APA Council Reports

At the fall component meetings of the American Psychiatric Association in Arlington, Va., September 10–13, 2014, the APA councils heard reports from their components. Following are summaries of the activities of the councils and their components.

The Council on Addiction Psychiatry

Frances R. Levin, M.D., Chairperson

The Council on Addiction Psychiatry is committed to providing psychiatric leadership in the study, prevention, and treatment of substance use disorders. The component provides recommendations to APA on research, training, and treatment, as well as issues related to public policy.

To facilitate effective collaboration and communication, the Council invites representatives of several federal agencies to attend its meetings. Participating agencies include the White House Office of National Drug Control Policy (ONDCP), the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the Center for Substance Abuse Treatment (CSAT), and the Veterans Health Administration (VHA). The Administration’s science-based plan to reform drug policy, physician training on substance use treatment, prescription drug monitoring programs, accessibility and availability of services, budgetary challenges, research priorities, and opportunities for APA to contribute meaningfully to important government initiatives were among the issues addressed by the group. Members also frequently collaborate with APA’s Department of Government Relations and representatives of other allied professional associations to remain abreast of and develop advocacy positions regarding legislative and regulatory issues that may impact the field.

The epidemic of prescription drug and heroin abuse remains a significant concern to the Council. Treatment availability and access must be expanded to meet the needs of addicted patients. To do so, many factors must be carefully considered, including diversion of buprenorphine, increasing the cadre of trained physicians, expanding the patient limits imposed by the Drug Addiction Treatment Act of 2000, and minimizing the proliferation of “pill mills.”

Representatives of the Council, the American Academy of Addiction Psychiatry, and the American Osteopathic Academy of Addiction Medicine met frequently to discuss potential and agreed upon a set of recommended policy changes that would significantly increase patients’ access to treatment but guard against the diminution of quality treatment. The recommendations of the coalition were shared with the Substance Abuse and Mental Health Services Administration (SAMHSA) and Health and Human Services (HHS) leaders and several Members of the United States Senate. The federal government continues to deliberate and is expected to take action in coming months.

Waiver-eligible buprenorphine training courses were presented at both APA’s Annual Meeting and the Institute on Psychiatric Services. Through the efforts of the Council as well as the American Academy of Addiction Psychiatry, the 2014 Institute on Psychiatric Services offered a series of more than a dozen sessions on substance use disorders.

The councils on Addiction Psychiatry and Psychiatry and the Law collaborated to develop an APA Position Statement on the Need to Monitor and Assess the Public Health and Safety Consequences of Legalizing Marijuana. Approved by the APA Board of Trustees in May 2014, the statement urges the Congress and the President to direct the Departments of Justice and HHS to establish coordinated, interagency mechanisms to monitor and measure the health and safety consequences of policies enacted by states that legalize cultivation, distribution, and possession of marijuana for medical or recreational use and to fund relevant research.

In late 2013, SAMHSA awarded a grant, Providers’ Clinical Support System for Medication Assisted Treatment (PCSS-MAT [www.pcssmat.org]), to the American Academy of Addiction Psychiatry (AAAP). The APA, the American Osteopathic Academy of Addiction Medicine (AOAAM), and the American Society for Addiction Medicine (ASAM) are partner organizations and together provide free evidence-based resources to train clinicians and the public about the effectiveness of medications used for treating opioid addiction. APA organizes and presents 16 webinars per year, each of which offers free continuing medical education. The sessions are offered live on the second Tuesday of each month. Session recordings are available for on-demand access at www.APAeducation.org.

APA is also a partner organization in the Providers’ Clinical Support System for Opioid Therapies. In that capacity, it collaborates with many other professional organizations to develop clinical resources, present training, and provide mentorship to physicians on the appropriate use of opioids for the treatment of chronic pain and for opioid addiction. APA presents occasional webinars on behalf of the program. This program will continue for another 3 years as a result of SAMHSA’s recent award to the American Academy of Addiction Psychiatry. APA will continue its partnership in the PCSS-O and will produce on-line case vignettes and self-assessment activities, as well as present webinars.

The Council on Advocacy and Government Relations

Barry Perlman, M.D., Chairperson

The Council continues to serve as the APA’s coordinating body for all legislative activities involving the federal and state governments. Activities include analyzing problems and anticipating needs for policies and planning strategies; actively collaborating with allied groups with shared goals to progressively move toward improved quality of care; and working with agencies that set policy on funding, access, and quality of psychiatric services at the federal, state, and local levels to affect legislation, regulations, and guidelines.

DGR staff and the Council hosted the 2014 APA Advocacy Leadership Conference in Washington, DC this past March. Over 80 APA members from around the country attended, meeting with over 150 congressional offices. Participants learned about the important issues the APA has been facing, how to package their message, and the importance of continuing grassroots advocacy back home.

The Council has developed ways in which to address psychiatric workforce shortages in population groups with acute mental health needs, notably veterans. With Council input, DGR has proposed an initiative to Congress. The Veterans Workforce Initiative has been introduced by Reps. David Scott (D-GA) and Larry Bucshon, M.D., (R-IN). H.R. 4234, the Ensuring Veterans’ Resiliency Act, authorizes the VA to recruit a select number of psychiatrists for full-time employment by offering competitive medical education loan repayment incentives. The bill promises to maintain a robust and stable psychiatric workforce in the VA.

The Council on Advocacy and Government Relations is working to increase communication and collaboration with district branch legislative representatives and areas on advocacy-related issues. One such effort could be educational webinars by DGR staff to apprise legislative representatives of legislative events and bring a more formal role to legislative representatives. The Council is interested in eliciting input from district branches and legislative representatives on how best to work together. The Council also will be considering ways to increase the involvement of Council members in relation to Congress and advocacy efforts on Capitol Hill.

The Committee on Advocacy and Litigation Funding, Jack Drescher, M.D., Chairperson, is charged with reviewing requests, typically from district branches and state associations, for financial support of projects that involve legislation, litigation, and advocacy. The Committee serves as a mechanism to evaluate requests for financial assistance to district branches and state associations and to make recommendations regarding funding through the Council on Advocacy and Government Relations and the Joint Reference Committee to the Board of Trustees. The Committee operates within a set of guidelines, approved by the Board, that establish the criteria for evaluating proposals and making recommendations for their disposition to the Board.

The APA Political Action Committee (APAPAC), John Wernert, M.D., Chairperson, is governed by a Board of Directors that is comprised of 12 APA members. APAPAC is the bipartisan political voice of the APA and enables APA to invigorate its patient and professional advocacy activities by supporting candidates for federal office. The PAC works to ensure the election of members of Congress who share mutual principles and goals with APA and who stand up for psychiatry’s position during the legislative process. Another extremely important role of the PAC is to educate other members of Congress as to why they should support positions vital to our patients and our profession.

The PAC raised about $325,000 from APA members during the current election cycle, still short of the $400,000 goal. Of the $325,000 raised, about $142,000 has been contributed in 2014 alone. Only four percent of eligible APA members have contributed to the PAC this cycle, one of the lowest participation numbers for a medical specialty PAC. Increasing this number is the top priority of APAPAC. Strengthening our political voice is vital to the APA’s advocacy efforts and crucial to the future of our specialty and our patients. APA is near the bottom of physician specialties in money raised. APAPAC has introduced the APAPAC Operative Program. The APAPAC Operative Program is designed to increase the participation rate among APA members by using peer support at the district branch/state association level. An APA member will represent his or her district branch/state association by educating fellow district branch/state association members on the importance of APAPAC and how contributions enhance the APA voice in Congress.

The Council on Children, Adolescents, and Their Families

Louis Kraus, M.D., Chairperson

The work of the 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 workshops, position statements, and liaison with allied children and adolescent organizations.

Following are highlights of Council activities in 2014:

The Council on Communications

J. Raymond DePaulo, M.D., Chairperson

The mission of the Council on Communications is to connect the public emotionally to psychiatrists, to create excitement about psychiatrists’ ability to prevent and treat mental illness, and to help brand psychiatrists as the mental health specialists with the most knowledge, training, and experience in the field. While representing psychiatry to the media and the public are a large part of APA’s continuous communications outreach, the dialogue with and among its members is also vital to the Association’s mission. Council on Communications members have the unique perspective of being both members and consumers of the media coverage that the APA generates, plus experts in various areas who are able to make a valuable contribution to the Association’s public education efforts.

This year, the Council was involved in a comprehensive, organization-wide audit of APA’s communications, both external and internal. For years the organization has recognized that the APA funnels a huge amount of information to its members and the public but through multiple channels and departments. In addition, the new world of digital media has established new standards for successful communications, especially in the arena of social media. The consulting firm Porter Novelli interviewed the Council to gauge how APA is perceived among members as a source of information vital for the profession and how it is viewed from a public information standpoint. The audit examined everything from how actions of the Assembly and the Joint Reference Committee are communicated to members to how the APA keeps them informed about important legislative developments. The result was a comprehensive report with recommendations about how the APA can consolidate and streamline its communications channels while invigorating its outreach to the media and the public.

In 2014, APA planned to launch a new collaboration and document-sharing platform on its website that would also serve as a forum for discussions among resident-fellow members (RFMs) and early-career psychiatrists (ECPs). Referred to as the APA Communities Portal, the Department of Information Systems tapped a group of Council members to test the new platform in a soft launch. This pilot program allowed Council members to assess the platform’s functionality, solidify the process for posting content and hosting meaningful discussions, and work out any glitches prior to the formal launch. The result is an important new resource for ECPs and RFMs to network, share experiences, and converse about issues important to them.

Each year, the Council on Communications oversees a Member Communications Award, which recognizes outstanding communications on the part of the district branches and state associations. The categories for entry include Overall Communications Plan, eNewsletters, Innovative and Emerging Technology and Websites. Members Scott Benson, M.D., Mary Fitz-Gerald, M.D., Peter Foster, M.D., Gariane Gunter, M.D., Molly McVoy, M.D., and Scott Reichlin, M.D., reviewed some excellent submissions in all categories. This year, three district branches were honored: the Arizona Psychiatric Society for the best eNewsletter, the Washington Psychiatric Society for their creative use of Innovative and Emerging Technology, and the North Carolina Psychiatric Association for its informative, member-focused website.

In the past few years, Council on Communications members have been extraordinarily generous with their time and expertise in writing regular blog posts for APA’s Healthy Minds blog, which addresses widespread and timely issues in mental health for the general public. A recent blog post by Serina Deen, M.D., M.P.H., titled “How Psychotherapy Changes the Brian,” shows how cognitive-behavior therapy correlates with physical changes in brain structures and grey matter. Hind Benjelloun, M.D., authored the blog post, “Telemedicine, Here I Come!” to highlight how telepsychiatry offers critical mental health services to individuals living in rural areas where there is a dearth of psychiatrists. Past Council member Claudia Reardon collaborated with guest blogger Pierre Gingerich Boberg on “How Does Your Primary Care Doctor Coordinate With Your Psychiatrist?” The blog post tackles the complex issue of integrated care and how psychiatry can fit into a collaborative care model with other branches of medicine.

One area in which the Council consistently offers input is in the continuous improvement of the APA website. As frequent users of the site, they offer invaluable insights from the member perspective. At each face-to-face meeting, they are presented with current website issues by Eric Fishman, APA’s Senior Director of Information Systems. This year, they considered the APA’s plan for an extensive redesign and offered valuable observations for how the site could be more functional and inviting to both members and the general public.

As psychiatrists who are eager to serve their patients in ways that are accessible to them, many members of the Council have become experts in using social media, and they have been generous in the sharing of knowledge about how to maximize its impact. At its meeting in May 2014, member Arshya Vahabzadeh, M.D., gave a presentation to the Council on how social media is becoming much more competitive because of the sheer volume of sites and individuals and organizations who now engage in social media. Dr. Vahabzadeh explained how the social media sphere offers both risks and the opportunity for engagement with patients and the general public. He asked the critical question, “How can my social media messages cut through the clutter and actively engage my followers in a conversation?” The answer, he explained, is to use messaging that has a strong emotional impact. Friends and followers tend to become authentically engaged when they have been touched emotionally by social media content, and this motivates them to join the conversation.

Many members of the Council have remained involved in communications issues even after their terms with the Council have expired. Ex-member and co-chair of the Council, Gabriela Cora, M.D., has recently hosted several Twitter chats on a variety of mental health subjects through the APA’s main Twitter account. The chats have attracted hundreds of participants and reached potential audiences in the millions.

After serving as the Council on Communications chair for the last 4 years, Jeffrey Borenstein, M.D., passed the torch to incoming chair Raymond DePaulo, M.D., who assumed the position in May 2014. In the quickly evolving field of communications, the Council will continue to seek out new ways to enhance interaction with the APA and other members and to educate the public about mental health.

The Council on Geriatric Psychiatry

Robert Paul Roca, M.D., M.P.H., Chairperson

The purpose of the Council on Geriatric Psychiatry is to serve as an expert resource to the APA in matters relating to the mental health care of older adults. To serve this purpose, the Council develops position statements and resource documents, creates educational materials, organizes and presents programs at the Annual Meeting, assists the APA leadership in its advocacy efforts at the federal level regarding legislation and regulation affecting geriatric psychiatry, recommends honorees for APA awards in geriatric psychiatry, and serves as an important point of contact between the APA and other organizations interested in the care of older adults, among other activities.

All of these activities call for communication and collaboration between the Council and other components and departments of the APA Governance as well as the American Association for Geriatric Psychiatry (AAGP) and other professional organizations with similar interests. Such collaborations have been essential to the Council’s work during the last several years.

A major focus of our work during in-person meetings and conference calls has been the controversy regarding the use of antipsychotic medications in persons with major neurocognitive disorders. These medications have been used for decades to help ameliorate certain behavioral and psychiatric complications of Alzheimer’s disease and related conditions. In recent years, questions have been raised about the effectiveness, safety, and cost of these drugs in this clinical setting. The Food and Drug Administration has placed a “black box warning” in the package insert of antipsychotics, and Congress, the Centers for Medicare and Medicaid Services (CMS), and the Government Accountability Office (GAO) have all evinced concern. Over the course of the year, the Council has been working with the APA’s Joint Reference Committee and the APA’s Clinical Guidelines Writing Group to create materials that may assist our members in understanding the controversy and determining the circumstances under which it is most reasonable to consider using these medications in patients with dementing illnesses. The result is a resource document entitled, “The Use of Antipsychotic Medications to Treat Behavioral Disturbances in Persons with Dementia.” It will be available on the APA website soon.

The Council has also been working with the Office of Government Relations to respond to inquiries about this matter from the CMS and the GAO. CMS has undertaken an initiative aimed at improving behavioral health care in nursing homes and safeguarding nursing home residents from unnecessary exposure to antipsychotic drugs. As part of this initiative, CMS is developing a national action plan that will use a multidimensional approach including public reporting, raising public awareness, regulatory oversight, technical assistance, training, and research. The action plan will be targeted at enhancing person-centered care for nursing homes residents, particularly those with dementia-related behaviors. The Council on Geriatric Psychiatry has been working with staff from the APA’s Council on Healthcare Systems and Financing to ensure that this process is informed by input from the APA and from geriatric psychiatrists in particular. The result has been a series of conversations with staff from these agencies offering our perspective on the options available for the treatment. As of this writing, arrangements have been made for APA staff and members of the Council on Geriatric Psychiatry to visit CMS officials in Baltimore for what we hope will be a series of meetings regarding this initiative.

At the same time, the Senate Committee on Homeland Security and Governmental Affairs has asked the GAO to investigate the extent of and rationale for antipsychotic drug prescribing to persons with dementia living in nursing homes and in the community. Pursuant to this, the GAO requested a phone meeting with APA experts. Council members participated in the call, provided GAO officials with education and perspective on the use of these drugs in these patients, and invited them to consult with us as they proceed in this work. The Council is committed to continuing to provide input to CMS and the GAO as they create reports and develop policy regarding this complex and controversial area of geriatric clinical practice.

It is important to point out that the Council’s work on antipsychotic use has been undertaken in close collaboration with the AAGP. This is only one of many examples of issues on which it is vital to work in tandem with our Council’s most relevant allied organization. Not surprisingly, all the members of the Council belong to the AAGP. In addition, the President-Elect and the Executive Director of the AAGP traditionally attend and present a report at Council meetings. This provides a forum for the Council and the AAGP leadership to discuss each other’s priorities and improves the odds that advocacy efforts at the federal level will be aligned and mutually reinforcing. It also provides opportunities to develop educational materials and programs that draw on the strengths of each group and serves as a platform for planning an APA presence at the AAGP Annual Meeting.

The Joint Reference Committee often assigns the Council the responsibility for implementing action papers passed by the APA Assembly. Through the passage of action papers, the members of the Assembly, in their capacity as representatives of the APA membership from around the country, bring forward requests for action on the part of the APA. When those actions call for expertise in geriatrics, this Council is asked to respond. Most recently, the Council was tasked with leading the response to an action paper calling for the creation of a resource to guide psychiatrists in their interactions with caregivers of persons with mental illness. The first step in creating this document involved communicating with the action paper author to confirm our understanding of his request. At the time of this writing, this Council has teamed up with the Council on Psychiatry and the Law to draft a document that will seek to address the clinical, ethical, legal, and regulatory aspects of these interactions. Early drafts will be shared with the action paper author to ensure that the final product is useful to those who requested it.

At the Council’s May meeting, there was discussion of developing enduring educational materials in geriatric psychiatry for APA members to supplement the educational programming presented in workshops and symposia at the Annual Meeting. At the suggestion of Dr. Deborah Hales, Council members decided to pursue creating CME materials in geriatric psychiatry for the eFocus program. This work is ongoing as of this writing.

One of the most gratifying tasks of the Council is recommending the honorees for the Jack Weinberg and Hartford-Jeste Awards. The Jack Weinberg Award recognizes psychiatrists who have made outstanding contributions to geriatric psychiatry as researchers, mentors, leaders, and clinicians over the course of their careers. The list of previous awardees comprises the leading figures in geriatric psychiatry over the last several decades and serves as a kind of honor roll for the field. The 2014 awardee was Dr. Davangere Devanand. The Hartford-Jeste Award was recently established to recognize young geriatric psychiatrists who show unusual promise. The 2014 awardee was Dr. Ipsit Vahia.

The Council on Healthcare Systems and Financing (CHSF)

Harsh K. Trivedi, M.D., Chairperson

The Council on Healthcare Systems and Financing continued its efforts to monitor and provide analysis for a number of significant issues that have an impact on the financing and delivery of, and access to, psychiatric care, including outreach to decision makers in the public and private sectors.

In an effort to fulfill the duties laid out in the Council’s charge, the Council maintained the following issue-specific work groups: the Work Group on Health Reform and Parity; the Work Group on Integrated Care; and the Work Group on Medicaid/State Mental Health Programs.

The Work Group on Health Reform and Parity worked to ensure that the requirements of the Parity Act and the Affordable Care Act are being implemented appropriately. With the issuance of the Final Rule on parity, the work group helped analyze how the parity requirements will be applied to self-funded and commercial insurance plans, the new health exchange plans, Medicaid managed care, and alternative benefit plans. Key issues with implications for psychiatric patients are as follows: the scope of the mental health/substance use disorder services plans must provide to be in compliance, network adequacy, and the types of information health plans are required to disclose to enable independent verification of parity compliance. The work group also continued its involvement with specific issues that have direct impact on psychiatric practices, such as coding restrictions, reimbursement rates, and the nonquantitative treatment limitations (i.e., medical management and other reporting protocols) that have been better defined in the Final Rule.

The extension of the Parity Act requirements under the Affordable Care Act (ACA), including the definition of the essential benefits package and independent reviews of claim denials, is also an area the work group is involved with. The work group has also begun to assess how payers are reshaping network criteria, and pay-for-performance methods are under way to provide educational material for members, as well as to ensure that APA has a say in payer policy deliberations.

The Work Group on Integrated Care has continued its focus on member education, including communication about research, and assessing gaps in APA policy. Work group members and other APA member leaders in integrated care gave presentations at the APA’s Annual Meeting and Institute for Psychiatric Services. Additional educational and training experiences are being developed. Integrated Care News Notes, a weekly electronic compilation of policy issues concerning integrated care and health care reform, continues to grow, with currently over 900 subscribers. APA’s webpage on Integrated Care now includes a series of brief videos from integrated care experts recorded at the 2014 Annual Meeting. Members of the work group serve as APA’s representatives to the Patient Centered Primary Care Collaborative (PCPCC), which is a key, large advocacy organization founded by primary care organizations in collaboration with large employers.

The Work Group on Medicaid/State Mental Health Programs continued its work to keep members informed of the various changes under way with state Medicaid programs and new federal efforts to better coordinate Medicare with state Medicaid programs for the dual eligible population and how these will affect the work of psychiatrists. Programs enabled through the Medicaid waiver process are fundamentally changing the landscape of payment and delivery of mental health/substance use disorder services for the seriously mentally ill population.

The Committee on Reimbursement for Psychiatric Care, Bruce Schwartz, M.D., Chairperson, continues to monitor the federally mandated Medicare prospective payment system (PPS) for inpatient and partial hospitalization psychiatric care. Key issues of concern include the expansion of performance-based approaches for the payment of treatment tied that are based on quality indicators. Ongoing liaison continues with key stakeholder organizations, e.g., the American Hospital Association; the Centers for Medicare and Medicaid Services; and the Medicare Payment Advisory Commission, which recently heard a report on how the PPS is working for psychiatry.

The Committee on RBRVS, Codes, and Reimbursements, Ronald Burd, M.D., Chairperson, is continuing its educational work necessitated by the major revisions to the psychiatry procedure (CPT) codes that went into place in January 1, 2013. The 2014 Final Rule on the Physician Fee Schedule corrected an anomaly in the fee schedule, and overall created more equitable reimbursement for psychiatrists who provide medical evaluation and management services. The APA’s advisors to the CPT Editorial Panel and RUC have continued their collaboration with other specialties on the refinement of codes that describe coordination of care. While representing the APA on the CPT Editorial Panel and at the RUC in discussions of other coding changes that may influence the way psychiatry is practiced in the future, Committee members also have continued to provide one-on-one assistance to APA members on coding and documentation through the APA’s CPT Coding Network, which is maintained through the Practice Management HelpLine. The Committee has also provided expertise on ongoing issues that have arisen with numerous payers.

The Council continues to assess the impact of health reform on psychiatric practice and the evolving payment methodologies for psychiatric services. Members have reviewed the report of the Work Group on the Role of Psychiatry in Health Care Reform, which was chaired by Paul Summergrad, M.D., and have been discussing those items that have implications for the Council’s work plan. Council members have been establishing liaisons with other APA councils whose work was implicated in the Summergrad group’s report.

The Council on International Psychiatry

Dilip V. Jeste, M.D., Chairperson

The Council on International Psychiatry was established by the APA Board of Trustees at their October 2013 meeting. The initiative for the establishment of the Council stemmed from an Assembly action paper, and with the support of the Board Ad Hoc Work Group on International Psychiatrists, was approved by the Board of Trustees. The charge of the Council was subsequently approved by the Board of Trustees at their March 2014 meeting.

The charge of the Council on International Psychiatry is as follows:

The purpose of the Council is to facilitate understanding of problems facing international psychiatrists and their patients. It will do so by focusing on international membership in the APA, and, through increased membership in the APA, avail all members of the opportunities in education, advocacy, prevention, and clinical care that membership in the APA provides.

The Council members are experts with experience in global mental health and who are broadly representative (geographically and culturally) of the APA international body. The Council has a standard council composition. APA members who have membership in international organizations may be appointed as corresponding members and serve as liaisons to their international organizations. The Council will utilize freely available electronic communication technology to interact and coordinate with organizations and individuals outside of the United States in lieu of international travel. No APA funds will be budgeted nor used for travel outside the United States by members of this Council for the work of this Council.

At present, the Council has one reporting component, the Caucus on Global Mental Health and Psychiatry.

The Caucus on Global Mental Health and Psychiatry was also established through an Assembly initiative and approved by the Board of Trustees at their December 2013 meeting as a special interest group of the APA. The Caucus focuses on global mental health education, research, and advocacy for improved mental health care for all through collaboration with health and mental health professionals. The Caucus also serves a catalyst within the APA for interdisciplinary, open discussions addressing global mental health needs with a focus on the biological, psychological, and social determinants of health and their presentations in the national and international arenas. Per APA policy, the Caucus Chairperson, Milton Wainberg, M.D., was appointed by then APA President, Jeffrey Lieberman, M.D., and met for the first time at the 2014 APA Annual Meeting in New York City. The Caucus is currently in the process of organizing abstract submissions on global mental health training and journal articles on international issues.

Appointments to the Council on International Psychiatry were made by then APA President-Elect, Paul Summergrad, M.D., and the Council will meet for the first time during the 2014 September Components meeting in Arlington, Va.

The Council on Medical Education and Lifelong Learning

Richard Summers, M.D., Chairperson

The Council on Medical Education and Lifelong Learning is responsible for the entire spectrum of medical education from medical students to residents and fellows to continuing medical education (CME) for all psychiatrists. The Council works to provide resources and programs for psychiatric education at every level in the United States, as well as globally. It includes premedical education, medical education, and graduate medical education for residents in psychiatry (both basic education and subspecialty areas, including, but not limited to, child and adolescent psychiatry, psychiatry, geriatric psychiatry, psychoanalysis, administrative psychiatry, public health, epidemiology and community psychiatry, psychotherapy, and pharmacotherapy), as well as psychiatric aspects of graduate medical education for other medical specialists and postgraduate CME and lifelong learning. The Council is also concerned with issues of workforce and personnel development as they relate to education as well as the education of other physicians and medical personnel in psychiatry.

The Council firmly believes that the APA, as a professional association, 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 follows:

Integrated Care

The Council is preparing a comprehensive review of education and training of psychiatrists for new roles in integration with primary care. The initiative includes:

Undergraduate Education/PsychSIGN

The Council provided support for the Psychiatry Student Interest Group Network (PsychSIGN), a group run by medical students to serve their peers interested in psychiatry. PsychSIGN seeks to promote the establishment of new psychiatry student interest groups (PsychSIG), support and encourage activity in existing groups, and provide resources to pursue a broad range of activities in medical schools, including community service projects around mental health and illness.

To support medical student and residency educators, the Council has asked the Board of Trustees to waive the DSM-5 copyright restrictions for allied, nonprofit education organizations for use in noncommoditized teaching/educational resources specifically for medical student education. The impetus for this request is the online Clinical Simulation Educational Modules for teaching medical students developed by ADMSEP using DSM-5. These modules are designed to be provided free for use by clerkship directors and medical students for general educational purposes. In some cases, the modules may also meet LCME standards ED-2 and ED-8.

Graduate Education

CMELL reviewed and provided feedback to the ACGME on the Psychiatry Milestones. Milestones represents a shift from time-based residency requirements to developmental benchmarks for residents within the six domains of clinical competence over the 4 years of their training.

The Council continues to monitor the following GME issues: combined residencies, and “fast tracking” into addiction psychiatry, psychosomatic medicine, and geriatric psychiatry fellowships.

Lifelong Learning

The Council serves as consultant to the CME activities of APA and to the overall CME program. The Council is involved in shaping APA education, in needs assessment for CME activities, and in identifying psychiatrist knowledge gaps. The Council provided input in the development of educational programs that assist members in their pursuit of self-assessment and lifelong learning and fulfillment of requirements for maintenance of certification. For example, Understanding the Evidence: Off Label Use of Atypical Antipsychotic Medication is a multi-part interactive CME program that disseminates evidence-based information on off-label use of atypical antipsychotics. Supported by a grant from the Agency for Healthcare Research and Quality (AHRQ), the goal of the program is to help physicians make informed treatment decisions when using these medications “off label.” This interactive CME program begins with a self-assessment test, and in the months that follow, a series of multimedia clinical modules will be available for CME credit. The self-assessment test is available at www.apaeducation.org.

The APA also provides CME programs for the district branches. In 2013–2014, the APA Department of CME provided credit to district branch members of the Subcommittee on Joint Sponsorship for over 100 meetings; 22 district branches received CME credit from APA. Many of the district branch meetings covered DSM-5 and changes to CPT coding.

The Scientific Program Committee, chaired by Philip Muskin, M.D, focuses on the CME content to be presented each year at the APA Annual Meeting. The committee also plays a vital role in working with APA staff to ensure that the presenters and content of our meeting meet ACCME guidelines, that sessions are worthy of receiving American Medical Association Physician’s Recognition Award Category 1 Credit, and that the overall program content meets the needs of our members by identifying and correcting learning gaps and clinical practice areas that may need special attention through the CME provided at this meeting. This year’s theme was “Changing the Practice and Perception of Psychiatry.”

The Scientific Program Committee for the Institute on Psychiatric Services, chaired by Hunter L McQuistion, M.D., coordinated the 66th Institute on Psychiatric Services. It took place on October 30th-–November 2, 2014, in San Francisco. The meeting theme, “Integrating Science and Care in a New Era of Population Health,” focused on the changes in service delivery and everyday practice, the scientific advancement of our field, and how society shapes our work. This 4-day conference featured more than 100 expert-led education sessions.

Education Awards

The Council conferred the following awards: the APA Vestermark Psychiatry Educator Award, the Irma Bland Award for Excellence in Teaching Psychiatry Residents, the Nancy C.A. Roeske, M.D. Certificate of Recognition for Excellence in Medical Student Education, the Administrative Psychiatry Award, the Jeanne Spurlock Minority Fellowship Achievement Award, and the Resident Recognition Awards.

The Council on Minority Mental Health and Health Disparities

Sandra Walker, M.D., Chairperson

The Council has the responsibility for the representation of and advocacy for both minority and underserved populations and psychiatrists from minority and underrepresented groups. The Council seeks to reduce mental health disparities in clinical services and research, which disproportionately affect women and minority populations. The Council aims to increase awareness and understanding of cultural diversity and to foster the development of attitudes, knowledge, and skills in the areas of cultural competence through consultation, education, and advocacy within both the APA and the field of psychiatry and public policy. The Council aims to promote the recruitment into the profession and into the APA and retention/leadership development of psychiatrists from minority and underrepresented groups both within the profession and in the APA.

The Council presented a symposium at the May 2014 APA Annual Meeting on Recovery, Race and Social Justice.

Five award lectures under the Council’s purview were presented at the Annual Meeting:

The 2014 Solomon Carter Fuller Award Lecture will be delivered by Dr. William Lawson at the October 2014 IPS meeting, as will the 2014 John Fryer Award Lecture, given by Dr. Dee Mosbacher. The Fuller Award acknowledges achievements of those contributing to the mental well-being of African Americans. The Fryer Award, named after the gay psychiatrist activist Dr. John Fryer, honors noteworthy work on behalf of sexual minority communities.

A work group of the Council developed a slide set to educate members and residents about the DSM-5 Cultural Formulation Interview (CFI). RFM and work group member Stacia Mills, M.D., presented the material (“DSM-5 CFI: A Culturally Appropriate Assessment”) in January at the Los Angeles County/USC Medical Center, her training institution. Dr. Mills, along with Drs. Russell Lim and Francis Lu, presented “Does the CFI Improve Cultural Competence in Adult Psychiatric Resident Physicians” at the March 2014 Annual Meeting of the American Association of Directors of Psychiatric Residency Training. Dr. Lu, chairperson of the work group, also showcased the topic (Ethical and Cultural Considerations and the CFI Guide) at the joint APA/American Nurses Association’s Minority Fellowship Program Winter Institute in February in Arlington, Va.

A first draft of a resource document on human trafficking was completed this year. The work group, which developed the material, is chaired by Dr. Ludmila De Faria and is comprised of members from this Council and representatives from the councils on Psychiatry and the Law and Children, Adolescents, and Their Families. These members include Drs. Rowena Mercado, Willie Siu, Marie-Claude Rigaud, Beverly Du, and Wun Kim.

The Council is aware of the gross underrepresentation of diversity in clinical trials and will explore initiatives to address this issue with the APA Council on Research. Dr. William Lawson, head of the Department of Psychiatry at Howard University in Washington, DC, offered to support the Council in this endeavor. Dr. Lawson represented the APA at the 2014 launch of PhRMA and the National Minority Quality Forum’s campaign to increase diversity in clinical trials.

Other issues that the Council addressed this year included vocalizing support for the reestablishment of the APA Committee on Jails and Prisons, given the significant disparities in incarceration rates and its impact on minority communities; exploring with Dr. Carole Warshaw the possibility of collaborating in some way with the National Center on Domestic Violence, Trauma and Mental Health, where she is Director, around culturally appropriate approaches to address domestic violence and trauma; expanding the visibility of diversity on the APA website; giving supportive feedback to the APA delegation to the AMA House of Delegates to support the AMA resolution: Culturally, Linguistically, Competent Mental Health Care and Outreach for At-Risk Communities.

The Council on Psychiatry and the Law

Steven Kenny Hoge, M.D., Chairperson

The Council on Psychiatry and the Law has continued its work evaluating legal developments of national significance, proposed legislation, regulations, and other government intervention that affect the practice of psychiatry, including the subspecialty of forensic psychiatry.

The Council on Psychiatry and the Law has been busy this year working with other councils on many different subject matters referred from the Joint Reference Committee (JRC):

In addition, the Council is working with the Council on Minority Mental Health and Health Disparities on human trafficking, with the Council on Geriatric Psychiatry and the Council on Children, Adolescents, and Their Families on establishing guidelines for interacting with caregivers, and with the Ethics Committee and Veterans Caucus on uncontrolled access to mental health records affecting veterans.

The Committee on Judicial Action has overseen APA consideration of involvement as a friend of the court in many cases at every level of the judicial system. The committee continues to review cases and to recommend to the APA Board of Trustees APA involvement in a number of cases that cover a range of topics. In addition, the committee works with district branches to provide guidance, input, and, in some cases, financial support for amicus briefs held at the state level. The Isaac Ray/Human Rights Committee also reports to the Council on Psychiatry and the Law. The committee met at the Annual Meeting in May and via a conference call over the summer to select recipients for each award. The Council will review the committee’s recommendations at the meeting in September.

The Council also has a Work Group on Persons with Mental Illness in the Criminal Justice System, chaired by Dr. Robert Trestman. The group is currently reviewing and updating the 2000 Psychiatric Services in Jails and Prisons: A Task Force of the American Psychiatric Association. In addition, the work group has worked with several members on the Council on the issue of segregation as it relates to juveniles.

The Council on Psychosomatic Medicine

Joel Dimsdale, M.D., Chairperson (May 2012–May 2014)

David Gitlin, M.D., Chairperson (May 2014–present)

Council Charge

The Council focuses on psychiatric care of persons who are medically ill and thus stands at the interface of psychiatry with other medical specialties. It recognizes that integration of biopsychosocial care is vital to the well-being of patients and that full membership in the house of medicine is essential to the well-being of our profession. Specific areas identified in the charge are summarized below followed by Council activity.

Support and/or lead ongoing efforts to improve the recruitment of psychiatrists into psychosomatic medicine fellowship programs:

Provide leadership at the interface of psychiatry with other medical specialties:

Provide training and education about the special needs of those with psychiatric illness in medically ill populations:

Advocate for the enhancement of training in psychosomatic medicine:

Work with other components and/or organizations on health care policy initiatives:

Support APA’s advocacy efforts to increase the funding of research in these areas:

The Council on Quality Care

Joel Yager, M.D., Chairperson

The Council on Quality Care monitors developments and carries out activities to ensure that the promotion and maintenance of the highest standards of care remain integral parts of the APA mission. This includes but is not limited to monitoring and participating in initiatives and disseminating information in the following areas: clinical practice guidelines; quality indicators; development and implementation of patient registries; standards and survey procedures; mental health information technology; and patient safety. The Council will collaborate with the Council on Research to respond to topics of mutual concern, such as patient outcomes.

Choosing Wisely Campaign

The APA’s recommendations for the Choosing Wisely Campaign, a national effort promoting clinician-patient conversations about appropriate care, were released on the day of the Council’s meeting, September 20, 2013. Information about this initiative and APA’s development can be found on the APA website: http://www.psychiatry.org/choosingwisely. As a follow-up to this effort, the Council on Quality Care is working with Consumer Reports (in partner with the ABIM Foundation) to develop official consumer-friendly educational materials based on the list content.

Strategic Discussion on an APA-Supported Registry

The Councils on Research, Quality Care, and Healthcare Systems and Financing initiated a strategic discussion on an APA-supported registry at the Council on Quality Care Meeting on May 7, 2014. The group determined that a Council-charged work group would be formed to formalize and operationalize decisions on how the APA should move forward with an APA-supported registry. Health care reform is increasing the focus on quality measures and patient outcomes, which can be well captured and reported by registries. Advances in information technology, including electronic data capture and infrastructure to link physicians nationwide, have made large-scale efforts more feasible and have led many specialty associations to explore opportunities to develop and support registries. The work group is tasked with considering what an APA registry would focus on that would be unique, meaningful, and relevant to members (for example, informing practice guidelines, quality assessment for payment, research, and tracking treatment outcomes).

Steering Committee on Practice Guidelines

Two work groups are developing new APA practice guidelines on 1) psychiatric evaluation and 2) the use of antipsychotics to treat behavioral symptoms of dementia. The guidelines on psychiatric evaluation are being revised to incorporate the APA Assembly’s feedback, and revised guidelines will be submitted to the Assembly for approval in November. For the guidelines on the use of antipsychotics for patients with dementia, a summary of the systematic evidence review is being drafted, and results from an expert opinion survey are being organized. In addition to the new guidelines, a Guideline Watch on 2007 APA’s Practice Guideline for the Treatment of Patients With Alzheimer’s Disease and Other Dementias is being reviewed. This document is a brief review of important research evidence and developments since the 2007 publication of the guideline. It will be published to accompany the 2007 guideline on PsychiatryOnline.org.

To meet standards of the Institute of Medicine and inclusion criteria of the National Guidelines Clearinghouse, guidelines must be informed by a systematic review of evidence. With support from a grant by the National Library of Medicine, APA is developing an evidence database to make systematic reviews more efficient for future APA guidelines development. In addition to performing systematic reviews in-house, APA develops guidelines using systematic reviews available from the Agency for Healthcare Research and Quality (AHRQ). An AHRQ-contracted evidence-based practice center is currently conducting a systematic review on treatment of bipolar disorder, which was a topic nominated by APA. A draft review is expected to be available in late October or early November of 2014. Other reviews that AHRQ is developing or has already published should also be of interest to APA, including PTSD, MDD, binge-eating disorder, and nonpharmacological interventions for the behavioral symptoms of dementia. The Council continues to discuss some of the strategic directions and questions that pertain to APA’s guideline development process, e.g., how to manage potential conflicts of interest of the guideline writing group members, whether to increase capacity within the guideline project, and to consider use of outside and collaborative efforts to address gaps in guidelines.

Committee on Mental Health Information Technology

The Committee’s name was changed from the Committee on Electronic Health Records to the Committee on Mental Health Information Technology, to encompass additional topics of importance to the field, such as technical data standards, health information exchange, and telemedicine. The group convenes monthly by conference call to oversee various activities, including responding to opportunities for public comment on regulations and other documents; initiating discussions with APP and NLM regarding issues of licensing and permission of incorporating DSM-5 terminology with SNOMED; maintaining discussions with MHIT interest groups (including SAMHSA) regarding coordination of HIT for behavioral health; opening a dialog with national EHR vendors about the scope and EHR needs of the behavioral health community by presenting a webinar (along with representatives from AACAP, SAMHSA, ONC, and HL7); working with the AmericanEHR survey, which has captured information on EHR products used by psychiatrists; contributing to a HIT column in Psychiatric News; and representing APA at HL7, which sets technical standards that will have great influence on how medical documentation is captured and transmitted.

Quality Improvement and Quality Measurement

The Council discussed issues and priorities facing the Association with regard to performance measure development and implementation and educating members about these increasingly influential topics. APA collaborates with other entities through national initiatives, such as the AMA-supported Physician Consortium for Performance Improvement (PCPI), and considers measure concepts internally through the practice guideline development process. Health reform will require psychiatry to define quality measures, as health care is moving toward pay-for-quality. It is crucial for the APA to be involved in defining quality measures, to avoid crucial measures pertaining to psychiatry being defined by commercial or other nonmedical groups. There are different philosophical approaches to measure development: developing focused measures on specific psychiatric disorders versus measures that are global to psychiatry (e.g., psychiatric evaluation) or to all of health care (e.g., care coordination, medication reconciliation). The group discussed changes within the PCPI mission, which is affecting specialty society responsibilities for previously developed measures. Measures originally stewarded by the PCPI (adult major depressive disorders, child and adolescent major depressive disorders, dementia, and substance use disorders) will now either be owned and managed by the APA (adult major depressive disorders) or shared among specialty societies (e.g., APA and the American Academy of Neurology will share the rights to the Dementia Measure Set). The group noted that measures are having the largest impact on entities such as hospitals, which have a significant portion of services paid by private insurance and federal programs such as Medicare and Medicaid. In addition, Board certification and medical licensure processes are moving toward incorporating quality measurement concepts, which will have a direct impact on the majority of practicing psychiatrists. The Council has agreed to request that APA administration develop and implement a communication strategy for educating APA leadership and membership about the current state of quality measurement and its impact on psychiatry.

Integrated Care and Health Reform

Due to the increased focus on quality improvement and quality measurement focusing on integrated care as a result of health care reform, members of the Council will collaborate with other components, such as the Council on Healthcare Systems and Financing, in tracking and steering developments and educating the field.

Reporting Work Groups

Several other work groups have been developed under the Council and are newly active or have received approval to continue to convene. The Patient Safety Work Group will focus on transitions of care that occur when patients are discharged from inpatient care, given that increased rates of suicide occur shortly after discharge from hospitals. The Standards and Survey Procedures Work Group continues to address policy and standards development that include activities with national organizations (e.g., the Joint Commission). The newly formed Mental Health and Psychiatric Apps Work Group will participate in activities related to identifying high-quality, high utility software applications that will assist psychiatric clinician practice. The Gender Dysphoria Work Group’s commission has been extended with the plan to develop resource documents focusing on gender dysphoria treatment. With the first meeting occurring at the APA Annual Meeting in May 2014, the Caucus on Psychotherapy convenes psychiatrists interested in any form of psychotherapy and psychosocial treatment.

The Council on Research

Dwight Evans, M.D., Chairperson

The Council on Research carries out activities to ensure that the substance and significance of research on mental health/illness remain integral parts of the APA mission and in the forefront of the national health agenda. The Council embodies the Association’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, and prevention research, and research training. These areas are represented by the committees and task forces under the Council’s jurisdiction.

The following is a brief report of the May 2014 meeting of the Council on Research.

Caucus on Alternative and Complementary Medicine

During the September 2013 gathering, the Council voted to revise the name of the Caucus on Alternative, Complementary, and Integrated Medicine to the Caucus on Complementary and Alternative Medicine. This modification was approved in 2014 and now gives the Caucus consistency with the nomenclature used by the National Institutes of Health’s (NIH) National Center on Complementary and Alternative Medicine.

Given the high level of public interest in complementary and alternative medicine (CAM), the Council discussed the importance of addressing the variability in quality data that currently exists in the literature. The Caucus agreed to work with the Council’s Diagnostic and Treatment Markers Work Group to develop a paper for publication in an academic journal delineating the current state of the evidence on CAM for specific mental health populations, in hopes of clarifying uncertainties about the integration of CAM in psychiatric medicine.

HIV/AIDS

The Steering Committee on HIV Psychiatry is focused on education, training, optimal clinical care, and research, with special interests in HIV-associated neurocognitive disorders, depressive disorders, and their interaction. In addition, the Committee has focused on hepatitis C virus (HCV) co-infection with HIV and comorbid cognitive impairment, as well as the need to address depression prophylaxis and treatment in this setting.

Current funding from the Substance Abuse and Mental Health Administration for the AIDS Education Project will end on September 30th. The APA submitted a proposal in partnership with the Education Development Center, Inc., the American Psychological Association, and the National Association of Social Workers to continue HIV psychiatric training, expand online HIV clinical education, and support the Minority Medical Student Elective in HIV Psychiatry.

Finally, the Assembly returned to the Joint Reference Committee the Position Statement on the Psychiatric Implications of HIV/HCV Co-Infection. Questions regarding format, references, and clinical treatment were returned to the Council and, subsequently, to original the authors. A revised statement will be returned to the Joint Reference Committee in October.

APA Patient Registry

The chairs of the Council on Research, Council on Quality Care, and Council on Healthcare Systems and Financing have appointed a work group to gather information to assist in decision making around the formation of an APA-sponsored patient registry to support the delivery of quality care and clinical research. This project is particularly relevant in light of recent health care reform under the Affordable Care Act, in which payment and accountability are tied to physician participation in registries. Over the remainder of 2014, the work group will continue discussing key factors in the development and implementation of a patient registry, including its scope, purpose, and layout; how to involve key stakeholders; and timeline and logistical development needs. The work group will prepare a final report of their recommendations to the Joint Reference Committee as to what activities the registry should support and how the APA can best help ensure the registry carries these out.

Committee on Psychiatric Dimensions of Disaster

The Committee reported on its recent efforts to enhance communication about disaster response to district braches and state associations, including providing a listing of designated disaster response liaisons for each district branch and state association through the APA’s website.

Task Force to Revise the Practice of Electroconvulsive Therapy (ECT)

An update on the status of the ECT and Neuromodulation Committee and the Task Force to Revise the Practice of ECT was presented to the Council. The Task Force chair noted an upsurge in interest on updating guidelines on the use of Transcranial Magnetic Stimulation (TMS), and the Council agreed that a paper on its clinical application be developed by the Council’s Diagnostic Markers and Treatment Work Group.

Diagnostic Treatment and Markers Work Group

At the 2014 Annual Meeting, the group identified several areas of priority in which they will develop position papers. These include diagnostic tests for mood disorders; predictors of patient response in depression; and a critical review of the ketamine literature. Also, as noted above, a position paper will be developed on the clinical use of TMS, and a review paper will be developed summarizing the evidence base on the efficacy of CAM interventions for patients with psychiatric disorders.

Corresponding Committee on Research Awards

The Committee reported on recent award decisions for the APA Award for Research.

Work Group on Research Training

The Work Group on Research Training reported on the status of the research colloquium.

Work Group on Health Services Research

The Council was updated on the status of the upcoming Health Services Senior Scholar Award lecture to be presented at the October 2014 Institute on Psychiatric Services meeting in Philadelphia.