sant (Brazil)

• • Dr. Toshiaki Furukawa (Japan)

• • Dr. Eduardo Humes (Brazil)

• • Dr. Nahed Khairy (Egypt)

• • Dr. Il Bin Kim (Korea)

• • Dr. Utsmai Menezes (Canada)

• • Dr. Anurag Misra (Nepal)

• • Dr. Alexandra Jean Palis (Philippines)

• • Dr. Elmars Rancans (Latvia)

• • Dr. Dan Siskind (Australia)

• • Dr. Nur Sena Uzunay (Turkey)

Assigned reviewers from the Council and Caucus coordinated with these individuals during the poster sessions at the APA Annual Meeting to review and discuss their research, address any feedback they may have requested, and share opportunities for engaging and collaborating with APA. The Council thanks the following Council and Caucus members who served as reviewers this year:

• • Dr. Muhammad Zeshan Ali (United States)

• • Dr. Saeed Ahmed (United States)

• • Dr. Ahmar Mannan Butt (United States)

• • Dr. Michael Esang (United States)

• • Dr. Vikas Gupta (United States)

• • Dr. Josepha Immanuel (United States)

• • Dr. Uyen-Khanh Quang-Dang (United States)

• • Dr. Asif M. Rahman (United States)

• • Dr. Sabreen Rahman (United States)

• • Dr. Soraya Seedat (South Africa)

• • Dr. Karim Sedky (United States)

• • Dr. Jennifer Severe (United States)

• • Dr. Mary Kay Smith (United States)

• • Dr. Dhanviney Verma (United States)

Membership Development and Engagement

Global Mental Health Caucus.

Caucus membership has increased to over 1,000 APA members, established with only 50 members in 2014, which may reflect the growing interest in the area of global mental health and the benefit of the Caucus and its activities to APA members. Under the leadership of the former Caucus Chair, Dr. Gabriel Ivbijaro of the United Kingdom, the Caucus established several work groups during his term to focus on reviewing the following topics: “Health Systems and Policy,” “Health and Well-Being,” “Research, Education, and Training,” and “Anti-Stigma and Advocacy.” The Caucus conducted an election for the 2019–2020 Caucus Chair position, which included the following four candidates: Dr. Arafat Al-Dujaili, an APA International Fellow in Iraq, Dr. Dave Baron, an APA Distinguished Life Fellow, Dr. Xiaoduo Fan, an APA Fellow, and Dr. Geetha Jayaram, an APA Distinguished Life Fellow. Dr. Jayaram received the majority of votes to become the 2019–2020 Caucus Chair and reports Caucus activities to the Council.

International Distinguished Fellows.

Council and Caucus members were involved in the nomination of the 2019 APA International Distinguished Fellows. Upon the recommendation of the APA Membership Committee, the APA Board of Trustees approved the following individuals to confer International Distinguished Fellowship during the 2019 APA Annual Meeting convocation ceremony: Dr. Roger Ng (Hong Kong) and Dr. Yusuf Matcheswalla (India).

Policy Development and Recognition

Chester M. Pierce Human Rights Award.

Upon the recommendation of the Committee and the Council, made in recognition that societal stigmatization, discrimination, and social violence toward immigrants and refugees internationally has become the major human rights issue of our day, including the maltreatment of immigrants and refugees in the United States, the APA Board of Trustees approved the 2019 APA Chester M. Pierce Human Rights Award to be jointly awarded to the following organizations:

• • Catholic Charities: Catholic Charities provides assistance to immigrants and refugees throughout the U.S. and offers a wide range of social and legal services to help immigrants and refugees establish their lives in new communities. The award was accepted by Jilma Meneses, the CEO of Catholic Charities-San Francisco.

• • Lutheran Immigration and Refugee Services: Lutheran Immigration and Refugee Services provides advocacy and social services for refugees and migrants from around the globe. The award was accepted by Dr. James Griffith on behalf of the organization.

• • International Rescue Committee: In the United States, the IRC has played a major role in multiple programs across the nation helping resettled refugees to rebuild their lives. The award was accepted by Patrick Poulin, Regional Director, U.S. Programs-Pacific West Region, of the International Rescue Committee.

The awards were presented by APA President, Dr. Altha Stewart, during the 2019 APA Annual Meeting session “The Multiple Faces of Deportation: Being a Solution to the Challenges Faced by Asylum Seekers, Mixed Status Families, and Dreamers.” The Chester M. Pierce Human Rights Award recognizes the extraordinary efforts of individuals and organizations to promote the human rights of populations with mental health needs by bringing attention to their work. Originally established in 1990 to raise awareness of human rights abuses, the award was renamed in 2017 to honor Chester M. Pierce, M.D. (1927–2016) and recognizes his dedication as an innovative researcher on humans in extreme environments, as an advocate against disparities, stigma, and discrimination, and as a pioneer and visionary in global mental health.

Position Statement on Mental Health of Foreign Nationals on Temporary Protected Status

The Council’s Work Group on Temporary Protected Status (TPS) developed a Position Statement on Mental Health of Foreign Nationals on TPS, which is under consideration by the APA Assembly. The background of the position statement notes that in 1990, the United States established the TPS program allowing foreign nationals unable to safely return to their home country due to catastrophic circumstances such as war, famine, natural disaster or epidemic, to remain in the United States. Countries currently part of the TPS program include El Salvador, Haiti, Honduras, Nepal, Nicaragua, Somalia, Sudan, South Sudan, Syria, and Yemen. In 2018, the TPS program was rescinded, affecting hundreds of thousands of foreign nationals in the United States. confronted with the possibility of returning to unsafe countries. Individuals and families under TPS face emotional, physical and psychosocial stress due to the uncertainty of their status, potential family separation, and are at risk of developing or exacerbating mental health problems. Unfortunately, many health providers, including psychiatrists, are unaware of this immigration status and its impact on individuals and families. The position statement encourages increased awareness of the TPS program as an immigration issue, aims to educate healthcare providers about the particular mental health concerns of the individuals in the U.S. under TPS, advocates for active screening for mental health symptoms and access to health care, including mental health care, and treatment for individuals and families under TPS, and to support funding of research on the mental health impact of TPS on individuals and families.

The Council on Medical Education and Lifelong Learning

Mark Hyman Rapaport, M.D., Chairperson

The Council on Medical Education and Lifelong Learning monitors emerging issues in psychiatry education and facilitates the development of education resources and programs. The purview of the Council includes medical education, graduate medical education for residents and fellows in psychiatry (both basic education and subspecialty areas), psychiatric aspects of graduate medical education for other medical specialists, and postgraduate continuing medical education and lifelong learning. The Council acts in an advisory role to the APA Division of Education in the development of its continuing education programs and initiatives. To facilitate collaboration and communication, the Council serves as a convening body for the allied psychiatry education organizations, including the American Association of Directors of Residency Training, the Association of Directors of Medical Student Education in Psychiatry, the Association of Academic Psychiatrists, the American Board of Psychiatry and Neurology, and the American Association of Chairs of Departments of Psychiatry.

The Council values the highest standards of clinical practice and lifelong professional development. As psychiatric educators, the Council on Medical Education and Lifelong Learning believes that the APA has an obligation to support the lifelong learning of its members. The Council’s major initiatives and activities are as listed below.

In the area of Graduate Education, the Council looked at clerkship length as a factor associated with medical student matriculation into psychiatry. In a 2017 review of factors associated with higher rates of recruitment into psychiatry, Spollen et al. found that educational culture and climate factors may have a significant impact on psychiatry recruitment rates. In one study but not in others, clerkship length was associated with higher recruiting schools.

The Council is collaborating with other psychiatry education groups ADMSEP, AADPRT, and AACDP, looking at mental health care for all trainees. New ACGME Common Program requirements mandate mental health care for trainees. CMELL discussed best practices and special considerations for psychiatry residents in access to mental health care. AADPRT is looking at the variety of models to understand how this access to care is being met at programs around the country with consideration of the role of telepsychiatry, and other existing models.

Training Program Leadership

The Council reviewed a drafted position statement from the Chairs of Departments of Psychiatry that departments of psychiatry with training programs must be led by a board-certified psychiatrist.

Addiction Requirements

The Council was asked to weigh in on expanding addiction requirements in residency training and continues to look at this issue.

Workforce Issues

Subspecialty workforce.

Discussions have been ongoing within psychiatry education as to why subspecialty positions are not being filled. The Council is working to gain a better understanding of this issue, looking at factors such as what is the “right” proportion for residents who should be entering subspecialty fellowships; what is the perceived value of the extra training; what is the correct number of generalists versus subspecialty trained providers. The Council organized a work group to determine what data is already available through AADPRT, the subspecialties, and other APA councils.

General workforce.

There is a growing need for psychiatry in the United States. The council has an interest in how have new slots been created and funded. The Council continues to be engaged in looking at general workforce issues and heard from the AADPRT Workforce Taskforce about its specific goals:

• • To examine and define the extent of the projected workforce shortage.

• • To identify and disseminate best practices regarding expansion of psychiatry training slots.

• • To develop strategies for overcoming the existing obstacles to expansion of psychiatry residency slots and anticipate possible changes in funding sources and models in the future.

• • To identify other solutions that go beyond expansion of psychiatry training slots.

• • To collaborate with allied organizations and institutions in study and advocacy relating to psychiatry workforce.

• • To consider ways of addressing psychiatrist maldistribution by preparing residents to care for patients in underserved areas.

• • To consider the long-term (20+years) mental health needs of the population and what psychiatric expertise will be needed, given demographic trends, changes in technology, and anticipated changes in models of care.

Continuing Board Certification: Vision for the Future Commission

The American Board of Medical Specialties organized Vision Commission posted its draft report from their two-year study of the future of Maintenance of Certification (MOC). Members of the Council reviewed the report and contributed their views to the American Psychiatric Association’s comment on the report. The APA responded to the Vision Commission report by saying that the Commission failed to improve the MOC process for physicians.

Wellness and Burnout Committee

In 2018, the APA created a standing committee under the Council on Medical Education and Lifelong Learning to examine ongoing issues related to well-being and burnout. The committee is currently reviewing the data on burnout collected by the previous workgroup, analyzing data from over 2,500 psychiatrist responses to the Oldenburg Burnout Inventory. The committee is also looking closely at how wellbeing and burnout issues affect minority/underrepresented psychiatrists as well as Early Career Psychiatrists.

Innovation Committee

A Standing Committee on Innovation under the Council on Medical Education and Lifelong learning was approved by the APA Board in 2018. This committee seeks to identify and promote the formation of novel ideas to transform mental health care. The committee supported the APA Psychiatry Innovation Lab at the APA Annual Meeting beginning in 2019. Medimmunity, a digital platform aimed at preventing burnout among medical trainees by providing structured support groups, online resources to help build resilience, and a forum to enable students and residents to connect with colleagues was the winner at the 2019 Mental Health Innovation Lab competition. The idea is based on an in-person, support program available at Mount Sinai known as PEERS (Practice Enhancement, Engagement, Resilience, and Support).

The Council on Medical Education and Lifelong Learn‐ing reviewed actions of the Assembly related to education and provided feedback.

Recognition of Psychiatric Expertise: Efficiency and Sufficiency

The AMA has an existing policy that states that MOC should not be a requirement for maintenance of licensure, hospital privileges, insurance credentialing, or employment. APA has been supportive of this policy. The Interstate Medical Licensure Compact has already released its eligibility requirements (http://www.imlcc.org/do-i-qualify/), which require individuals to “hold a current specialty certification or time-unlimited certification by an ABMS or AOABOS board.”

The Council weighed in and supported: Designation of psychiatry as primary care for any medical school scholarships requiring primary care service and medical school loan repayment subsidies for psychiatrists practicing in community mental health centers and state psychiatric facilities. The Council also weighed in on Access to Care Challenges and the Role of Residents.

Addressing Racial Discrimination Against Physicians

The Council was provided with an update on the work of the ad hoc workgroup developing a Web-based “toolkit” to address racial discrimination against psychiatry trainees and practicing psychiatrists. The Council on Diversity and Health Equity is leading the content development. The Council discussed the focus of the project and discussed reaching a broader audience.

Joint Sponsorship of CME Credit for District Branches and Allied Associate Groups

With input from the Council on Medical Education and Lifelong Learning, the APA’s Joint Sponsorship program allows District Branches and allied psychiatry organizations with missions aligned with the CME mission of APA to apply for continuing medical education credit from the APA for their meetings. The joint sponsorship program welcomed new groups into the program in 2019: The Ross Center, Mind to Mindful, the American Association of Community Psychiatrists and the American Professional Association, Inc. Goals of the joint sponsorship program include strengthening allied relationships and expanding opportunities, furthering educational goals, enhancing the APA learning management system, and bringing in new learners.

Education Awards

The Council initiates nominations for APAs education awards, the Nancy C.A. Roeske, M.D., Certificate of Excellence in Medical Student Education, Irma Bland Award for Excellence in Teaching Residents, and the Vestermark Psychiatry Educator Award recognizing excellence, leadership, and creativity in the field of psychiatric education; in 2019 the Vestermark award was presented to Alan Louie, M.D.

The Council on Minority Mental Health and Health Disparities

Eric Yarbrough, M.D., Chairperson (June 2019–present)

Christina Mangurian, M.D., M.A.S, Chairperson (June 2016–May 2019)

The Council on Minority Mental Health and Health Disparities (CMMH/HD) advocates for minority and underserved populations and psychiatrists who are underrepresented within the profession and APA. CMMH/HD seeks to reduce mental health disparities in clinical services and research, which disproportionately affect women and minority populations. CMMH/HD aims to promote the recruitment and development of psychiatrists from minority and underrepresented (M/UR) groups both within the profession and APA.

2018–2019 CMMH/HD Accomplishments and Initiatives

The following Positions Statements were developed by CMMH/HD and approved by APA Board of Trustees from 2018 to 2019:

• Mental Health Equity and the Social and Structural Determinants of Mental Health,” 2018

• Discrimination of Religious Minorities,” 2018

• Human Trafficking,” 2018

• Police Brutality and Black Men,” 2018

• Addressing Health Disparities in Substance Use Disorders and the Justice System,” 2019

• Diversity and Inclusion in the Physician Workforce,” 2019

• Racism in the Psychiatric Workplace,” 2019

The following APA Position Statements were reviewed and reaffirmed by the CMMH/HD from 2018–2019:

• “Religious Discrimination, Persecution, and Genocide”: reaffirmed year, 2018; origin year, 1997

• “Transgender-Gender-Variant-Access-Care”: reaffirmed year, 2018; origin year, 2012

• “Transgender-Gender-Variant-Discrimination”: reaffirmed year, 2018; origin year, 2012

• “Cultural Psychiatry as a Specific Field of Study”: reaffirmed year, 2019; origin year, 2013

Joint Meeting of the CMMH/HD and M/UR Caucus Representatives

The Joint Meeting of the CMMH/HD and the Assembly Committee of M/UR Representatives took place at the 2018 September Components. The two groups generated the following deliverables:

1. Significant movement on addressing edits by APA Division of Communication regarding the APA Stress Trauma Toolkit due to the Current Social and Political Climate.

2. Development of a roster of M/UR psychiatrists (based on expertise) to speak on behalf of APA on issues related minority mental health. The roster will be provided to the for the Division of Communications.

3. Strategizes for APA Division of Membership to successfully initiate outreach to non-APA members who are M/UR.

U.S. Joint Statement Warning Against Conversion Therapy

CMMH/HD was asked by APA’s Division of Policy, Programs, and Partnerships to review the 2019 US Joint Statement on Conversion Therapy on behalf of APA. The document was written by the Psychotherapist Association for Gender & Sexual Diversity (PAGSD). After careful review of the document, CMMH/HD voted unanimously that APA endorse the statement and recommended that PAGSD incorporate APA’s longstanding policies against conversation therapies as references/resources.

Looking Back, Striding Forward: The 1969 Walk-In and Its Legacy

The History and Intergenerational Workgroup, composed of CMMH/HD members, have developed a trailer (click here) for the APA documentary “Looking Back, Striding Forward The 1969 Walk-in and its Legacy.” The purpose of the film is to commemorate the May 1969 walk-in of a group of Black psychiatrists who demanded that the world’s largest professional organization of psychiatrists recognize and address minority mental health needs, mental health disparities, and the racially charged sociopolitical climate in the United States. The monumental moment in APA history impacted policy and advocacy work regarding mental health disparities for decades. This documentary could eventually be put on the APA website and used for recruitment purposes of future M/UR members.

APA Stress and Trauma Toolkit Due to the Current Social and Political Climate

CMMH/HD is on the final leg of the Stress and Trauma toolkit Due to the Current Social and Political Climate before it is released publicly. The toolkit was a joint effort between CMMH/HD and M/UR Caucus Leadership to provide psychiatrists with best practices for assessment and treatment of minority and vulnerable groups who are impact by the current state of the socio-political climate. Toolkit Sections include recommendations for assessment and treatment of the following groups: African American, Asian American, Hispanic, Indigenous, LGBTQ, Muslim, Undocumented Immigrants, and Women. A section focused on the assessment and treatment of Jewish Americans has been developed and is currently in review by APA’s Workgroup on Anti-Semitism.

APA 2019 Annual Meeting

Scientific sessions.

CMMH/HD endorsed eight presentations that included a member of CMMH/HD a during were highlighted during the 2019 APA Annual Meeting in San Francisco. The included:

• • Placing justice and health equity at the center of residency education: A case study of new initiatives at UCLA (Enrico Castillo, M.D.)

• • Reducing health care disparities through careers in public service: Lessons from three educational tracks in public/community psychiatry throughout California (Enrico Castillo, M.D., and Christina Mangurian, M.D.)

• • Gender Bias in Academic Psychiatry in the Era of the #MeToo Movement (Christina Mangurian, M.D.)

• • Peripartum, Gynecologic, and Primary Care for Women with Serious Mental Illness: New Initiatives and Challenges (Christina Mangurian, M.D.)

• • Racism and Psychiatry: Achieving Health Equity for Minority Communities Through Faith-Based Partnerships (Morgan Medlock, M.D.)

• • Racism and Psychiatry: Growing a Diverse Psychiatric Workforce and Developing Structurally Competent Psychiatric Providers (Morgan Medlock, M.D.)

• • Racism and Psychiatry: Understanding Context and Developing Policies for Undoing Structural Racism (Morgan Medlock, M.D.)

• • Trauma Inflicted to Immigrant Children and Parents Through Policy Of Forced Family Separation (Nubia Chong, M.D.)

M/UR award lectures series.

Seven award lectures at the 2019 Annual Meeting were under the purview of the CMMH/HD. Each awardee was vetted and approved by CMMH/HD. Lectures and awardees included:

• • Simon Bolivar Award Lecture given by Esperanza Diaz, M.D., on “Advocacy: A Hallmark of Psychiatrists Serving Minorities”

• • John Fryer Award Lecture given by Shannon Minter, Esq, on “The Essential Role of Mental Health Professionals in Securing Equality for LGBTQ People”

• • Solomon Carter Fuller Award given by Loma K. Flowers, M.D., on “’What Were You Thinking?’” A Keystone Question for Emotional Fitness”

• • Oskar Pfister Award Lecture given by George Fitchett, D.Min, Ph.D., on “Evidence-Based Spiritual Care: A New Paradigm for Health Care Chaplaincy”

• • The Kun-Po Soo Award Lecture given by Stanley Sue, Ph.D., on “What We Know and Don't Know About Asian-American Mental Health”

• • Alexandra Symonds Award Lecture given by Samantha Meltzer-Brody, M.D., on “This Can't Be as Good as It Gets: The Importance of Disruptive Innovation in Reproductive Psychiatry”

• • George Tarjan Award Lecture given by Britta Ostermeyer, M.D., on “The integration of International Medical Graduates into American Psychiatry.”

Conversations on diversity.

In conjunction with APA’s Division of Diversity and Health Equity (DDHE), CMMH/HD sponsored Conversations on Diversity, which was attended by several members of APA’s M/UR Caucuses, APA/APAF Fellows, and APA leadership. Eric Yarbrough, M.D., chair of the minority Council served a facilitator along with Nadia Woods, M.S.W., DDHE Senior Program of Diversity Initiatives. “Conversations” allows members to strategize ways to increase diversity and practice inclusion within APA as well as their professional entities. A total of 70 people attended. Exit evaluations shows that 98% of those surveyed thought the session was “thought-provoking” and “useful.”

The Council on Psychiatry and the Law

Debra A. Pinals, M.D., Chairperson

The Council on Psychiatry and Law is responsible for evaluating legal developments of national significance that affect the practice of psychiatry and the availability and quality of mental health care, including case law, legislation, regulation, and all other forms of legal regulation of psychiatric practice. It includes a focus on practice areas such as correctional psychiatry and the subspecialty of forensic psychiatry. In the past year, the Council has worked on a wide variety of issues. This report highlights some of the topics covered between 2018 and 2019.

Civil Commitment for Adults With Substance Use Disorder

The Council on Psychiatry and Law has developed a position statement on civil commitment for adults with substance use disorder. This document was created in response to a renewed interest in laws pertaining to civil commitment for substance use disorders (SUDs), especially in light of the opioid overdose epidemic and a growing desire to increase access to services. The statement neither endorses nor opposes SUD commitment statutes, but it does state the conditions that should be satisfied by all SUD commitment programs. This position statement is currently being reviewed by the APA Board of Trustees.

Pharmaceutical Marketing

In 2017, the Council formed a workgroup to address pharmaceutical marketing practices that have been aimed at judges and legislators relating to individuals involved in the justice system. In an earlier position statement, Treatment of Substance Use Disorders in the Criminal Justice System (2016), APA took the position that medication treatment, as offered by medical professionals in accordance with evidence-based practices, is an essential component of treatment for many individuals with substance use disorders in criminal justice settings. However, pharmaceutical marketing efforts have potentially exacerbated barriers to appropriate access of treatment by influencing the types of medication treatment offered in justice settings, especially in the case of alternative-to-incarceration programs. With input from the Council on Addiction Psychiatry, the Council on Psychiatry and Law drafted a position statement to condemn marketing efforts and pharmaceutical lobbying tactics that have employed this misinformation to argue for restrictions on the range of available medications. This draft position statement emphasizes the paramount importance behind granting treating clinicians access to the full range of medication treatments for substance use disorders, including methadone and buprenorphine, and will be submitted to the Joint Reference Committee for review at its next meeting.

Clinical Issues Pertaining to Access to Firearms

Individuals with mental illness may encounter firearms restrictions more frequently given the growing number of incentives offered to states to update their NICS database input and number of Gun Violence Restraining Order laws enacted nationwide. With the evolving legal landscape, psychiatric input may be requested by individuals seeking relief from these restrictions and government agencies administering registries or relief processes. The relevant statutes are often unclear as to what information should be offered by a psychiatrist, so the Council drafted a resource document offering guidance to general psychiatrists faced with these requests. The Council’s draft resource document highlights several important factors a general psychiatrist should take into consideration before undertaking the task of certifying a patient’s fitness for firearm possession. These factors include limitations on knowledge, time, and resources, liability considerations, performing evaluations in a potential tension-filled context, and the impact on the therapeutic relationship. The document also outlines two different types of statements – limited and expanded—that psychiatrists can make depending on the extent to which they feel qualified to offer an assessment. This draft resource document will be submitted to the Joint Reference Committee for review at its next meeting.

Role of Guardians in Consenting to Psychiatric Treatment

The role of guardians in consenting to psychiatric treatment—especially inpatient psychiatric hospitalization—for persons with mental illness has become increasingly complex and nuanced across states. In some states, a judicially appointed guardian may consent to psychiatric hospitalization or other mental health treatment, whereas in other states the only route for psychiatric hospital admission is through involuntary civil commitment. In order to ensure timely access to treatment balanced by protection of a vulnerable population, the Council drafted a position statement to guide the authorization of treatment for persons with mental illness by a guardian, health care agents or other legally authorized surrogates. This draft has resulted in further debate and discussion, and the Council will continue to work on what direction to take regarding this issue.

Committee on Judicial Action (Marvin Swartz, M.D., Chairperson)

The Committee on Judicial Action, chaired by Dr. Marvin Swartz, is a component of the Council that considers and recommends APA involvement as a friend of the court in cases at every level of the judicial system and covering a range of issues. This year, APA coauthored an amicus brief to the U.S. Supreme Court in the case of Kahler v. Kansas, supporting the recognition of an insanity defense broad enough to allow meaningful consideration of the impact of serious mental disorders on individual culpability. The Committee recently recommended joining an amicus brief in the case of Stewart v Azar, asserting that Kentucky’s new work requirements for Medicaid Beneficiaries will not improve the health of the Medicaid Beneficiaries, and in the case of Texas v United States, describing why, under proper analysis, the individual mandate is severable from the remaining provisions of the Affordable Care Act. The Committee is also in the process of writing an amicus brief in the case of Kahler v Kansas, which involves the constitutionality of the insanity defense. The Committee also joined an amicus brief in the case of Moore v. Texas, asserting that an accurate diagnosis of intellectual disability requires clinical judgment based on a comprehensive assessment of three criteria: (1) general intellectual functioning; (2) adaptive functioning in conceptual, social, and practical domains; and (3) whether the relevant deficits were onset during the development period.

Other Topics

The Council continues to work on an array of topics, including evaluation and restoration of competence to stand trial, stalking and intrusive behavior by patients toward psychiatrists, child commitment, and voluntary and involuntary hospitalization. Members of the Council have also formed a workgroup with members of the Council on Addiction Psychiatry to address issues at the intersection of law and addiction, including supervised injection sites and assuring the appropriate care of pregnant and newly-delivered women with substance use disorders. The Isaac Ray Award Committee and Manfred S. Guttmacher Award Committee each report to the Council. The Isaac Ray Award recognizes a person who has made outstanding contributions to forensic psychiatry or the psychiatric aspects of jurisprudence; it was awarded to Dr. Peter Ash in 2019. The Manfred S. Guttmacher Award recognizes an outstanding contribution to the literature of forensic psychiatry; it was awarded to Drs. Jacob Holzer, Robert Kohn, Patricia Recupero, and James Ellison for editing and authoring Geriatric Forensic Psychiatry: Principles and Practice. Both committees are in the process of selecting their 2020 recipients and selections will be submitted to the Council for approval during the September Component Meetings.

The Council on Quality Care

Grayson Norquist, M.D., M.S.P.H., Chairperson

Melissa Arbuckle, M.D., Ph.D., Vice Chair

The Council on Quality Care’s overarching goal is to ensure the highest standards of care remain an integral part of APA’s mission. To achieve this goal, the Council on Quality Care (hereafter referred to as “Council”) monitors advances, carries out activities, and disseminates information related to, but not limited to, the following areas: clinical practice guidelines; quality measures and performance indicators; implementation of patient registries; standards and survey procedures; clinical informatics that leverage health information technologies to improve care and track costs; and patient safety. The Council collaborates with other groups within APA’s governance structure to respond to topics of mutual concern, such as patient outcome measures, accreditation standards, and the effects of quality improvement efforts on clinical practice, individual patient outcomes and general population health.

Committee on Mental Health Information Technology (CMHIT)

The CMHIT works on topics related to the use of technology in clinical practice. Recently, the committee has focused on developing resources to assist members in meeting requirements for federal pay-for-performance or pay-for-reporting programs and is providing input to the Centers for Medicare and Medicaid Services’ (CMS) on its proposed rule on Promoting Interoperability among electronic health records for the 2020 Fiscal Year. The Committee recently provided feedback on the Office of the National Coordinator for Health Information Technology’s (ONC) 21st Century Cures Promoting Interoperability and Information Blocking Notice of Proposed Rule Making. Comments focused on the impact of the information blocking provisions within the rule on psychiatric care, as well as other proposals focused on the new definition of “Electronic Health Information.” The Committee also submitted comments to the ONC regarding interoperability and administrative burden for Information and another proposed rule policies.

The Committee commented on behalf of the APA on the Food and Drug Administration’s (FDA) precertification program for software as a medical device (SAMD). These comments detailed several concerns regarding the policies and procedures that would allow software developers to regulate themselves regarding the utility, efficacy, and safety of mental health and substance use disorder software applications. Furthermore, the letter recommended that the FDA refer to APA’s Mobile App Evaluation Model for the type of standards that should be used during the precertification process. APA also offered to recommend APA member subject matter experts to participate in the development of future iterations of the precertification process.

The CMHIT is expanding the ability of the APA to provide advice about current mobile mental health apps by developing the APA App Advisor. To expand the App Advisor’s capability beyond the current Apps Evaluation Model, the Committee will appoint volunteer-experts to a multistakeholder expert panel. This panel will conduct a review of potential standards applicable to apps. The APA released a public call for nominations to be submitted by August 2019. The expert panel will include member-psychiatrists, other mental health providers, software developers, informaticists, medical residents, and patients with lived experience of mental illness. Training and reviews will begin approximately the first week in October, and the APA will host a meeting of the group in early November.

Through collaboration between APA’s member-experts, members of the CMHIT and the Committee on Telepsychiatry will review content on psychiatry.org with the goal to build a “Digital Health Hub.” The hub’s objective is to connect members to resources posted on psychiatry.org.

Committee on Practice Guidelines (CPG)

The Committee on Practice Guidelines continues to focus on developing evidence-based practice guidelines to assist psychiatrists and others with clinical decision-making. The guideline writing group, chaired by Dr. George Keepers, is finalizing the newest Practice Guideline for the Treatment of People with Schizophrenia. The recommendation statements include psychopharmacological and psychotherapeutic treatments. This guideline is based on an AHRQ systematic review plus additional published meta-analyses. The draft version of this guideline was available for public comment through the end of June 2019. The CPG anticipates receiving approval by the APA Assembly and Board of Trustees this fall after review and possible incorporation of public comments. Additional resource materials will be published with the guideline, including an online CME vignette; family/care provider information; and provider summary/teaching slides.

Currently, there are two other assembled Guideline Writing Groups. The first writing group, chaired by Dr. Victor Reus, is working on the guideline for the treatment of bipolar disorder based on an Agency for Healthcare Research and Quality (AHRQ) systematic review, along with supplemental reviews and an expert survey.

Chaired by Dr. Catherine Crone, the second writing group is working on a guideline for the treatment of eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, night eating syndrome, avoidant/restrictive food intake disorder) based on an expert survey and a systematic review completed by the APA with Doctor Evidence, a systematic review company.

Upcoming systematic reviews for guidelines on the treatment of borderline personality disorder, delirium, and treatment-resistant depression are in the pipeline.

Committee on Quality and Performance Measurement (CQPM)

The CQPM focuses on matters related to nationally implemented quality measures that impact psychiatrists and their patients, as well as psychiatric quality measures that may be used by other health care providers who diagnose and treat individuals with mental and/or substance use disorders.

With support from the CQPM members, the APA has begun to outline quality measures that are patient-centered and clinically useful. The CQPM has started to prioritize topics for quality measurement. This will provide the CQPM with a strategy to provide comments to quality measure developers (e.g., Mathematica, RAND, etc.); the National Quality Forum; and federal and state policy makers and quality program administrators who rely on quality measures as tools to operationalize the goals and strategies set forth by national and state regulations.

In addition, this prioritization effort will aid in the drafting of APA’s comments during future public comment periods for CMS quality programs (Medicare and Medicaid). This includes CMS’s Inpatient Psychiatric Facility, Long-Term Care Hospital Quality Reporting Programs, the Medicare Shared Savings Plan Quality Program; the Merit-based Incentive Payment System (MIPS); and other quality measures developed and/or used by other entities separate from the government and government contracts.

The first round of the CQPM’s prioritization process resulted in quality measure topics being defined for inclusion into APA’s successful application for measure development funding awarded in September 2018. The funding supports the APA Measure Development Initiative. Among the responsibilities of the CQPM is the oversight of measures developed by APA.

The Committee also developed a position statement, “Utilization of Measurement Based Care” that was approved by the Board of Trustees in December 2018. This position statement supports the development and implementation of measurement-based care for psychiatrists and other health care providers who treat individuals with mental and/or substance use disorders.

Reporting Workgroups and Other Work With Member-Experts

Several workgroups report to the Council. The Patient Safety Workgroup continued their efforts this past year on a variety of safety issues, such as the development of definitions for patient observation and refinement of case studies for use in mock root-cause analyses for psychiatric training programs. Under the Council’s charge, they are also examining an action assigned by the JRC that specifically focuses on patient safety and clinical environment workflow prior to an inpatient psychiatric facility’s (IPF) construction or renovation. This has importance for mitigating ligature-point and other self-harm risks in this care-setting.

The Standards and Survey Procedures Workgroup and other APA member-experts addressed accreditation program policy updates and implementation of behavioral health standards, like those of The Joint Commission (e.g., National Patient Safety Goals on Suicide Prevention), URAC, and others.

Two other workgroups formed this year are:

1. The Quality Strategy Workgroup that consists of Council and CQPM members who were charged with examining and formulating recommendations for the APA regarding potential next steps to improve APA’s position within the national quality landscape. In addition, this workgroup will make recommendations for steps to improve alignment among APA’s quality efforts (i.e., quality measure development, practice guideline development, and PsychPRO, APA’s Mental Health Registry).

2. The IPF Workgroup consists of APA members and one nonpsychiatrist with expertise in quality care. They are charged with identifying APA’s priorities regarding quality measures currently adopted by CMS’s Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program as well defining strategic recommendations and topics for future inpatient measure development by APA and outside quality measure developers.

Technical Advisors

The Council on Quality Care, with support from its component groups, participated in several internal and external expert panels this year. For example, the Council, including members from the CQPM, participated in strategic discussions on continued development and updates to APA’s mental health registry (PsychPRO). They also served on advisory panels to formulate recommendations for the quality measures included in the 2020 Medicaid Core Sets (for children and adults). The Council on Quality Care has been successful in achieving multiple appointments on external quality measurement panels and accrediting organizations’ decision-making bodies, and the National Quality Forum-convened National Quality Partnership’s Serious Mental Illness and Social Determinants of Health Data Integration Action Teams. These multistakeholder panels are responsible for defining national quality measurement strategies, developing meaningful quality measurement tools, recommending appropriate use of quality measures and how institutions will be surveyed for behavioral health care. These appointments afford APA an authoritative voice in the national quality enterprise.

The Council on Research

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

Carolyn Rodriguez, M.D., Ph.D., Vice Chair

The Council on Research continues to help ensure that research on mental health remains integral to the American Psychiatric Association’s (APA) mission and in the forefront of the national health agenda. The Council embodies APA’s commitment to advance psychiatric knowledge through the conduct of research by physician scientists across a broad range of research fields and issues: basic science, clinical diagnosis and assessment, treatment research, epidemiology, health services, computational psychiatry, and research training. These areas are represented by the committees, caucuses, and task forces under the Council’s Jurisdiction. The following is a brief report of the May 2019 meeting of the Council on Research and its future plans.

APA Registry Discussion

The Council continues to help guide and support the refinement and scaling of APA’s Mental Health Registry, PsychPRO. Following the completion of 2018 MIPS reporting, PsychPRO staff began the process of refreshing participant dashboards with 2019 data as well as onboarding new participants for 2019. The newly configured dashboards provide participants with quality measures data for tracking and improving performance throughout 2019 in preparation for reporting at the top of 2020. New participant agreements have been received from 55 practices since the beginning of 2019. Based on recruitment rates from previous years, we expect to receive a total of approximately 100 additional agreements through September 2019, when registration closes for the 2019 reporting period.

PsychPRO staff worked to meet the numerous requirements necessary to remain a certified QCDR throughout the year, including the submission of Data Validation Plans for 2018 that were accepted and approved by CMS on June 5, 2019.

Outreach strategies aimed at increasing registry participation beyond what was seen for MIPS reporting are currently being implemented. These strategies include a rollout of marketing and promotional efforts including but not limited to Google Ads and social media. Postcard mailout campaigns will target non-APA member psychiatrist and other behavioral health providers.

PsychPRO continues to work with various vendors to identify PRO modules that offer superior user experience in order to expand functionality for practices focused on measurement-base care (MBC). The current focus on MBC by various regulatory and accreditation bodies means providers in the field will be seeking solutions for efficient and effective implementation of MBC processes. PsychPRO is ideally suited to deliver this functionality as well as provide for tracking and improving patient care using patient-reported data generated with MBC processes.

For more information about the Registry, please go to www.psychiatry.org/psychiatrists/registry.

Component Updates

Committee on Research Training: The Council’s Work Group on Research Training, chaired by Charles Nemeroff, M.D., Ph.D. and Steven Siegel, M.D., Ph.D., met to discuss the outcome of the 2019 Research Colloquium for Junior Psychiatrist Investigators (Colloquium) and plans for the 2020 Colloquium. The Colloquium continues to be jointly funded by a National Institute on Drug Abuse (NIDA) R-13 grant, the APA Foundation (APAF), and through our partnership with the American College of Neuropsychopharmacology (ACNP) and the Society of Biological Psychiatry (SOBP).

The 2019 Colloquium was a two-day event held on Saturday, May 18, and Sunday May 19 at the APA’s Annual Meeting in San Francisco. Day one of the event saw representatives from APA/APAF, NIDA, ACNP, and SOBP present on work-life balance, career trajectory, mentorship, research training, and funding opportunities to early research career (ERC) psychiatrists. This experience was augmented by a social sponsored by Colloquium co-chair Steven Siegel, M.D., Ph.D., and the University of Southern California on Saturday night, giving participants the opportunity to talk outside of Colloquium hours.

On day 2 of the Colloquium, awardees were divided into 2 tracks: Track 1 included ERC psychiatrists in the beginning stage of developing area(s) of research interest and needed mentorship in doing. Track 2 included ERC psychiatrists who had identified one or more clear research areas of interest but needed mentorship in moving forward to develop a K-award project or finetuning their research portfolio. Participants were further divided into five different research areas including Alcohol, Pain, and Substance Abuse Research; Clinical Psychobiology; Health Disparities and Health Services Research; Molecular, Translational, and Neuroscience Research; Treatment from Psychopharmacology and Psychotherapy to Neural Strategies for small group breakout sessions with their peers and team mentors.

This year, 47 senior psychiatric research mentors including Drs. Wilson Compton, John Krystal, Nina Kraguljac, Anand Kumar, Carolyn Rodriguez, and James Potash from the Council on Research took part in the event. Twelve biostatisticians/methodologists participated and provided valuable perspective often unavailable to young researchers. The 2019 panel of statisticians originated from APA (3), Stanford University (2), University of California in Irvine (1), University of California in San Francisco (1), University of California in San Diego (4), and the 2017 Psychiatric Research Fellow Adrienne Grzenda from the University of California Los Angeles (1). The Work Group hopes to continue its efforts to include a panel of statistical and methodological mentors to help senior psychiatric researchers in the mentorship of Colloquium awardees.

APA Past President (2016–2017) Maria Oquendo, M.D., Ph.D. and Bernardo Ng, M.D., chair of the APA’s Council on International Psychiatry, continue to lead the effort to expand the Research Colloquium to include more international ERC psychiatrists. Six international mentees from Brazil (2), Colombia (1), Japan (1), and France (2) were invited to attend this year’s Colloquium. International mentees were selected and sponsored by their institution, country’s psychiatric association or branch of SOBP, or were self-funded.

Currently, we are working with our ACNP partners to plan a half-day program at the ACNP Research Mentorship Booster Session, which will be held on December 7, 2019 during the organization’s Annual Meeting in Orlando. All Colloquium awardees are invited to attend the ACNP booster session. Simultaneously, we are preparing for a new cycle of 2020 Research Colloquium applicants and began promoting this even in July 2019. Plans to continue the research mentoring experience for the Colloquium awardees, including quarterly post-Research Colloquium webinars and attendance at the ACNP and SOBP annual meetings, are currently underway.

Research Awards and Fellowships

The Award for Research, the highest award for research given by the APA, was presented to Stephen Strakowski, M.D., on May 22, 2019, during his award lecture on “Brain Changes at the Onset of Bipolar Disorder” by APA’s past-president (2016–2017), Dr. Maria Oquendo. In addition, the Judd Marmar Award, established in 1999 to honor an individual who has made a substantial contribution to advancing the biopsychosocial model of psychiatry, was presented, by APA’s current president, Dr. Bruce Schwartz, to Kerry J. Ressler, M.D., Ph.D., on May 22, 2019 during his award lecture on “Modulating Aversive Memories in Psychiatry: From Rodents to Humans.”

Several other prominent researchers were acknowledged for their outstanding contributions to psychiatry and psychiatric research during the 2019 Early Research Career (ERC) Breakfast held May 21, 2019: Godfrey Pearlson, M.B.B.S., M.A., Yale School of Medicine, received the 2019 APAF/American Association of Chairs of Departments of Psychiatry Research Mentorship Award; Manpreet Singh, M.D., Stanford University, was the recipient of the 2019 Blanche F. Ittleson Award for Research in Child and Adolescent Psychiatry; and the mentor/mentee team of Dost Öngür, M.D., and his trainee, Cagri Yuksel, M.D., of McLean Hospital, received the Kempf Fund Award for Research Development in Psychobiological Psychiatry. During the ERC Breakfast, Alison Hwong, M.D., Ph.D., a PGY-3 Psychiatric Resident at the University of California San Francisco, was acknowledged as the recipient of the APAF Psychiatric Research Fellowship.

A. John Rush. M.D. received the 2019 APA Health Services Research-Senior Scholar Award, and A. Robinson Williams M.D. received the 2019 APA Health Services Research-Early Career Award.

Committee on Psychiatric Dimensions of Disasters

Chair: Joshua Morganstein, M.D. The Committee on Psychiatric Dimensions of Disaster coordinated with the APA Communications Department to reach out to the district branches and state associations impacted by recent tragic events including, but not limited to, the volcano eruption in Hawaii; wildfires in California; hurricanes in the Gulf of Mexico and along the east coast; and shootings in Pennsylvania, Maryland, California, and Toronto. Committee chair Dr. Morganstein, and former chair Dr. Ursano, visited APA Administration Headquarters to discuss priorities for the committee, including ongoing enhancement of networking during disasters, the development of educational resources, and potential funding sources for disaster-related training opportunities.

Diagnostic Biomarkers and Novel Treatment Workgroup

This Workgroup, chaired by Charles B. Nemeroff, M.D., Ph.D., generated three manuscripts, which have been reviewed and approved by the Joint Reference Committee (JRC) and Board of Trustees (BOT), and will be submitted for publication. These manuscripts are as follows: “Amyloid and Tau in Alzheimer’s Disease: Biomarkers or Molecular Targets for Therapy,” “A Review of the Evidence for Using Hormonal Strategies in the Treatment of Depression,” and “The Use of Social Media in Recruiting Participants for Mental Health Research Purposes: A Systematic Review and Best Practices Report.”

The Workgroup provided an overview of recent initiatives, including the examination of hormones in the treatment of depression, the use of psychedelics as therapeutic agents, and the role social media plays in clinical research. Draft manuscripts of these topics will be submitted for critique and approval by the Council on Research, JRC, and BOT.

The Workgroup also successfully led the Presidential Symposium during the 2019 Annual Meeting that focuses on the state of biomarkers in psychiatry. Lastly, members expressed interest in studying the clinical utilities of biomarkers for Alzheimer’s disease, early developmental markers of schizophrenia, biomarkers of autism spectrum disorder, and machine learning for psychiatrists.

DSM Steering Committee

Chair: Paul S. Applebaum, M.D.; Vice Chairs: Kenneth Kendler, M.D., and Ellen Leibenluft, M.D.

The DSM-5 Steering Committee, its Subcommittee on Minor Changes, and its Review Committees continue to be active since the last report in the Fall of 2018. At the APA Annual Meeting in San Francisco, the Steering Committee approved six minor changes. Two proposals are under review by their relevant Review Committees, who have recently submitted recommendations to the Steering Committee. The Steering Committee had requested additional information for three proposals prior to additional consideration for referral to the appropriate Review Committees. One proposal was approved by the Steering Committee; it was posted for public comment and is undergoing additional review. In addition to these active proposals, a consensus workshop was held on June 3 in New York City to determine the agreement on the inclusion of a set of diagnostic criteria for grief in Section II. A set of draft criteria was developed at the workshop, and testing of validators (reliability, validity, clinical utility, etc.) was conducted using various databases. Results were collected in September.