APA Council Reports

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), and the Substance Abuse and Mental Health Services Administration (SAMHSA) to participate in its meetings. The Council has focused on physician training for treatment of substance use disorders, the confidentiality of substance use disorder (SUD) information in patient records, the 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 Departments of Government Relations and Policy, Programs, and Partnerships, the Council has provided guidance on the Association’s legislative and regulatory advocacy efforts around the national opioid crisis and trends in SUDs. This included having a member of the Council testify before Congress on SUD legislation.

As the Trump 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 when individuals are leaving the emergency room or the criminal justice system. Members have also helped staff respond to regulatory activities, such as NIDA’s outline of a five-year strategic plan and regulations from the Drug Enforcement Agency to improve access to treatment through mobile narcotic treatment programs, and legislative and regulatory changes to improve access to care during the Public Health Emergency declared by the Administration as a result of COVID-19.

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 supporting the recognition and treatment of opioid use disorder. More than a dozen medical specialty and stakeholder organizations provide free continuing medical education in case vignettes that can be accessed through the APA’s Learning Center and the program’s dedicated website (www.pcss-o.org). 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 online given the inability to do in-person trainings during APA’s Annual Meeting in April 2020. 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.

Council members represent the APA and actively participate in the American Medical Association’s (AMA) Task Force to Reduce Opioid Abuse, which comprises representatives of state medical associations and medical specialty societies. The member organizations recognize that to address the epidemic of prescription drug abuse effectively, physicians must develop and implement strategies to reduce the harm caused by the overprescribing of opioids and utilize evidence-based practices in treating pain and substance use disorders. Led by Dr. Patrice Harris, a former President of the AMA and former member of the 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. In July, the Task Force released a 2020 drug overdose report that shows a dramatic increase in fatalities involving illicit opioids, stimulants (e.g., methamphetamine), heroin, and cocaine and a similarly dramatic drop in the use of prescription opioids.

The Council on Advocacy and Government Relations

Katherine Kennedy, M.D., Chairperson

The Council on Advocacy and Government Relations (CAGR) serves as the APA’s member-led coordinating body for advocacy activities involving federal and state government. To help mitigate the continued challenges associated with access to mental health and substance use disorder-related care, CAGR works actively with the Department of Government Relations to engage APA membership in advancing APA’s advocacy priorities. CAGR's fellow mentorship program and liaison work with other components also enhances this effort.

CAGR Promoting Advocacy and Workgroup Collaborations

Psych News Series.

As APA’s member-led advocacy body, CAGR has committed to a regular advocacy submission to Psych News, designed to inform readers about specific legislative issues or activity. Articles written by CAGR members have ranged from calls to action—Making Parity a Reality Requires Ongoing Advocacy, Vigilance (August 2019)—to raising awareness—Trump’s ‘Public Charge’ Rule Takes Effect; Discourages Use of Safety-Net Services (April 2020). The articles have been a resource for APA members to engage in informed discussions with their policymakers.

Congressional Advocacy Network Workgroup.

CAGR and the APAPAC Board established a joint workgroup to develop strategies to increase member participation in the Congressional Advocacy Network (CAN). Chaired by Dr. Mary Helen Davis and Dr. Brian Hart, the workgroup is developing recommendations for CAGR and the APAPAC Board in engaging APA members in personal advocacy, enhancing existing relationships, and developing new relationships with federal legislators. The workgroup has reviewed APA's advocacy programs and discussed the barriers to advocacy that many psychiatrists face; and has identified concrete steps that members can undertake to promote advocacy and developed recommendations for pursuing advocacy during the epidemic.

District Branch Advocacy Collaboration Workgroup.

The Council established the District Branch Advocacy Collaboration Workgroup tasked with identifying new strategies for communications that can better engage district branches to enhance member involvement in advocacy and increase their collaboration with the APA in state and federal advocacy efforts. Chaired by Dr. Debra Koss, the workgroup will continue to identify metrics of success for these strategies.

Structural Racism

CAGR, like other APA components, is committed to eliminating structural racism. CAGR held multiple discussions on the subject and received a briefing from Dr. Cheryl Wills about the charge and goals of the APA Presidential Task Force. Building on those discussions, CAGR is developing ideas for advocacy engagement by APA members related to health equity, diversity, inclusion and structural racism, including compiling a resource document to help identify anti-racist policies that promote equitable access to mental health care.

Federal Affairs

Congressional Response to COVID-19—CARES Act and Successor Legislation.

Since March, Congress has passed, and the president has signed a series of four COVID-19 stimulus packages designed to bring support to our economy and public health systems. Each package included APA-supported provisions, including long-sought legislation to improve patient safety by modernizing patient privacy regulation, expanding access to telehealth services, funding mental health support services for healthcare workers, and creating the provider relief program. With each supplemental package, CAGR members jumped into action advocating for various provisions, including the continuation of telehealth and the appropriation of billions of dollars needed in emergency support to preserve access to mental health care during and after the pandemic.

Ensuring Funding for Priority APA Programs.

During the fiscal year 2021 appropriation process, APA continued to advocate for adequate funding of APA’s priority mental health and substance use disorder programs, including programs housed within the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institutes of Health (NIH), the Centers for Disease Control and Prevention, and the Health Resources and Services Administration (HRSA). Among several other requests, APA sought increases in funding for programs including the Community Mental Health Services Block Grant with a newly proposed $35 million set-aside for crisis services, additional funds for the Minority Fellowship Program, and a sustained investment in the Loan Repayment Program for Substance Use Disorder Treatment Workforce program.

APA-Endorsed Parity Legislation Passes Committee.

APA strongly supports increased implementation and enforcement of parity for mental health and substance use disorder treatment. APA endorsed parity legislation (H.R. 7539) was introduced by Reps. Kennedy (D-MA), Bilirakis (R-FL), Porter (D-CA), and Upton (R-MI) that would require the Labor department to conduct random audits of health plans to ensure compliance. In July, H.R. 7539 was favorably voted out of the full House Energy and Commerce Committee.

Federal Legislation to Change the Medicare Definition of Physician.

This year, APA faced a major scope of practice battle on the federal level with Congresswoman Judy Chu (D-CA) introducing H.R. 884, the Medicare Mental Health Access Act. The bill would expand the definition of a “physician” under the Medicare program to include clinical psychologists, which APA opposed. APA President Jeffrey Geller testified in opposition to H.R.884 before the House Energy and Commerce Health Subcommittee, and more than 3200 APA members wrote 5000 letters to their U.S. Representative to oppose the legislation, which was subsequently not called up for a Committee vote in July.

The Pandemic and Prejudice Against Asian Americans.

Amid the COVID-19 pandemic, there have been consistent reports of coronavirus-related discrimination against Asian Americans. Rep. Grace Meng (D-NY) and Sen. Kamala Harris (D-CA) introduced resolutions (H.R.908/S.580) that stipulate that Congress condemns all forms of racism and scapegoating, and calls on public officials to denounce any anti-Asian sentiment. APA supported both the House and Senate resolutions. Through a grassroots advocacy alert, CAGR and APA members sent more than 450 letters reaching 180 federal representatives urging them to support the congressional resolution condemning the anti-Asian sentiment.

Support for International Medical Graduates (IMGs) in the Health Care Workforce.

The pandemic placed a strain on the health system and underscored the persistent shortage of health care professionals across the country. Throughout the 116th Congress, APA worked on several fronts to ensure protections for IMGs to retain their ability to train and practice in the United states.

• • APA sent a letter of support to House and Senate sponsors of bipartisan legislation, the Healthcare Workforce Resilience Act (H.R. 6788/ S. 3599), and APA advocates sent more than 1,500 letters to Capitol Hill, asking more than 300 members of Congress to cosponsor the legislation.

• • APA supported the bipartisan, bicameral Conrad State 30 and Physician Access Reauthorization Act (S. 948/H.R. 2895) introduced by Sen. Amy Klobuchar (D-MN) and Rep. Brad Schneider (D-IL), and APA members voiced their support by sending letters encouraging Members of Congress to reauthorize the program.

Expanding Telehealth in a Pandemic.

APA was one of the first medical associations to publicly advocate for enhancing access to telehealth at the beginning of the COVID-19 health emergency. After APA member input, APA sent a letter to Congress urging that a waiver of existing restrictions be included in the first COVID-19 package from Congress. These swift actions and continual advocacy with Congress and the Administration this year allowed many psychiatrists to transition to delivering mental health care to their patients via telehealth and receiving payment equivalent to an in-person visit. The desire to retain many of the changes that have facilitated the telehealth delivery model after the public health emergency declaration ends has led APA to recommend extending current telehealth waiver authority for at least a year after the end of the public health emergency declaration, and permanently removing the site of services and geographic restrictions. CAGR and APA members sent 550 letters to urge Congress to permanently lift or extend these temporary flexibilities to ensure continuity of care for mental health patients. Several district branches also sent their own letters supporting federal telehealth access changes.

Advancing the Use of Telehealth Through an Education and Advocacy Webinar.

As states lifted stay-at-home orders and data showed COVID-19 continued to spread in some areas, the use of telehealth remained an important tool for patients to access mental health and substance use disorder treatment while keeping patients, clinicians, families, and communities safe through physical distancing. To better inform our membership, APA hosted an educational webinar for members to refine the use of telehealth to better serve their patients. CAGR Chair Dr. Kiki Kennedy presented on APA’s advocacy efforts at the federal and state levels to continue telehealth flexibilities, in addition to APA leadership speaking to the need for greater access to mental and substance use disorder treatment amid the pandemic.

Congressional Advocacy Network (CAN).

The Congressional Advocacy Network (CAN) is a tool CAGR uses to bring an even greater voice to psychiatry’s advocacy efforts. More than 340 APA members participate in the CAN program, which is designed to help develop, train, and energize a national network of psychiatrists who will commit to communicating and building personal relationships with members of Congress. As CAN members themselves, CAGR members meet with their federal lawmakers to foster these relationships and better serve as mentors for other advocates living in their region.

State Affairs

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 2020, state-led initiatives include maintenance of certification, involuntary commitment, expanding treatment for substance abuse disorders, and adoption of integrated care models, such as collaborative care.

Telemedicine.

Many states have made positive, albeit temporary, changes to increase access to care during the COVID pandemic, with many states requiring all payers to cover care delivered via telehealth services the same as in-person care. APA has developed model legislation to make these temporary changes permanent. APA has already provided draft telemedicine legislation to over 20 district branches that have voiced interest in pursuing this legislation; APA will be working closely with these district branches and others as they continue the legislative process.

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 2020, Arizona, Indiana, Maryland, Oklahoma, and West Virginia enacted APA’s model legislation. Virginia signed sections of APA’s parity legislation into law this spring, as well.

Safe Prescribing.

APA has worked closely with district branches and state associations across the country to address legislation that would expand scope of practice for psychologists, nurse practitioners, physician assistants, and pharmacists. 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 patient safety in their states.

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 district branch/state association grant requests for specific public affairs challenges on the state level. Due to limited budgets in many of APA’s district branches/state associations, CALF grants are heavily relied upon by states in confronting new legislative policy challenges. Once CALF approves an initial request from a district branch/state association, 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 Nebraska, Montana, and Arizona.

The Council on Children, Adolescents, and Their Families

Gabrielle Shapiro, M.D., Chairperson

Overview of Council

The work of the Council on Children, Adolescents, and Their Families (Child Council) is directed toward maximizing the effectiveness of APA in addressing the mental health needs of children, adolescents, and their families. Its charge is primarily carried out through APA meetings workshops, position statements, and collaborations with other APA Councils and allied children and adolescent’s organizations.

2019–2020 Child Council Mentorship Program and Guide.

The Child Council developed a mentorship program and guide for its APA/APAF Fellows. The guide has the potential to be used as a template across APA Councils as a roadmap to successful mentorship of feature APA leaders. Names of mentorship attendees are presented in Table 1.

Interest Groups

The Council has formed the following workgroups to address multiple topics in child and adolescent psychiatry:

• 1. Suicide Prevention in Youth

• 2. Crisis Response

• 3. First Break Psychosis/Integrated Care/Transitional Age Youth

• 4. Digital Medicine/Social Media

• 5. Immigration

Council Liaisons

Individual members of the Child Council have been assigned to serve as liaisons to other APA councils to increase synergies between the Child Council and those councils. Since adoption of this concept, the Child Council has worked with other APA councils to vet positions statements and collaborate on multiple projects that involve mental health of children and adolescents.

Committee on Women’s Mental Health

Ludmila DeFaria, M.D., Chairperson

The Board of Trustee-approved Committee on Women’s Mental Health falls under the auspices of the Council of Children, Adolescents, and Their Families. The Committee held its inaugural meeting in March. Committee members discussed their collective priorities and areas of concern, including intersectional issues, clinical concerns, and access to care. Members formed three work groups: the work group on psychiatric treatment during pregnancy, the work group on perinatal substance use screenings, and the work group on DSM-5 revision of postpartum criteria. The Committee worked on revising several position statements that were referred to them by APA’s Joint Reference Committee. The topics of these position statements ranged from HIV infection and women, Medicaid coverage for maternal postpartum care, abortion and women’s reproductive health care, and screening and treatment of mood and anxiety disorders during pregnancy. Members of the Committee have a working relationship with representatives from ACOG, in an effort to increase collaboration in several areas pertaining to maternal mental health care. The group will be submitting abstracts for educational sessions at APA’s 2021 Annual Meeting.

American Academy of Child and Adolescent Psychiatry (AACAP) Anxiety Disorders

Parents’ Medication Guide.

In 2019, the Child Council, on behalf of APA, voted to endorse the Anxiety Disorders: Parents’ Medication Guide by AACAP with modifications. The guide is slated to be released in 2020.

Positions Statements

Multiple positions statements were developed or recommended for revision or retirement by the Child Council.

Newly Developed Position Statements.

• 1. Position Statement on Deportation of Medically Vulnerable Individuals

• 2. Position Statement on Suicide in Minority and Underrepresented Youth

• 3. Position Statement on Sexual Abuse of Migrants in Ice Custody (from Committee on Women’s Mental Health)

• 4. Position Statement on Growing Fear over Coronavirus Spread and Mental health Impact in ICE Detention Centers

Position Statements Recommended for Revision.

• 1. Position Statement on Abortion and Women’s Reproductive Health Care in Development (from Committee on Women’s Mental Health)

• 2. Position Statement on Screening and Treatment of Mood and Anxiety Disorders During Pregnancy and Postpartum (from Committee on Women’s Mental Health)

The Council on Communications

Isabel Norian, M.D., Chairperson

In the interval between the November 2019 meeting of the APA Assembly in Washington, DC, and the April 2020 APA Meeting, the Council drafted a position statement on Use of the Terms Client and Provider, a statement that followed from an action paper previously passed by the Assembly in May 2019. In June, the Council presented its draft position statement to the Joint Reference Committee, which approved it as written. This paper will be voted on by the Board of Trustees at its next meeting.

The Council is re-evaluating its potential contributions to APA communications across four main domains: communication with the public, communication with members, communication with stakeholders, and communication within APA itself. The Council has elected to organize itself into three work groups, each with dedicated focus to a particular content area: Social Media Work Group, Media Interface Work Group, and Antiracism Action Work Group. This organization will facilitate concrete progress on individual projects and initiatives between meetings. The Council is meeting monthly and will continue to do so such that momentum on individual initiatives can be maintained.

The Council has been working to keep its members connected in real time via frequent communication about current events and is collaborating in real time with the Office of Communications and Public Affairs administrative staff so that efforts may be coordinated as effectively as possible in pursuing shared goals for APA and its members. The Council is renewing its efforts to identified liaisons to as many of the other Councils as possible. The Council chair is in the process of attending one meeting with each of the other councils as part of the introductions process. Several liaisons to other councils have been identified, and the Council strives to complete a full complement of liaison assignments prior to the Components meetings in September. The Council has welcomed liaisons from CAGR and CMELL and seeks to obtain 100% liaison representation from other Councils in the coming year.

The Council is in the process of developing a Webinar related to social media as part of a broader initiative to bring more APA members on board with this critical communication tool of our time. More information about progress on this initiative will be ready for presentation at the Components meeting.

Additional plans are under way to expand education about social media to our members, including revamping the “Social Media” section of the APA website, with plans to include new video modules and a virtual “library” of references in one easy-to-access location. The Council also anticipates participating in an initiative this year focusing on developing talking points on the benefits of hiring psychiatrists.

The Council wishes to express its deepest appreciation to immediate past Chairperson Dr. Carol Bernstein for her dedication to the work of the Council in recent years and strives to continue to work to identify ways it can best be of service to APA, to its members, and to the communities we serve.

The Council on Consultation-Liaison Psychiatry

Sejal Shah, M.D., Chairperson

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 and is active in identifying ways to educate medical students and residents about the field. To encourage more medical residents to join the subspeciality, the Council, in collaboration with the Academy of Consultation-Liaison Psychiatry, hosted a webinar focused on how to apply for a consultation-liaison psychiatry fellowship during COVID-19. The Council members and Academy also shared lessons learned with members on how to navigate delivering services and providing support for colleagues in areas with high rates of COVID-19.

The Council continued its series of articles for Psychiatric News to help members understand the work of consultation-liaison psychiatrists following its name change from Psychosomatic Medicine. Published articles include:

• 1. “Understanding the Breadth and Depth of C-L Psychiatry: Assessing and Managing Delirium” (March 19, 2020)

• 2. “Complex Psychopharmacology in Medically Ill Patients” (March 5, 2020)

• 3. “Decisional Capacity Assessment” (February 4, 2020)

• 4. “Pediatric Psychiatry” (July 18, 2019)

In addition, the Council developed a position statement on Medicaid Coverage for Maternal Postpartum Care to support the extension of Medicaid coverage to one year postdelivery in an effort to improve treatment outcomes for women with postpartum depression and other psychiatric disorders. The Council is also working with the HIV Steering Committee to update position statements related to HIV. The HIV Steering Committee was able to move its Medical Student Elective, which provides fourth-year medical students an opportunity to participate in a month-long clinical elective in HIV psychiatry at one of several prominent universities across the country, to a virtual program and expand the number of participants.

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 collaborates with other professional groups to develop best practices in geriatric psychiatry, promote research, and provide education and training to psychiatrists, other physicians, residents, medical students, and allied mental health professionals.

Position Statements

The Council’s new position statement entitled “Disaster Preparedness and Response for Older Americans” was published in January 2020 and is available on the APA website. The revised position statement on the “Use of Antipsychotic Medication in Patients with Major Neurocognitive Disorder” was accepted by the Assembly and is awaiting approval from the Board of Trustees.

In collaboration with the Council on Health Care Systems and Financing, the Council revised the position statement entitled “Ensuring Access and Appropriate Utilization of Psychiatric Services of the Elderly.” This is currently awaiting approval from the Board of Trustees as well. Finally, this Council, in collaboration with the Council on Addictions, has undertaken an extensive revision of the position statement on “Substance Use in Older Adults.” It is anticipated that this will be completed by the fall of 2020.

Telepsychiatry as a Means of Increasing Access to Mental Health Services for Older Adults

The Council has long been a strong advocate for reducing geographic restrictions on Medicare reimbursement for telepsychiatry in order to increase older adults’ access to mental health services. It has been very gratifying to see the constructive adaptation of regulations governing telepsychiatry in the setting of the COVID-19 pandemic.

It has been particularly helpful that Medicare and many other payers have been willing to reimburse for audio-only clinical encounters. This has made it feasible for psychiatrists to continue to treat older adults who are seeking to avoid contagion by staying home and who do not have the equipment and/or know-how to use audio-visual platforms. The Council is grateful that the APA has been and remains a strong advocate for these and other telehealth policy reforms that enhance access to care for elderly Americans in need of mental health treatment.

The Intersection Between Geriatric Psychiatry and Community Psychiatry

During the 2019 Fall Component Meeting, the Council discussed the interface of geriatric psychiatry with community psychiatry. A new Fellow on the Council suggested that the Council reach out to trainees interested in community psychiatry to highlight the opportunities at this interface so that they might consider training in geriatric psychiatry. Several Council members have worked at and written about this interface and offered to work on the project. It is anticipated that this effort will result in a publication that will appear in Psychiatric News in the next year.

Allowing Non-Fellowship-Trained Psychiatrists Who Have Sufficient Experience and Expertise Working With Older Adults to Sit for the Geriatric Psychiatry Specialty Board Examination

Given the continuing growth of the over-65 population and well-documented undersupply of geriatric mental health specialists, the Council holds a particular interest in expanding the ranks of the recognized geriatric mental health workforce. Many proposals have been considered. One idea has been to pilot the notion of allowing psychiatrists who are not fellowship-trained - but who have substantial experience and expertise working with older adults - to sit for the Geriatric Psychiatry specialty board examination. There is an agreement that this might increase the ranks of the certified and raise the profile of adult psychiatrists who are already doing lots of geriatric psychiatry without formal training. A subgroup of the Council is exploring the option of developing a position statement on this topic.

Proposal for ICD-10-CM to Revise Diagnostic Codes for Dementia and Related Neuropsychiatric Symptoms and Manifestations

With the aging of the population, and the associated increase in the prevalence of Alzheimer’s disease, the need for expert dementia care is going to continue to grow.

Patients in this growing cohort often have significant noncognitive neuropsychiatric symptoms and manifestations (e.g., anxiety, depression, and mood disorders) that affect their prognosis, care needs, and the costs of care. It is, therefore, critical for diagnostic systems such as the ICD-10 to have sufficient granularity to allow for the identification and differentiation of these manifestations. A group of leading geriatric psychiatrists, including several Council members, submitted a proposal to the CMS requesting the revision of existing codes and the creation of new codes for specific conditions that occur in association with dementia. The Council was briefed about the initiative and the meeting with CMS officials. Discussions are ongoing regarding how best to ensure that ICD-10 allows for the capture of data critical to the understanding of the full spectrum and prevalence of psychopathology in dementia and the associated care needs.

APA Geriatric Awards

Council recommends honorees for the Jack Weinberg Award in Geriatric Psychiatry and the Hartford-Jeste Award for Future Leaders in Geriatric Psychiatry. The 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 Hartford-Jeste Award recognizes early-career geriatric psychiatrists who have made significant contributions to the field of geriatric psychiatry through excellence in research, teaching, clinical practice, and community service and have demonstrated the potential to develop into future leaders in the field. This year the Council voted to put forward Dr. Helen Lavretsky for the Jack Weinberg award and Dr. Kristina Zdanys for the Hartford-Jeste Award.

Council Response to COVID-19

The COVID-19 pandemic is having a profound impact on older adults, particularly those with mental illness. Inspired by the experience of having published “Culture, Heritage, and Diversity in Older Adult Mental Health Care” (American Psychiatric Association Publishing 2019), the Council discussed the possibility of pulling together the lessons of the current pandemic over the next year and developing a volume on pandemic preparedness for older adults. There was general agreement that this was worthy of further consideration. Drs. Maria Llorente, Micheline Dugue, and Robert Roca drafted a preliminary outline of the book, which has been submitted to APA Publishing for review.

The Council on Healthcare Systems and Financing

Robert Trestman, Ph.D., M.D., Chairperson

The Council on Healthcare Systems and Financing (CHSF) continues its efforts to monitor and provide analysis for a number of significant issues that affect the financing, delivery of, and access to psychiatric care. These efforts include outreach to decision makers in both the public and private sectors. Council members provide guidance on APA’s responses to the Administration on healthcare reform, quality and payment reform.

CHSF has recently reviewed numerous documents, member resources, and letters to the Administration relating to COVID-19. This included Council members providing feedback on APA’s Committee on Psychiatric Dimensions of Disaster draft guidance document entitled Changing the System: Cultivating Preparedness For Future Public Health Emergencies and input on a letter to the Administration on President Trump’s Executive Order: Regulatory Relief to Support Economic Recovery.

Council members will also be assisting in Dr. Geller’s Presidential Initiative on the number of psychiatric beds in the United States. Dr. Trestman, Council Chair, is leading the Initiative’s subgroup on the financing of psychiatric beds. As the subgroup focuses on barriers associated with current financing models and making recommendations regarding financing that might serve to facilitate the development of sustained bed capacity, Council members are providing relevant expertise to the subgroup.

The Council finalized the Resource Document on Social Determinants of Health, which has been posted on APA’s website for members. CHSF has convened two work groups, the first on hospital inpatient psychiatric care, which focuses on issues relating to inpatient care (bed shortages, staffing, etc.). The second work group was formed as a result of the Board of Trustees work group on Continuing Care Criteria for Acute Inpatient Settings. The Board work group drafted a report which included several recommendations for the Council work group to assess and address. This work group is a joint venture with the Council on Quality.

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 Integrated Care Committee developed a guide for psychiatrists on how to use CPT codes to bill for non-face-to-face consultations with primary care and other physicians—along with a one-page guide on the consultation and billing process for patients. The guides refer to the kind of non-face-to-face “curbside” consultations that many psychiatrists regularly provide—answers to impromptu requests from primary care and other physicians for advice about managing psychiatric conditions or possible psychiatric complications related to medical treatment. CMS issued the codes in 2019 and began paying for the consults this year.

Committee on RBRVS, Codes and Reimbursement

Gregory Harris, M.D., M.P.H., Chairperson

Members of the Committee on RBRVS, Codes and Reimbursement 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. They have been actively involved in the recent revisions to the Evaluation and Management CPT codes for care provided in the outpatient setting. These changes have resulted in an increase in payments, a decrease in required documentation, and will offer psychiatrists the option of billing these services based solely on time. The Committee will be monitoring CMS’ response, as the change is set to take place effective January 1, 2021. Member education has also occurred with regard to billing of telehealth services during the COVID-19 crisis. Committee members continue in their appointed roles with the AMA CPT Editorial Panel and AMA RUC, weighing in on proposals of interest to psychiatry.

Committee on Reimbursement

Laurence Miller, M.D., Chairperson

The Committee continues to focus on alternative payment models, including bundled payments for specific services. The Committee developed a survey designed to understand the needs of the membership with regard to alternative payment models so that APA can access its educational and advocacy efforts. Members have been involved in the discussions on payment for coordinated specialty care for patients with first episode psychosis. Most recently, members provided input on payment options for a model of care for SMI patients which provided remote care, including administering medication, making the model particularly timely due to the COVID-19 crisis.

Committee on Telepsychiatry

Jay Shore, M.D., M.P.H., Chairperson

In response to the COVID-19 public health emergency, the Committee on Telepsychiatry has decided to expand upon its existing Telepsychiatry Toolkit. The Toolkit, which has undergone two major expansions since its creation, will now include a section on emergency/disaster facets of telepsychiatry practice. Content will include links to external resources, including relevant literature, as well as video clips, similar to the content contained in the existing 50-plus pages in the Toolkit. Rollout is expected to begin toward the end of summer. A small work group was created to draft the model legislation. Moving forward, the state government relations team will work with district branches to roll-out and amend the legislation, as needed, during various states’ legislative sessions. Members of the Committee were panelists on Congressional briefings hosted by APA, providing an overview of key policy areas that are essential to removing barriers to psychiatric care. Finally, members of the Committee participated in webinars sponsored by APA one entitled, Advancing the Use of Telehealth Through Education and Advocacy and the other, Telepsychiatry in the Era of COVID-19.

The Council on International Psychiatry

David C. Henderson, M.D., Chairperson

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. David C. Henderson, the Committee Chair is Dr. James Griffith and the Caucus Chair is Dr. Samuel Okpaku.

Coronavirus (COVID-19)

The Council began discussions on the impact of the COVID-19 pandemic in February 2020 with several Council members participated in briefings by the World Health Organization Information Network for Epidemics (WHO EPI-WIN) on how to deal with the outbreak, including the psychological and mental health aspects. The Council shared resources from the WHO and CDC with APA Committee on Psychiatric Dimensions of Disaster addressing social stigma associated with the pandemic which were included in APA’s online COVID-19 resources. The Council also established a work group to develop a resource on contagion stigma shared as the APA blog post “Mitigating Risks for Contagion Stigma” which included recommendations for monitoring stigma practices, including those by public figures, monitoring the well-being of the least powerful in society, such as immigrants, and strategies to counter stigmatization. Several Council members have also participated in discussions with the World Psychiatric Association (WPA) on the global response to the pandemic. The WPA established an advisory committee to respond to the global emergency and has linked to the APA’s online COVID-19 resources. At the writing of this report, the Council continues to monitor developments with COVID-19 with the expectation of an increase in anxiety related cases and long-term impact of social distancing policies on relationships, including therapeutic relationships, and on vulnerable populations experiencing severe trauma.

Education and Professional Development

Developing a Global Mental Health Curriculum in Psychiatry Residency Programs.

Over the past two years, the Council and the Caucus worked together to develop the Resource Document “Developing a Global Mental Health Curriculum in Psychiatry Residency Programs.” Former Caucus Chair, Dr. Geetha Jayaram, and Council member, Dr. Bibhav Acharya, led efforts to finalize the document for approval by the APA. The Resource Document is now available on the APA website and serves as a guide to assist psychiatric residency training programs interested in developing and implementing a global mental health curriculum and for medical students and psychiatric residents interested in global mental health. The Council received feedback from members of the APA Council on Medical Education and Lifelong and the APA Council on Quality Care who shared that it will be helpful to institutions developing global mental health programs and the Global Mental Health Task Force of the Association of Directors of Medical Student Education in Psychiatry (ADMSEP), who are in the process of developing learning objectives for global mental health education for U.S. medical students and resources to meet those objectives, shared that the Resource Document would be helpful to their work as well.

Scientific Program.

In lieu of the 2020 APA Annual Meeting not occurring, several Council members coordinated to include a recording of the session “The Social Determinants of Health: Essential Elements to Global Health Care Quality and Outcomes” in the 2020 APA On Demand. The original session included Dr. Sergio Grande to discuss underserved populations, Dr. Roy Kallivayalil to discuss rights to health, Dr. Vincenzo Di Nicola to discuss child development factors, and Dr. Eliot Sorel to discuss social determinants of health and mental health. A summary of the session was presented to the Council during their virtual April meeting which included a review of information on social determinants of health from Robert Wood Johnson Foundation and the University of Wisconsin Public Health Institute. A brief overview of the course “Global Mental Health: A Training Curriculum” originally scheduled for the 2020 APA Annual Meeting was also shared with the Council by Dr. James Griffith and Dr. Vivian Pender. The course was to highlight the difference in global mental health education in residency and fellowship programs and the need for global mental health training to better understand how to work with diverse populations. The presenters plan to resubmit the course next year.

International Presenter Development.

In lieu of the 2020 APA Annual Meeting not occurring, the 2020 International Poster Engagement Program, which engages with international researchers on their poster presentations and coordinated by Council members and former APA/APA Foundation Minority Fellows, Dr. Josepha Immanuel and Dr. Jennifer Severe, adjusted its format to connect with participants electronically. At the beginning of the year, the Council submitted a report reviewing the first three-years of the program which has included 41 participants from 24 countries. Participants include non-U.S. psychiatric residents and early career psychiatrists with reviewers from the Council and Caucus engaging with participants in bilateral learning, knowledge exchange, and professional enrichment to support membership development. While many participants were already APA members, those who were not became members after participating in the program and many continued on as members beyond their participation, reflecting the value of the program as a member benefit. Additionally, participants reported the program made them feel “welcomed,” “included,” and “valued” at the APA Annual Meeting. One participant noted that “the practice of psychiatry can be very different” around the world, and that the Annual Meeting provides a great opportunity to “share what we do in our own health care systems.” The program has proven to be enriching not only to participants, but also to the APA members serving as program reviewers.

Global Mental Health Caucus.

The Caucus has maintained a membership of about 1,000 APA members reflecting the interest in global mental health. The former Caucus Chair, Dr. Geetha Jayaram, worked closely with the Council to finalize the development of the Resource Document “Developing a Global Mental Health Curriculum in Psychiatry Residency Programs” and also offered guidance to Caucus members developing abstracts for consideration for the 2020 APA Annual Meeting. The Caucus election of the 2020–2021 Caucus Chair position included as candidates Dr. David Ndetei of Kenya and Dr. Samuel Okpaku of the United States. Dr. Okpaku received the majority of votes to become the 2020–2021 Caucus Chair. At the writing of this report Dr. Okpaku has connected with the past Caucus Chairs, including Drs. Milton Wainberg, Eliot Sorel, Khurshid, Vincenzo Di Nicola, Gabrielle Ivbijaro, and Geetha Jayaram, to discuss the future priorities and goals of the Caucus.

Policy Development and Recognition

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

The Council’s APA position statement on “Mental Health of Foreign Nationals on Temporary Protected Status” was approved by the APA. The Position Statement aims to increase education and awareness of the mental health of foreign nationals in the United States with Temporary Protected Status (TPS) as many health providers, including psychiatrists, are unaware of this immigration status and its impact on individuals and families in the United States. The Council previously participated in the development of the APA Position’ Statement on the “Role of Psychiatrists in Addressing Care for People Affected by Forced Displacement. Both position statements are available on the APA website.

Chester M. Pierce Human Rights Award.

The 2020 recipient of the APA Chester M. Pierce Human Rights Award was the nonprofit news organization Global Press. Global Press works to ensure that people around the world have access to more dignified, precise information about the world and the people in it. Among Global Press’s innovations is its Duty of Care program, which ensures the physical, emotional, digital and legal safety of its reporters, who are located all over the world. The Global Press Duty of Care Training Manual is the first guide of its kind to address the specific risks and challenges faced by local journalists who are often in more danger than foreign correspondents who parachute into global communities temporarily. In 2019, Global Press made this program available to more than 1,000 local journalists outside of the Global Press network for the first time, to demonstrate that high-quality local journalist safety and well-being is complex, but possible.

World Psychiatric Association.

The following Council members were nominated and accepted to be candidates in the upcoming 2020 World Psychiatric Association Election:

• • Dr. Paul Summergrad, Candidate for WPA Secretary for Finances

• • Dr. Edmond Pi, Candidate for WPA Secretary for Scientific Meetings

• • Dr. Bernardo Ng, Candidate for WPA Zone 2 (United States) Representative

While the WPA Election is scheduled to take place virtually in October 2020, the WPA World Congress of Psychiatry, originally scheduled to occur at the same time, has been rescheduled to take place March 10–13, 2021 in Bangkok, Thailand.

Conclusion

At the writing of this report, the Council is undergoing a review of a proposal to consider changing the name and the charge of the Council to focus on population health and priorities for supporting relevant policy, education, and international membership development. Additionally, the Council is discussing the work and findings of the APA Presidential Task Force to Address Structural Racism Throughout Psychiatry and how it intersects with the work of the Council.

The Council on Medical Education and Lifelong Learning

Eindra Khin Khin, 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 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.

Position Statement on Leadership in Academic Departments of Psychiatry

The Council on Medical Education and Lifelong Learning developed a position statement, which also supports the position of the American Association of Chairs of Departments of Psychiatry, that leaders of academic departments of psychiatry should be psychiatrists. While current Accreditation Council on Graduate Medical Education (ACGME) policy requires that training directors be physicians, there is no requirement that academic department chairs be physicians. Given the changes occurring within medicine, financial and staffing pressures within psychiatric departments can impact training programs. Department leadership by psychiatrists is required to ensure that physician program directors have support, which ensures the integrity of their training programs. Departmental leadership by a psychiatrist also ensures that trainees have role-models and mentorship for psychiatrists in leadership positions. The ACGME should ensure that psychiatry accreditation standards reflect this position.

Addressing Racial Discrimination Against Psychiatry Trainees and Practicing Psychiatrists

With the Council on Minority Mental Health and Health Disparities, the Council on Medical Education reviewed and gave input toward the development of a continuing medical education course, Responding to Racism from Patients, Families, and Guests toward Residents and Practicing Psychiatrists. The course provides guidelines, recommendations, policies, and case studies to address such discrimination.

COVID-19 and Psychiatry Education

As a convening body for Allied Psychiatry Education groups the Council is continuing to discuss the impact and the opportunities in psychiatry education at all levels due to COVID 19. With its allied education organizations, representing medical students and graduate education, the Council began discussion of effects of COVID and the education of the psychiatry workforce, as well as the effect the racial climate is having on academic psychiatry and psychiatry overall. There are concerns for resident wellbeing with increased anxiety and isolation as well as faculty attrition. Other factors being discussed are institutional financial impacts, increased workload expectations, hiring freezes, and virtual recruitment.

Climate-Related Psychiatric Service Needs

The Council is reviewing literature and consulting with other groups to determine if there are unmet educational needs of the psychiatry workforce at all levels regarding climate change and the role of psychiatry and if evidence exists to address these needs through a specific curriculum.

Opinions of the Membership on Participation in Maintenance of Certification

A workgroup of the Council was convened to assist APA leadership in the development of a survey to the membership to collect and better understand APA members’ opinions on the current Maintenance of Certification process. In collaboration with the Division of Research, the survey was developed and provided to a demographic cross section of the APA membership in July 2020. Results are being analyzed for distribution to the membership.

Medical Supervision of Psychiatry Residents and Fellows

The Council continues to discuss the need for an APA position and for the Accreditation Council on Graduate Medical Education (ACGME) to address in a specific way the supervision of residents in regard to the medical piece of diagnosing and treating psychiatric disorders—psychiatry residents should not be solely supervised by advance practice providers in regards to the medical piece of diagnosing and treating psychiatric disorders. The Council continues to examine what is happening in supervision in large and small programs, current RRC existing statements on supervision, and recommendations going forward.

Addiction Requirements in Residency Training

Council discussed and provided feedback to the Addiction Council on expanding the number of required weeks of addiction training. There is general support for competencies and proficiencies, but rotation requirements should not be overly prescriptive in terms of settings and durations. ACGME has been moving towards fewer specific program requirements related to specific topics; adding more specificity for addiction would go against the general trend of introducing new mandates. The Council had partial support for requiring residents to complete Buprenorphine x-waiver training as part of residency given the specific regulatory aspects required in being able to use this medication.

General and Subspecialty Workforce

Discussions have been ongoing within psychiatry education as to why subspecialty positions are not being filled. The Council is looking at factors such as what is the “right” proportion, what is the perceived value of the extra training, what is the correct number of generalists vs. subspecialty trained providers, what are the barriers, and what are the incentives. The Council heard from the Addiction, CL, and Geriatric Workforce Task Force and from AADPRT Work Force Task Force, who are both developing recommendations to address workforce/subspecialty issues. Barriers to pursuing subspecialty training include indebtedness, negative attitudes and beliefs, not enough exposure during residency, lack of mentors, fellowship salary. Some factors influencing pursuit of subspecialty training were early interest and role models/mentors. Possible recommendations include: Increasing compensation/other financial incentives; Improving Access; Link trainees to a community of practice; APA website – create a central place to look for information about subspecialty fellowships; APA Annual Meeting –Career Development for residents – subspecialty participation.

The Committee on Physician Well-Being and Burnout

The Committee on Physician Well-being and Burnout is a standing committee of APA charged to examine ongoing issues related to well-being and burnout. In January 2020, the Committee launched a survey, Access Yourself, APA Well-Being Self-Assessment 2.0 to learn more about the rates and causes of burnout in minority and underrepresented psychiatrists. The survey remains open for response and is a tool for recognizing burnout (https://www.psychiatry.org/psychiatrists/practice/well-being-and-burnout/assess-yourself). It includes questions about demographics and practice setting, as well as the Oldenburg Burnout Inventory and the Patient Health Questionnaire-9 (PHQ-9). A 2017 survey from the committee established that burnout was a significant concern among APA members, with 73% of respondents at risk. The new survey will shed light on whether members of minority and underrepresented groups experience burnout differently and inform future efforts to address it for all psychiatrists. Limitations of the APA psychiatrist well-being, burnout and depression data include convenience sampling, the limitations of the instruments chosen, a scarcity of longitudinal data, and insufficient power to study important questions like the relationship between burnout and diversity.

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 now consists of 32 district branches and 21 allied organizations. Goals of the joint sponsorship program include strengthening allied relationships, expanding opportunities, and furthering educational goals.

Education Awards of the Council

The Council initiates nominations for APA’s 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.

The Council on Minority Mental Health and Health Disparities

Eric Yarbrough, M.D., Chairperson

Overview of Council

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 groups both within the profession and APA.

2019–2020 CMMH/HD Accomplishments and Initiatives

The following Positions Statements were developed by CMMH/HD and approved by the APA Board of Trustees from 2019 to 2020:

• • Issues Related to Sexual Orientation and Gender Minority Status, 2020

• • Abortion and Women’s Reproductive Health Care Rights, 2020

• • Xenophobia, Immigration, and Mental Health, 2020

• • Mental Health Needs of Undocumented Immigrants, Including Childhood Arrivals, Asylum-Seekers, and Detainees, 2020

The following Positions Statements were sent to the CMMH/HD for review in 2019–2020:

• • Position Statement on Suicide in Black Youth, 2019

• • Position Statement on Sexual Abuse of Migrants in ICE Custody, 2019

COVID−19 Letter to HHS Requesting States to Collect and Disseminate Data Based on Race/Ethnicity

The CMMH/HD reviewed and approved a letter by the APA to support the collection of data by race and ethnicity related to COVID-19 across states.

Addressing Racial Discrimination Against Psychiatry Trainees and Practicing Psychiatrists

APA’s DDHE and Division of Education are working with the authors of the action paper to develop a web-based CME module on this topic. In addition, the Council on Minority Mental Health and Health Disparities is developing a CME module on various aspects of racial discrimination that can be used to address the action paper requests.

Media Project

CMMH/HD is creating a media project that will include development of prepared talking points for addressing mental health issues among minority and underserved populations. This will require collaborations with Council on Communication as well as APA Division of Communications and the Division of Diversity and Health Equity. The Council will also work to provide the APA Communications with a rolodex of experts in minority mental health.

APA Stress and Trauma Toolkit for Treating Historically Marginalized Populations in a Changing Political and Social Environment

In September, APA Stress and Trauma Toolkit for Treating Historically Marginalized Populations in a Changing Political and Social Environment, was published. Please click here to access the toolkit. 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 affected 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.

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 be published on the APA website and used for recruitment purposes of future M/UR members. Looking Back, Striding Forward: The 1969 Walk-in and its Legacy is expected to be released by Spring 2020.

Inclusion of Territorial Acknowledgments in APA Meeting Programming

APA’s Division of Diversity and Health Equity will work with APA Meetings and Education to identify the traditional inhabitants of the lands, when available, on which APA conferences are to be held. This will be executed utilizing the Bureau of Indian Affairs (BIA) federally-recognized Tribal Directory and The US Department of Arts and Culture guide on Honor Native Land: A Guide And Call To Acknowledgment. The script—written by APA staff in coordination with the president of the Caucus of American Indian/Alaska Native/Native Hawaiians Psychiatrists—could read: “I would like to acknowledge the Indigenous people whose land we are gathered on today. I recognize we are guests of these ancestral lands of Indigenous people who came before us. I would like to recognize this land has been cared for by them for hundreds of years and our responsibility is to honor them and their ancestors.”

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, the interface of addictions and the law, 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 from 2019–2020.

Stalking, Intrusive Behaviors, and Related Phenomena by Patients

The doctor-patient relationship should ideally be a collaborative and mutually respectful one. In some instances, however, patients may engage in behaviors that can engender concern and even fear in the psychiatrist involved. When these behaviors are repeated, unwanted, and distressing, we might colloquially refer to them as “stalking.” In the midst of a stalking episode, it may be difficult for the psychiatrist to know how to proceed, what steps to consider to protect oneself, and what choices to consider to manage the patient-physician relationship. As a result, the Council has developed a resource document to provide practical guidance to psychiatrists, as well as psychiatrists in training and their supervisors, who are confronted with the issue of stalking or other intrusive behaviors by their patients. It was drafted via the consensus of individuals whose practices intersect at the interface of law and psychiatry and was approved by the Joint Reference Committee in October 2019 and is available at https://www.psychiatry.org/psychiatrists/search-directories-databases/library-and-archive/resource-documents.

Mental Health Issues Pertaining to Restoring 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 developed a resource document offering guidance to general psychiatrists faced with these requests. The Council’s 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 polarized 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 resource document was approved by the Joint Reference Committee in February 2020 and is available at https://www.psychiatry.org/psychiatrists/search-directories-databases/library-and-archive/resource-documents.

Pharmaceutical Marketing

In 2017, the Council began to address pharmaceutical marketing practices that have been aimed at judges and legislators relating to individuals involved in the justice system. In a 2016 position statement, Treatment of Substance Use Disorders in the Criminal Justice System, 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 developed 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 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 was approved by the APA Board of Trustees in July 2020.

Consent to Mental Health Treatment by Guardians

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 developed 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 position statement was approved by the APA Board of Trustees in July 2020.

Voluntary and Involuntary Hospitalization of Adults With Mental Illness

Modern concepts of psychiatric treatment properly emphasize the use of recovery-oriented, person-centered, trauma-informed, community-based treatment. However, individuals experiencing severe distress or functional impairment should have access to short-term and continuing inpatient psychiatric treatment when necessary. When persons with mental illness who need inpatient care are unwilling to consent to voluntary admission, some form of involuntary hospitalization should be available when they are found to meet certain criteria. The Council on Psychiatry and Law, in collaboration with the Assembly Committee on Public and Community Psychiatry, developed a position statement outlining the principles that should govern psychiatric hospitalization of adults with mental illness. This position statement was approved by the APA Board of Trustees in July 2020.

Competence to Stand Trial Evaluation and Restoration Services

As a result of complex system challenges at the intersection of mental health services and the criminal justice system, a backlog has developed for jail detainees awaiting competence to stand trial assessments and transfers for restoration services, most with serious mental illness, intellectual or developmental disabilities and/or other conditions affecting cognitive functioning. In a significant proportion of these cases, the detainees have ended up in jail due to inadequate access to preventive community mental health services and a suitable range of crisis stabilization services. In response, the Council developed a position statement outlining the principles that should guide reforms of the current system for assessing competence to stand trial of defendants under criminal charge and for providing treatment at the proper level of care and the most reasonable setting for those found incompetent. This position statement was approved by the APA Board of Trustees in July 2020.

Capital Sentencing and the Death Penalty

Psychiatrists have become increasingly aware of deficiencies of the capital sentencing process and the administration of the death penalty in cases involving persons with mental disorders and disabilities. Major concerns include insufficient attention to mitigating evidence of diminished responsibility of offenders who were suffering from mental disorder or disability at the time of their offenses, unfairness in postconviction adjudication, and inhumane treatment of persons on death row. The Council developed a position statement that combines several previously approved APA Position Statements on capital punishment into a single integrated statement, and it was approved by the APA Board of Trustees in July 2020.

Committee on Judicial Action (Reena Kapoor, M.D., Chairperson)

The Committee on Judicial Action, chaired by Dr. Reena Kapoor, 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. APA has recently joined briefs in the following cases: Bostock v. Clayton County, Altitude Express Inc v. Zarda, RG & GR Harris Funeral Homes Inc v. EEOC, asserting that the scientific literature regarding gender and sexuality supports the understanding that discrimination on the basis of sexual orientation and gender identity is discrimination because of sex; the remand of G.G. v. Gloucester County School Board back to the Fourth Circuit, asserting that the exclusion of transgender individuals from facilities consistent with their gender identity undermines their treatment; Flores v. Barr, asserting that the present situation under the Flores Settlement Agreement is barely tolerable for children and the Rule will make things much worse; California v. Texas, arguing that § 5000A enacted by the Affordable Care Act should remain constitutional following passage of the 2017 Tax Cuts and Jobs Act; as well as multiple amicus briefs concerning access to abortion in states including Alabama, Oklahoma, Texas, and Tennessee.

Other Topics

The Council continues to work on an array of topics, including chemical castration laws, child commitment laws, nonemergent involuntary medication in jails, and mental health courts. Members of the Council have also formed a workgroup with members of the Council on Addiction Psychiatry to draft a resource document on supervised consumption sites. 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. Jeffrey Swanson in 2020. The Manfred S. Guttmacher Award recognizes an outstanding contribution to the literature of forensic psychiatry; it was awarded to Dr. Susan Hatters Friedman and the Group for the Advancement of Psychiatry’s Committee on Psychiatry and the Law for their work Family Murder: Pathologies of Love and Hate. Both committees are in the process of selecting 2021 award recipients.

The Council on Quality Care

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

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 patient safety. The Council collaborates with other groups within APA’s governance structure to respond to topics of mutual concern, such as quality 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 Committee on Mental Health IT (CMHIT) has continued its work on refining a process for mobile mental health applications (“apps”). In December, the APA App Advisor Expert Panel, comprised of members, psychologists, social workers, patients with lived experience, and other mental health professionals, met and evaluated a number of mental health apps using the App Evaluation Model and Framework. They subsequently revised that framework and have met virtually several times since then. At the request of the APA Office of Legal Counsel, an additional step was added to the evaluation process to allow app developers an opportunity to provide clarification or additional information on the Panel’s evaluations. This is now completed, and the new App Advisor pages will soon be live. The Panel continues to evaluate apps in the meantime.

CMHIT also has formulated a plan to update their existing digital health content pages to include new and updated material around the following topics: Application Programming Interfaces (APIs); the “digital divide”; adapting technology into new workflows; digital therapeutics; and payment advocacy for the use of technology in care. The Committee has identified a potential new software solution to integrate into its current existing pages that would aggregate information into an auto-populating FAQ for users. Staff are reviewing the feasibility of this software (i.e., integration into current APA technology with IT and Communications, as well as cost and legal implications). The Committee may also develop other deliverables, such as short informational videos or diagrams depicting technological integration into clinical workflows.

Committee on Practice Guidelines

The Committee on Practice Guidelines continues to focus on developing evidence-based practice guidelines to assist psychiatrists and others with clinical decision-making and the care of patients. The newest guideline, Practice Guideline for the Treatment of Patients with Schizophrenia, is available at: https://www.psychiatry.org/psychiatrists/practice/clinical-practice-guidelines along with an online CME vignette, clinician pocket guide, family/care provider information, and provider summary/teaching slides.

There are currently three assembled and functioning Guideline Writing Groups. The first writing group, chaired by Dr. Victor Reus, is developing an updated 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.

A second writing group, chaired by Dr. Catherine Crone, is in the late phases of developing a guideline for the treatment of eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, night eating syndrome, avoidant/restrictive food intake disorder [ARFID]) based on an expert survey and a systematic review completed by the APA with Doctor Evidence, a systematic review company. This guideline will be available for public comment during fall/winter 2020. This writing group will begin work on a delirium guideline when the systematic review is complete at the end of 2020 and after the eating disorders guideline is finalized.

A third writing group, chaired by Dr. George Keepers, will begin work on a revised and updated guideline for the treatment of borderline personality disorder when a systematic review is complete in early 2021.

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 CQPM members, the APA has begun the process of identifying and prioritizing topics for quality measurement. This has provided the CQPM with a strategy on which to base APA comments for developers of quality measures (e.g., Mathematica, RAND, NCQA, 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. This prioritization effort will also 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 Quality Reporting Program, the Long-Term Care Hospital Quality Reporting Program, the Merit-based Incentive Payment System (MIPS), and other programs.

Reporting Workgroups and Other Work With Member-Experts

The Council oversees the work of the following workgroups:

• • Patient Safety Workgroup: This workgroup updated their charge and will be working on issues related to suicide risk reduction (i.e., ligature risk, observation, suicide risk screening/assessment), medication safety, and development of member education materials (i.e., patient safety tips). The workgroup will also be subsuming the work of the former workgroup on Standards and Survey Procedures within their charge. Members of the Standards and Survey Procedures Workgroup are those member experts that represent psychiatry’s interest with various accrediting and standard-setting bodies.

• • Quality Strategy Workgroup: This workgroup is composed of members from the Council and the CQPM and is in the process of finalizing recommendations for the APA regarding potential next steps to advance APA’s position within the national quality landscape and better align APA’s internal quality efforts (i.e., quality measures development, practice guideline development and PsychPRO, APA’s Mental Health Registry).

• • Inpatient Psychiatric Facility Workgroup: This workgroup consists of APA members and one nonpsychiatrist with expertise in quality care related to the inpatient setting. They have reviewed and are in the process of prioritizing quality measures currently adopted by CMS’s Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program. As part of this process, the group will define strategic recommendations and topics for future inpatient measure development by APA and/or outside quality measure developers.

Technical Advisors

Members of the Council on Quality Care, with support from its component groups, continue to serve in leadership and advisory roles with external quality measurement groups, including the National Quality Forum and the Core Quality Measures Collaborative. 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 the APA an authoritative voice in the national quality enterprise.

The Council on Research

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

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 April 2020 meeting of the Council on Research and its plans.

Component Updates

Work Group 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 2020 Research Colloquium for Junior Psychiatrist Investigators (Colloquium). The Colloquium, originally scheduled for April 25 and 26 during the APA Annual Meeting in Philadelphia, was postponed due to COVID-19. The Work Group is planning to host a virtual Colloquium at the end of this year with the date yet to be determined. The Colloquium is typically a two-day event held on Saturday and Sunday at the APA’s Annual Meeting. In contrast, the virtual Colloquium will be an intensive one-day event. The first half of the day will see representatives from APA/APAF, NIDA, ACNP, and SOBP present on work-life balance, career trajectory, mentorship, and funding opportunities to early research career psychiatrists (ERC). During the second half of the day, awardees will be divided into two tracks: Track 1 will include ERC psychiatrists in the beginning stage of developing area(s) of research interest and need mentorship in doing so; Track 2 will include ERC psychiatrists who have identified one or more clear research areas of interest but need mentorship in moving forward to develop a K-award project or finetuning their research portfolio. Participants will be further divided into 5 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 discussions with their peers and mentors.

This year, Drs. Wilson Compton, Nina Kraguljac, John Krystal, Carolyn Rodriguez, and Ned Kalin from the Council on Research and its components will serve as mentors in the program. Additionally, biostatisticians/methodologists will participate to provide a valuable perspective often unavailable to young researchers. 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., past 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. Eleven international mentees from Argentina (2), Brazil (2), Colombia (1), Japan (1), and France (2), Mexico (1), the Netherlands (1), and Nigeria (1) were invited to attend this year’s Colloquium. International mentees are selected and sponsored by their institution, country’s psychiatric association or branch of SOBP, or are self-funded.

Lastly, the Colloquium continues to be jointly funded by the APA Foundation (APAF), the American College of Neuropsychopharmacology and the Society of Biological Psychiatry, and the National Institute on Drug Abuse (NIDA). A renewal grant application for the Colloquium, with Dr. Diana Clarke, Deputy Director of Research and Staff Liaison for the Council on Research at the APA and Scientific Coordinator of the Colloquium, as the principal investigator, was successfully funded for 3 years.

Research Awards and Fellowships.

The Award for Research in Psychiatry, the highest award for research given by the APA, was presented to Maurizio Fava, M.D., Psychiatrist-in-Chief of the Massachusetts General Hospital (MGH), director, Division of Clinical Research of the MGH Research Institute, executive director of the Clinical Trials Network and Institute, (MGH), associate dean for clinical and translational research and the Slater Family Professor of Psychiatry at Harvard Medical School. Dr. Fava is a world leader in the field of depression. 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 awarded to Milton Wainberg, M.D. Dr. Milton Mainberg is the Founding Chair of the Caucus of Global Mental Health and Psychiatry of the American Psychiatric Association, a Professor of Clinical Psychiatry at Columbia University/New York State Psychiatric Institute, Director of the NIMH-funded Columbia University Global Mental Health Implementation Science T32-Post Doctoral Fellowship, and NIMH/Fogarty International-funded Portuguese-speaking African countries Mental Health Implementation Research Training Program. Several other prominent researchers were recognized this year for their outstanding contributions to psychiatry and psychiatric research: Melissa Arbuckle, M.D., Ph.D. received the APAF/American Association of Chairs of Departments of Psychiatry Research Mentorship Award; Vilma Gabbay received the Blanche F. Ittleson Award for Research in Child and Adolescent Psychiatry; and the mentor/mentee team of Robert Sweet, M.D. and his trainee, Brandon McKinney, M.D. received the Kempf Fund Award for Research Development in Psychobiological Psychiatry. Christina Mangurian, M.D. past chair of the Council on Minority Health and Health Disparities, received the 2020 APA Health Services Research Senior Scholar Award, and Samuel T. Wilkinson, M.D. received the 2020 APA Health Services Research Early Career Award.

This year, the APAF awarded 7 non-renewable small research grants to APA/APAF fellows to study the Impact of COVID-19 on a) patients with mental and substance use disorders, b) the psychiatric workforce (including early career psychiatrists), and/or c) the practice of psychiatry. The review committee for these small grants was chaired by Dr. Jonathan Alpert, chair of the Council on Research and included 4 other APA members. The 7 successful APA/APAF fellows included Drs. Anees Bahji, Sebastian Cisneros, Devin Cromartie, Juliet Edgcomb, Youngjung Kim, Michael Mensah, and Tina Thomas. Drs. Anees Bahji and Youngjung Kim, were past awardees of the Research Colloquium for Junior Psychiatrists Investigators.

Committee on Psychiatric Dimensions of Disaster.

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 affected by recent tragic events, including, but not limited to, wildfires in California, earthquakes in Puerto Rico, and mass shootings in Canada. Committee members led special webinars on disaster psychiatry topics and participated in interviews through major media outlets, such as CNN, CNBC, and The Washington Post. The Committee has been engaged in supporting APA’s response to the COVID-19 pandemic and written a number of pandemic-related guidance documents, including on essential procedures, redeployment of psychiatrists to other roles in medicine, and exposure to COVID-related death, among others.

Diagnostic and Novel Treatments Work Group.

Chair: Charles Nemeroff, M.D., Ph.D.; This Workgroup, chaired by Charles B. Nemeroff, M.D., Ph.D., generated five manuscripts, which were reviewed and approved by the Joint Reference Committee (JRC) and Board of Trustees (BOT), and were 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,” “The Use of Social Media in Recruiting Participants for Mental Health Research Purposes: A Systematic Review and Best Practices Report”, “Biomarkers of Schizophrenia,” and “Big Data and Machine Learning: A Primer for Psychiatrists.” The Workgroup provided an overview of current initiatives, including biomarkers of Autism Spectrum Disorder, ecological momentary assessment, cannabinoids and THC in psychiatry, and the neuropsychiatric sequelae from COVID-19. Draft manuscripts on these topics will be submitted for critique and approval by the Council on Research, JRC, and BOT in upcoming meeting.

Health Services and Health Disparities Work Group.

Chair: Jonathan Alpert, M.D., Ph.D. The primary focus of the Health Services and Health Disparities Work Group has been the effects of climate change on mental illness and psychiatric service needs. The Work Group provided an overview of recent initiatives, including a systematic review and the use of Behavioral Risk Factor Surveillance System (BRFSS) and social media data to predict psychiatric service needs and utilization related to climate change and mental health. The Work Group is interested in issues of access to mental health care, workforce development, and patient-reported outcomes. Additionally, the Work Group is interested in the topics of gun violence, LGBTQ health research methodology, SMI and integrated care, and other areas of societal interest where they could identify gaps in research and potential research questions.

DSM Steering Committee

Chair: Paul S. Appelbaum, M.D.; Vice-Chairs: Kenneth Kendler, M.D. and Ellen Leibenluft, M.D. The DSM Steering Committee, its Subcommittee on Minor Changes, and its five Review Committees continue to be active since the last report in the Fall of 2019. A major project this year has been the development of the DSM-5-TR, involving a thorough revision of the text and inclusion of all changes made to DSM-5 since its publication in 2013. DSM-5-TR is being prepared for publication in 2021. Revisions to the diagnostic criteria for Avoidant Restrictive Food Intake Disorder (ARFID) and the inclusion of codes for Suicidal Behavior and Non-Suicidal Self-Injury in the chapter on Other Conditions That May Be A Focus of Clinical Attention were approved by the APA Assembly and Board of Trustees at the conclusion of the review process. A proposal for a new diagnostic category of Prolonged Grief Disorder, which was derived from a workshop organized by the Steering Committee in New York City in June 2019, was posted for public comment; revisions were made in response to comments and the revised proposal is now in review. Also posted for public comment was a proposed change in the text for Intellectual Disability, which was approved. Several other proposals for the addition, deletion, or modification of diagnostic criteria are at different stages of the review process or awaiting further information from the proposers.

APA Registry Discussion

The Council continues to help guide and support the refinement and scaling of APA’s Mental Health Registry, PsychPRO, including the development of the registry’s research guidelines document. This document is intended to provide the principles and process for access to the registry’s data repository for research. The growth of PsychPRO participation has allowed for the accumulation of a data repository that could be very beneficial in the improvement of care for patients with mental and substance use disorders. A wealth of clinical data are collected in the course of usual care in “real-world” settings.

PsychPRO continues to provide the important function of regulatory reporting for quality programs, including CMS’ Merit-based Incentive Payment System or MIPS. Maintaining its certification as a qualified clinical data registry or QCDR is instrumental in this endeavor. As a QCDR, PsychPRO is also developing new quality measures for the field, which positions the APA and it’s membership and stakeholders to help lead in providing good data for transitioning to a value-based payment system. Good quality measurement of the care psychiatrists and other behavioral health clinicians provide will be key in driving the field forward and establishing proper payment mechanisms for providers. The Research Council can continue in its guidance and support of this work through a variety of activities including review of research that helps establish evidence-based and measurement-based care (MBC) practices.

PsychPRO continues to work with various vendors to identify PRO modules and EHRs that offer superior user experience in order to expand functionality for practices focused on measurement-base care (MBC). PsychPRO is suited 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.