APA Council Reports

At the fall component meetings of the American Psychiatric Association in Arlington, Va., September 5–8, 2012, 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

John A. Renner, Jr., M.D., Chairperson

The Council on Addiction Psychiatry is committed to providing psychiatric leadership in the study, prevention, and treatment of addictive 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). Prescription drug abuse, physician training on substance use treatment, prescription drug monitoring programs, accessibility and availability of services, funding, research priorities, and opportunities for APA to contribute meaningfully to important government initiatives were among the issues addressed by the group.

APA is a partner organization in two programs that are funded by the Substance Abuse and Mental Health Services Administration and its Center for Substance Abuse Treatment: The Physicians’ Clinical Support System-Buprenorphine (PCSS-B) and the Prescribers’ Clinical Support System-Opioid Therapies (PCSS-O).

The PCSS-B is a training and mentoring program focused on increasing access to treatment for opioid-dependent patients. It provides training that leads to waiver eligibility for physicians to provide office-based treatment of opioid dependence and provides ongoing support and information. As a partner organization, APA offers 8-hour buprenorphine training sessions at the Annual Meeting and the Institute on Psychiatric Services. Additionally, monthly webinars are organized for physicians who have waivers and for other interested clinicians. The hour-long presentations address cutting-edge topics in treating substance use disorders and feature nationally prominent clinical experts, researchers, and government officials. Webinars are scheduled for the second Tuesday of each month at noon (Eastern Time Zone). Recordings of the live sessions are accessible at www.pcssb.org and at www.psychiatry.org\pcssbwebinars. Council members remain abreast of PCSS-B activities and contribute advice and expertise to the program.

As a PCSS-O partner, APA collaborates with 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. The partner organizations are the American Academy of Addiction Psychiatry (lead), American Psychiatric Association, American Medical Association, American Osteopathic Academy of Addiction Medicine, American Dental Association, International Nurses Society on Addictions, and the American Society for Pain Management Nursing. APA offers occasional webinars for its members and other interested clinicians and makes recordings available at www.psychiatry.org\pcssowebinars. A workshop is also organized for presentation at the APA Annual Meeting on a topic related to the appropriate use of opioids for treatment of chronic pain. Additional information on this program is available at www.pcss-o.org.

Planning was initiated for a 2013 APA Annual Meeting research track to be sponsored by NIDA. The series will include lectures, symposia, and the Addiction Performance Project. Topics are as follows: Advances in Pharmacotherapies to Treat SUDs; Cannabis Use and Youth: Updates on Risk, Assessment, and Treatment; Smoking Cessation in Patients with Severe Mental Illness: New Research Findings & Clinical Implications; Smoking and ADHD Comorbidity–Mechanisms and Clinical Implications; Comorbid Psychiatric and Substance Use Disorders: Common and Specific Influences and Implications for Early Identification and Treatment; and Update on Prescription Drug Abuse and Treatment Options for the Psychiatrist.

The Council developed position statements on Use of Opioid Medications With Terminally Ill Patients and on Residency Training Needs in Addiction Psychiatry for General Psychiatrists. Each was forwarded for final approval by the Assembly and Board of Trustees. An update to the association’s current position statement on Marijuana as Medicine is in process.

Additionally, the Council reviewed State initiatives to limit duration and/or dose of treatment for opioid dependence and appointed a workgroup to develop information and resources that can be used by state associations to address them; provided input to the American Psychiatric Foundation on suggested substance abuse/addiction topics and expert guests for the Healthy Minds television series that is broadcast on many PBS stations; and commented on action papers forwarded by the Assembly. The topics of the action papers included urine collection as a means to monitor patient status and address diversion of controlled substances and accessibility of the states’ prescription monitoring programs by VA prescribing physicians.

The Council maintains close communication and collaboration with leaders of the American Academy of Addiction Psychiatry in addressing issues of mutual importance. It also maintains frequent communication with staff of 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 Council on Advocacy and Government Relations

Robert Paul Cabaj, M.D., Chairperson

The Council on Advocacy and Government Relations was established in May 2009 as part of the reorganization of APA councils and components. The Council was consolidated to include the charges of the Council on Advocacy and Public Policy, the former Committee on Government Relations, and the former Committee on Mental Health Care for Veterans and Military Personnel and Their Families. The Council also absorbed some of the charges of the former Council on Social Issues and Public Psychiatry. The Committee on Advocacy and Litigation Funding was retained as a corresponding committee.

The Council continues to serve as 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; working with agencies that set policy on funding, access, and quality of psychiatric services at the federal, state, and local level to affect legislation, regulations, and guidelines.

The Council has been reviewing coordinated care initiatives and collaborative care models bringing together psychiatry and primary care, including health care homes. In addition, the Council is interested in discussing systemic health delivery proposals that recognize the interrelationship between health reform, mental health parity, Medicare coverage and payment issues, Medicaid budgetary concerns, and other inpatient and outpatient issues that intersect with the practice of psychiatry.

The Council has been actively monitoring the implementation of the Essential Health Benefits (EHB) Bulletin issued by the Secretary of Health and Human Services in early December 2011. The EHB Bulletin delegated the power to individual states to regulate the essential health categories covered in insurance plans. The Council, however, is encouraged by the rule’s promise to ensure that there are adequate mental health provider networks within qualified health plans to be sold by individual state health insurance exchanges.

The Council on Advocacy and Government Relations is working to increase communication and collaboration between district branches and areas on advocacy-related issues. The Council is working with APA’s Department of Government Relations (DGR) to develop communication between areas and district branches on current and ongoing advocacy efforts. 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 2012 APA Advocacy Day event was held March 12–14, 2012, in Washington, DC. Advocacy Day is designed to give members a first-hand look into the legislative agenda for the second session of the 112th Congress and provide hands-on advocacy training. This year, APA hosted 86 members from 43 states to bring APA’s legislative message to Capitol Hill. Participants visited over 230 offices where they advocated on issues related to veterans and returning military personnel, physician reimbursement and the flawed Medicare Sustainable Growth Rate, classification of psychologists as “physicians,” and more. The APA has since received positive feedback from Hill offices on their meetings with our members, and DGR has used APA member meeting evaluations to provide follow-up to members of Congress on key issues in their state or district.

Originally created in 2002, and re-established in 2009, the Committee on Advocacy and Litigation Funding, Jeffrey Metzner, 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.

As in recent years, much of the work of the Council, through the efforts of the Committee on Advocacy and Litigation Funding, has been focused on supporting APA district branches and state associations “in the field” in their own efforts to expand mental health parity, or to halt legislative expansion of the scope of practice by clinical psychologists and other nonphysician mental health practitioners. Most recently, the Council has assisted the Ohio Psychiatric Physician Association (OPPA) with funds for efforts to combat psychologists' attempts to be classified as physicians. As of this writing, OPPA has been successful in maintaining the legitimacy of psychiatrists as the role of mental health physicians.

As the district branches and state associations respond to legislative and regulatory matters of critical importance to their members, the financial support provided by the Board of Trustees through the committee’s consideration process is of direct and major importance. To date, APA has provided district branches and state associations nearly $3 million to support their efforts.

The APA Political Action Committee (APAPAC), John Wernert, M.D., Chairperson, is governed by a Board of Directors that is composed of 14 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.

APAPAC contributed over $400,000 to federal candidates and committees in the 2010 election cycle. While APAPAC was still able to play a big role in the 2010 elections, we did see a decrease of over $100,000 in the dollars raised from APA members this cycle. Only 5% of eligible members contributed to APAPAC in 2009–2010; if we can just double that percentage, we can become one of the larger medical specialty PAC’s in the country. In the 2012 election cycle, APAPAC raised over $380,000.

Opportunities to advance the legislative goals of APA will continue in 2013, as will the challenges to be overcome. APA is well positioned to work with leadership on both sides of the aisle, particularly in the committees most relevant to our legislative agenda. As dynamic issues related to the practice of psychiatry have emerged and evolved over the last year, the members of the Council have served as key advisers to DGR and the Board of Trustees on pressing national priorities impacting psychiatrists and their patients.

The Council on Children, Adolescents, and Their Families

Louis Kraus, M.D., Chairperson

The work of the Council on Children, Adolescents, and Their Families 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 2012:

At the 2012 Annual Meeting in Philadelphia, the Council presented scientific sessions on

The Council continued its assessment of APA policy statements related to child and adolescents. Most of these existing statements were deemed relevant and timely. However, the position statements on Newborn Infant Adoptions, Therapies Focused on Memories on Childhood Physical and Sexual Abuse, and Legal Proceedings and Access to Psychiatric Care for Juvenile Offenders are being revised to reflect contemporary thinking.

The Council kept abreast of governmental activities that relate to child and adolescent mental health through regular communications with Lizbet Boroughs, APA Deputy Director of Federal Affairs. The Council maintains a close association with Kristin Kroeger-Ptaskowski, Deputy Executive Director of the American Academy of Child and Adolescent Psychiatry (AACAP), who regularly attends Council meetings to report on AACAP developments and AACAP collaborations with APA, which in 2012 included development of changes to psychiatric codes in the Current Procedural Terminology (CPT) manual.

The Council provided input to the APA Work Group on the Role of Psychiatry in Health Care Reform with regard to the role of child and adolescent care in health care reform, specifically as related to integrated care. The Council submitted a number of recommendations, including but not limited to increased focus on training and prevention and better consultative models for children with both mental and physical illness.

The Council petitioned to formalize the College Mental Health Caucus as an official Board-approved APA entity. The caucus evolved from the APA college mental health listserv that was created nearly 10 years ago. Jerald Kay, M.D., had been the moderator of the listserv and convener of caucus meetings until that role was transferred to Leigh White, M.D., in May 2012. The Council also sought a name change for the Caucus of Psychiatrists Treating Persons with Mental Retardation and Developmental Disabilities to the Caucus of Psychiatrists Treating Persons with Intellectual Disabilities, the reason being that the term mental retardation connotes negativity.

APA awards for achievements in child and adolescent mental health, administered by the Council, were given in 2012 to Norbert Enzer, M.D. (Agnes Purcell McGavin Award for a Distinguished Career in Child and Adolescent Psychiatry); Carl Bell, M.D. (Agnes Purcell McGavin Award for Prevention); and Bradley Peterson, M.D., (Blanche Ittleson Award for Research in Child and Adolescent Psychiatry). John Schowalter, M.D., and Beth Ann Brooks, M.D., were the chairpersons of the respective committees that made these selections.

The APA Child and Adolescent Psychiatry Fellowship is also under the Council’s purview and promotes interest among psychiatry residents in pursuing careers in child and adolescent psychiatry through mentorship and travel scholarships to attend child- and adolescent-related programming at the APA Annual Meeting. Five residents are selected annually. The faculty advisor to the fellowship is Cathryn Galanter, M.D. The fellowship is funded by Shire Pharmaceuticals.

The Council on Communications

Jeffrey Borenstein, M.D. Chairperson

No field is more dynamic or constantly in flux than communications, in which new technologies are born, evolve, and then give way to ever newer ones. The APA makes use of all the tools in the toolbox to keep its members, journalists, and the general public informed about all the developments in psychiatry. From print, video, and Web-based media to public opinion polls and social media, the Council on Communications partners with the Office of Communications and Public Affairs to help steer and enhance psychiatry’s image and the standing of APA.

The Council, which is chaired by Jeffrey Borenstein, M.D., is populated by some of APA’s most enthusiastic and engaged members. Its mission 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.

Council on Communications members are some of APA’s most media-savvy and often engage in some communications efforts of their own. Dr. Borenstein is the host of the award-winning television show, Healthy Minds, which appears on PBS stations in over 60% of American households. The show, which profiles patients, advocates, and physicians, seeks to bring mental illness out of the shadows, to demystify diagnoses, and to alleviate the stigma suffered by patients. The council’s Vice Chairperson, Gabriela Cora, M.D., M.D.A., helps produce and star in Mission Makeover, a television reality show focused on guiding troubled women into more healthy and fulfilling lives on the Lifetime Network. Dr. Cora is also a Psychology Today blogger and the author of a book, published in 2012, focused on mental health for stressed-out executives.

Last year, the Council helped to guide APA’s redesign of its website, making the new website more dynamic and engaging and far easier to navigate. Council members weighed in on the “framework,” or architecture, of the site, as well as its functionality and overall look and feel. In its meetings, Council members asked thoughtful questions and made numerous suggestions to APA’s Chief Information Officer that were incorporated into the final product. In understanding the dearth of knowledge about mental illness among the public, one area that they especially focused on is the section geared toward patients, their loved ones, and members of the public, a section that formerly existed as a separate website.

Members of the Council on Communications gave more than lip service to the new website; several of them have been regular contributors to the site’s blog. They have brought a wealth of knowledge and expertise to the task, allowing APA to inform the public about high-profile issues, such as bullying, mental health in minority communities, spirituality and mental health, and the effects of domestic violence on children, to name just a few. Scott Benson, M.D., Jeff Borenstein, M.D., Gina Duncan, M.D., Gariane Gunter, M.D., Nubia Lluberes, M.D., Claudia Reardon, M.D., Arshya Vahabzadeh, M.D., and Felicia Wong, M.D., have all made excellent contributions to the blog as former or current members of the council. They bring to the effort both medical knowledge and the invaluable real-life experience from their treatment of real patients.

In 2012, under the guidance of Scott Benson, the Council formalized the establishment of the Member Communications Award, which recognizes outstanding communications efforts of the district branches and state associations in both print and electronic formats. Supplanting the former Newsletter of the Year Award, the new award recognizes the plethora of new media platforms available to district branches today, including e-newsletters, e-mail alerts, websites, and blogs, and also includes a category for an overall strategic communications plan. The Council reviewed the first submissions in 2012, and at the 2013 May Assembly Meeting, the Maine Association of Psychiatric Physicians, the Michigan Psychiatric Society, and the Maryland Psychiatric Society will all be presented with certificates honoring their selection as recipients of a Member Communications Award.

One of the recurring projects of the Office of Communications and Public Affairs is an annual public opinion poll, used to assess public attitudes about mental health and psychiatry. The poll, most recently conducted by Harris Interactive, has yielded valuable information in the past, some of which APA uses to generate publicity. Another use of the poll is to reveal areas in which more public education is needed. Some interesting findings from recent years show that the general public values mental health equally with general health and that psychiatrists are high on the list of mental health professionals that they would consult if they felt they or a loved-one had a mental health problem. Last year, the Council on Communications became more involved in designing key questions that can be asked year after year, making the poll truly longitudinal and more informative than ever.

Considering the pending publication of DSM-5, the Council’s members were kept informed about, and made helpful suggestions concerning, DSM media relations. The Council considered everything from the media outreach plan to the actual marketing of the book by American Psychiatric Publishing. One important question that the Council was presented with this year was how APA should respond to criticisms on the part of psychiatrists, psychologists, and psychology organizations. Their suggestions included researching the impact of the media outlet to ascertain whether a response would be effective, exploring and utilizing the possible relationships between APA leaders and the psychology groups, providing members with a Q&A to assist them in talking about DSM and publishing frequent DSM updates in Psychiatric News. The Council recognized the contentious nature of the blogosphere and counseled that being proactive in responding to media criticism needs to be balanced with an understanding of the credibility of the media source in question.

One project that the Council members were enthusiastic about is the creation of APA’s Annual Meeting app. Communications Council members tend to be early adopters of new technologies, and they fully embraced the new meeting app, utilizing it, comparing it to other apps they have used, and providing suggestions for how it could be more useful and replete. Another area that Council members are fully conversant with is social media platforms like Facebook and Twitter, and Gaby Cora, in particular, shared her own experiences as an avid user of social media. Dr. Cora related to the Council and OCPA how the integration of her TV appearances and social media (including the posting of her videos on YouTube) very quickly made her a presence in the social media cybersphere, allowing her to address a much larger audience than she was likely to access through traditional media.

Council on Communications members have been extremely generous with their time and energy in helping to facilitate and improve communications among early-career psychiatrists (ECPs) and members-in-training. The need for these groups to reach out to each other and engage in a dialogue has been longstanding, and the younger members of the Council were a driving force in having a special LinkedIn subgroup formed to address the need. Council member and ECP Trustee Molly McVoy, M.D., as well as Michael Takamura, M.D., volunteered to manage the subgroup, which is now active and accessible to any APA member who has joined the APA’s primary LinkedIn account.

As mentioned above, Dr. Borenstein’s Healthy Minds TV show helps to put a human face on mental illness through in-depth interviews of the patients who experience it, the doctors who treat it, and the advocates who fight to reduce stigma. The show has won several awards, including three silver and two bronze Telly Awards and a fair Media Council Folio Award. The Council members helped to brainstorm new topics and new ways to promote the show, recommending greater involvement with APA’s social media efforts and the posting of episodes on YouTube.

The work of the Council on Communications contributes to some of APA’s most important goals: maintaining the public perception of psychiatry in a contentious and changing media environment, keeping APA at the top of journalists’ rolodexes as the go-to organization for information about mental health, and humanizing our often stigmatized patients. The challenge of accomplishing all this with the latest media and communications tools promises that the Council will continue to play an integral role in APA in the years to come.

The Council on Geriatric Psychiatry

Brent Forester, M.D., Chairperson

The Council on Geriatric Psychiatry was formed when the Council on Psychosomatic Medicine and Geriatric Psychiatry was divided into two separate councils with distinct goals. The Council on Geriatric Psychiatry focuses on the specific needs of older adults. Recognizing that integration of care is vital to the well-being of elderly patients, geriatric psychiatrists stand at the interface of psychiatry with other medical specialties. The Council aims to provide leadership in the field of geriatric psychiatry and accomplishes this goal by initiatives related to geriatric psychiatry education, research, and clinical care. The Council also strives to work collaboratively with other professional and advocacy groups to develop best practices in geriatric psychiatry while providing education and training to other physicians (including but not limited to psychiatrists), residents, and medical students, as well as to other allied mental health professionals (including but not limited to nurses and social workers) at scientific meetings and in other settings focused on the special needs of geriatric populations with mental illness.

The Council held their first official meeting during the Components Meeting in Arlington, Va., September 6, 2012. The Council used this opportunity to develop ideas to help bring geriatric psychiatry to the forefront of research and clinical practice initiatives and promote geriatric psychiatry within the profession at large. Ideas discussed included avenues with which to expose geriatric psychiatry to trainees, disseminating data/reports that emphasize the importance and significance of the field, and utilizing media outlets to promote successful aging to the general population. To advance the goal of providing education and training to other physicians, the Council will endorse 10 symposia focusing on geriatric psychiatry to be presented by Council members at the 2013 Annual Meeting. Topics will include geriatric depression, successful aging, and the role of the geriatric psychiatrist in health care reform, to name a few.

The Geriatric Psychiatry Council discussed the recent landmark Institute of Medicine (IOM) report focusing on the geriatric mental health workforce. Special Guest Speaker, Ms. Christine deVries, CEO and Executive Vice President, American Association for Geriatric Psychiatry (AAGP), presented the IOM report titled, “The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?” This report, issued in July 2012, outlines the mental health and substance use workforce needs for the growing population of older adults in the United States. The report documents the prevalence of mental health and substance use problems among older adults, the interaction between mental health and medical comorbidities, including dementia, and specific recommendations for legislation, training, and reimbursement to provide quality care for older adults. AAGP and APA also cosponsored a Capitol Hill briefing on the IOM report featuring speakers who served on the IOM Panel.

APA Staff member Jeff Regan, Deputy Director, Senate Affairs, Department of Government Relations, joined the Council to offer updates on current legislation on the use of antipsychotics in long-term care settings as well as current advocacy efforts of APA. Mr. Regan discussed key legislation containing several key provisions:

Staff member Ellen Jaffe, Editor and Production Manager, Healthcare Systems and Financing, discussed the upcoming Current Procedural Terminology (CPT) changes, which will take effect January 1, 2013. Of particular interest to Council members were changes that would differentiate psychiatric services from that of psychologists and social workers and codes that will allow for multiple services on the same day. Staff member Karen Sanders, Associate Director for Publicly Funded Services, Healthcare Systems and Financing, presented an update on Medicare services in light of recent health care reform initiatives. Ms. Sanders also discussed APA efforts to use health care reform to catapult psychiatry into the future, including incorporating behavioral health into primary care, bundled care and medical homes, and how to quantify the value of psychiatry. Council members agreed that geriatric psychiatry should be integral to these efforts given the demographic realities of primary care. Other topics discussed included electronic health records and confidentiality issues and accountable care organizations and their interface with CMS.

In addition to the goals set forth during the components meeting, Council members are also actively promoting the field of geriatric psychiatry within their own health care institutions and community practices. Uyen-Khanh Quang-Dang, M.D., M.S., a Resident Psychiatrist at the University of California, San Francisco (UCSF), and APA Leadership Fellow (2012–2014), is currently a PGY-3 at UCSF in the Residency Research Training Program. Her research project is centered on culturally adapting Problem Solving Therapy for Vietnamese Older Adults. She is currently translating the Problem Solving Therapy-Older Adult manual from English to Vietnamese and facilitating focus groups with Vietnamese mental health professionals in the San Jose and San Francisco areas. Dr. Quang-Dang was also an AAGP Geriatric Mental Health Scholar for the 2012 AAGP Conference and presented a poster with her mentor, Laura Dunn, M.D., titled “Influences on Surrogates' Willingness to Enroll Relatives in Alzheimer's Disease Clinical Research.” She has also represented the AAGP-PAC at a fundraiser for Congressman Pete Stark.

As we look ahead into 2013, the Council seeks to continue its mission of educating others about geriatric psychiatry. To that end, we are preparing a proposal for a geriatric psychiatry themed episode of APF’s “Healthy Minds” series on PBS. By juxtaposing expert testimony with field and/or case studies, this program will generate conversations among family members who may be facing similar situations and identify resources for clinical assistance. Topics covered will include an episode to raise awareness of the increasing prevalence of Alzheimer’s disease and related dementias with advancing age, the adverse impact of behavioral disturbances (including depression and agitation) on quality of life for the patient and caregiver alike, and the benefits of careful clinical assessment and treatment. The goal of the program is to communicate the hopeful message that interventions for both the caregiver and the patient with dementia are available to improve quality of life and reduce premature institutional placement. The Council on Geriatric Psychiatry looks forward to pursuing this and other projects to help further increase knowledge of and access to geriatric psychiatric care.

The Council on Healthcare Systems and Financing (CHSF)

Anita Everett, M.D., Chairperson

The Council on Healthcare Systems and Financing continued its efforts to monitor and provide analysis for a number of important issues that have an impact on the financing of and access to mental health care. This includes outreach to decision makers in business and industry regarding insurance coverage.

In an effort to fulfill the duties as laid out in the Council’s charge, the Council now has 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 is aggressively working to ensure that the requirements of the Parity Act are implemented appropriately. Priority areas of concern include general parity policy issues of consequence to psychiatry, including unresolved issues in the Interim Final Regulations, such as the scope of services required under parity, how the parity requirements will be applied to Medicaid managed care plans, and what information health plans are required to disclose. The work group is also concerned with more specific issues that have direct impact on psychiatric practices, such as coding restrictions, reimbursement rates, and nonquantitative treatment limitations. The extension of the Parity Act requirements under the Affordable Care Act, including the definition of the essential benefits package, is also an area with which the work group is involved.

The Work Group on Integrated Care has member education as one of its priorities. The work group chair and other APA members have developed the only course available to psychiatrists on how to work in collaborative settings and presented at APA’s annual meeting, Institute on Psychiatric Services (IPS), and at other venues. The group continues to maintain the integrated care Web page and a listserv that provides its more than 300 subscribers with weekly information on relevant policy topics. The work group is exploring the many psychiatric workforce training issues, practice opportunities, and payment reform issues created by the move to collaborative care. Lastly, the work group is completing a document for members discussing liability issues in integrated treatment settings.

The Work Group on Medicaid/State Mental Health Programs is actively engaged in assisting district branches in addressing onerous budget cuts to Medicaid that have an impact on treatments and services for those with serious mental illnesses.

The Committee on Reimbursement for Psychiatric Care, Joseph T. English, M.D., Chairperson, continues to monitor the federally mandated Medicare prospective payment system (PPS) for inpatient and partial hospitalization psychiatric care. 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.

The Corresponding Committee on RBRVS, Codes, and Reimbursements, Ronald Burd, M.D., Chairperson, is continuing its work relating to the revision of the psychiatry procedure codes (Current Procedural Terminology [CPT]) that was done through the American Medical Association (AMA) CPT Editorial Panel and the AMA RVS Update Committee. Almost all of the codes have been changed for 2013, and psychiatrists will be able to code more appropriately for the evaluation and management services they provide under the new coding schema. Because this marks a major change in the way psychiatrists will code for the services they provide, the committee has been involved in creating educational resources for APA membership, including webinars, templates to assist in documentation, and training sessions for district branches.

The Council on Medical Education and Lifelong Learning

Sandra Sexson, 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 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 Career Development believes that APA has an obligation to support the lifelong learning of its members. The Council also believes that the American Board of Psychiatry and Neurology (ABPN) maintenance of certification (MOC) provides an ongoing process of education and assessment to improve practice performance while maintaining Board certification.

The Council understands that MOC is an evolving process, as it is continuously refined by the American Board of Medical Specialties and ABPN. We support the spirit of MOC and APA’s continued efforts to educate its members about the process of MOC and develop products to facilitate ease in achieving the goals set forth in these requirements.

Some major initiatives/issues the Council continued to address were as follows:

The Scientific Program Committee, Josepha Cheong, M.D., Chairperson, 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 Accreditation Council for Continuing Medical Education 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.

The Scientific Program Committee for the Institute on Psychiatric Services, David Pollack, M.D., Chairperson, coordinated the 64th Institute on Psychiatric Services. It took place on October 4–7, 2012, in New York. The theme was “Pursuing Wellness through Recovery and Integration.”

The Board of Trustees approved the creation of a new Caucus on MOC Issues. The Caucus will meet annually during APA’s Annual Meeting and will discuss concerns from members about the MOC process as instituted by ABPN.

The Council on Minority Mental Health and Health Disparities

Sandra Walker, M.D., Chairperson

The Council on Minority Mental Health and Health Disparities 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 APA and the fields of psychiatry and public policy. The Council aims to promote the recruitment into the profession and into APA, as well as foster retention/leadership development of psychiatrists from minority and underrepresented groups, both within the profession and in APA.

The following are key activities of the Council in 2012:

Training and Education

APA Policy

APA Organization

APA Diversity Awards

In 2012, the Council conferred annual awards for individual achievements on behalf of the population for which they are concerned as follows:

The Council on Psychiatry and the Law

Patricia Ryan Recupero, M.D., J.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 met during the September component meetings in Arlington, Va. The Council received updates from the Workgroup on Persons with Mental Illness in the Criminal Justice System and the Isaac Ray/Human Rights Award Committee. Award recommendations were sent to the American Psychiatric Foundation Board for the Isaac Ray Award. In addition, the Council spent time discussing the forensic involvement in DSM-5 and reviewing an American Medical Association Policy on Abuse of Psychiatry. The Council also heard a presentation from the American Psychiatric Foundation on the Judges Criminal Justice/Mental Health Leadership Initiative program.

Additionally, during the September Components meeting, the Council on Psychiatry and the Law held a joint meeting with the Council on Minority Mental Health and Health Disparities and the Committee on Judicial Action titled “Needs of Persons with Mental Illness in the Immigration Process.” The joint session had several guest speakers, including Melissa Crow, Director, Legal Action Center, and Laila Hlass, Clinical Teaching Fellow in the Center for Applied Legal Studies at Georgetown Law School, along with several guest speakers from Yale University. The meeting focused on problems of detainees with mental illness and the role of psychiatrists in helping with asylum requests for which mental health issues are relevant. The councils worked together to submit a proposed position paper to the Joint Reference Committee.

The Committee on Judicial Action, chaired by Paul Appelbaum, M.D., has overseen APA consideration of involvement as a friend of the court in many cases at every level of the judicial system. In the summer of 2012, after review by the Committee, APA submitted an amicus brief in Tibbals v. Carter and Ryan v. Gonzales. The cases are before the U.S. Supreme Court and ask the Court to recognize the right of incompetent capital prisoners to have appeals stayed until their competence is regained. The APA amicus brief supported this request, noting the ways in which serious mental disorders can interfere with defendant’s abilities to participate in appeals of their death sentences. In addition, APA, after review by the committee, also signed onto amicus briefs in the cases of Fisher v. Texas and Golinski v. OPM. The case of Fisher v. Texas challenges the constitutionality of affirmative action programs in college admissions at the University of Texas, while Golinski v. OPM is a 9th Circuit Court of Appeals case challenging the federal Defense of Marriage Act, which denies equal benefits to same-sex couples.

The Council on Psychosomatic Medicine

Joel E. Dimsdale, M.D., Chairperson

The newly formed Council on Psychosomatic Medicine met informally at the 2012 Annual Meeting and held its first official meeting in September 2012. Seven members of the current Council on Psychosomatic Medicine were also active within the previous Council on Psychosomatic Medicine and Geriatric Psychiatry.

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. It accomplishes its goals by initiatives related to research, clinical care, education, and health care policy.

Members initially met to revise their charge and develop a work plan. The Council’s work plan focus is below.

Raising the Visibility of the Subspecialties Among Trainees

Raising awareness of, and recruitment into, the subspecialty remains a top priority. The focus has been on designing educational programs that target and engage members in training (MITs) via the APA Annual Meeting. In the coming year, the Council intends to expand its outreach efforts to include additional meeting venues and online initiatives.

Annual meeting activity.

The annual meeting attracts about 1,400 trainees each year, with opportunities to reach them in a variety of venues:

Named lecture award.

Members discussed raising the visibility of the subspecialty through initiation of a “named” APA lecture at either APA’s Annual Meeting or Institute on Psychiatric Services. Since discussions about APA awards are currently in a state of flux, Council action is on hold until they have concluded.

Developing Strategies for APA to Better Affiliate With the Allied Subspecialty Organizations

In an effort to better partner with APA’s allied organization, the Academy of Psychosomatic Medicine (APM), members discussed ways the groups could work together toward common goals. Resident recruitment into the subspecialty is one such goal.

Resident newsletters.

Members promoted the availability of APM’s new resident newsletter, Frontiers in Psychosomatic Medicine, to APA resident members via a resident e-mail list. Publicity also included a mention in Psychiatric News, and an ad in the psychosomatic issue of AJP’s Residents’ Journal.

Subspecialties representatives.

Many of the members of the Council are also in leadership positions within APM. This has improved communications between the two organizations and provides a catalyst for collaboration.

Website linkages.

APA’s psychosomatic page currently links to APM’s website, annual meeting information, and practice guidelines.

Producing Policies and Programs That Advance the Understanding of the Care of Medically Ill Patients

Over 10 million Americans suffer from comorbid chronic medical and psychiatric illnesses, making the need to properly evaluate, diagnose, and treat such individuals a major public health mandate and priority. The Council strives to produce and disseminate information that serves psychiatrists who care for these patients.

Position statements.

Members of the Council on Psychosomatic Medicine and Geriatric Psychiatry were asked by the Joint Reference Committee (JRC) to respond to an action paper to develop guidance/resources for members on work/life balance (incorporating issues of physician impairment.) Linda Worley, M.D., drafted the policy, APA Position Statement on Physician Wellness, which the council reviewed and approved in September 2011. The statement was adopted in December 2011.

Working Toward Integrated Patient Care

Letter of support.

The Council on Psychosomatic Medicine submitted a letter of support for the publication of DSM-5 PC for consideration by the Board of Trustees. The Council feels that as integrated care continues to emerge, it will be essential that psychiatry provide leadership and direction for our medical colleagues, who struggle with providing effective medical care for patients with co-occurring conditions. The goal will be for DSM-5, PC version, to be a practical resource for the field, providing best practices screening instruments in sync with an abbreviated version of the text from DSM-5. It will be seen as a guide to DSM-5, which will remain as the primary reference manual.

Cooperation With the Council of Healthcare Systems and Finance.

Because of the effect on the patient populations served, the Council has a high degree of interest in following the emerging trends in integrated care, publicly funded care, and the medical home. Staff from the Office on Healthcare Systems and Financing routinely provide updates at Council meetings. The Council has discussed the critical importance of the current momentum toward integrated care, since the specialty lives at the interface of psychiatry and general medicine. Members feel a sense of urgency about participating in APA’s efforts in this area.

The Council on Research and Quality Care

Joel Yager, M.D., Chairperson

The Council on Research and Quality Care monitors developments and carries out activities to ensure that the substance and significance of research on mental health/illness and the promotion and maintenance of the highest standards of care remain integral parts of the APA mission. The Council is also charged with promoting and maintaining the highest quality of care. Additionally, the Council is charged with facilitating the development of resources to improve education, clinical programs, research, and the organization of mental health systems in times of disaster, as well as to advance global psychiatry. Specific areas of focus include, but are not limited to, basic science; clinical diagnosis and assessment; treatment research; research training; health services; prevention research; research awards; research ethics; ECT and other electromagnetic therapies; quality indicators and the National Quality Measurement Enterprise; Standards and Survey Procedures (national accrediting bodies); psychotherapy by psychiatrists; HIV/AIDS; patient safety; practice guidelines; and electronic health records (EHRs). The following is a brief report of the Council’s September 2012 meeting.

The Council submitted revised position statements on medical psychotherapy and generic versus proprietary medications, as well as revision to the resource document “Consensus Report of the APA Work Group on Neuroimaging Markers of Psychiatric Disorders” for Joint Reference Committee (JRC) review. The following position statements are undergoing review and revision: Publication of Findings From Clinical Trials and Somatic Cells Nuclear Transfers (SCNT) Research. The Council received an update on the DSM-5 development effort and an outline of six potential research projects for 2013. The Council will next convene by conference call in January or February 2013 and in person at the 2013 Annual Meeting.

Steering Committee on Practice Guidelines

The new guideline development process is well underway. The Psychiatric Evaluation guideline development effort has used a survey of experts to derive consensus evidence to supplement published evidence. Several guidelines are undergoing maintenance: systematic literature reviews have been completed or are in process for Eating Disorders, OCD, Alzheimer’s Disease, and SUD, and guideline “watches” are being authored by experts who developed the original guidelines. The next guideline development effort, based on a published AHRQ evidence review, will be on treatment with atypical antipsychotics.

Committee on Electronic Health Records

Regulations on the second stage of “meaningful use” of Medicare and Medicaid EHR Incentive Programs have been finalized. Additional requirements for use of an EHR will take effect in 2014. SAMHSA is the lead federal agency on behavioral health and health information technology and has reached out to APA. The committee has developed EHR Functionality Tables, an extensive listing of EHR features that are important to psychiatric practice, which are undergoing final formatting before posting on APA’s website. The committee has initiated a regular column on HIT in Psychiatric News, with the first article published in late October 2012.

Committee on Research Awards

The committee reported on recent award decisions and noted that the APA’s nomination process as defined in the APA operations manual will be reviewed.

Committee on Psychiatric Dimensions of Disasters

The workgroup provided a written update of their activities, which include the 2012 Bruno Lima Awards, disaster support to various district branches (e.g., in response to Hurricanes Isaac and Irene; the Oak Creek, Wisc. Sikh Temple Shooting; and the Aurora, Colo. Movie Theater Shooting), and Annual Meeting sessions. The Council commended the committee for its work.

Workgroup on Patient Safety

The workgroup outlined proposed topics/work products: a suicide prevention protocol, which could incorporate recommendations from a planned symposium at the Institute on Psychiatric Services (IPS) on this issue; information on handoffs, which is an important topic in the patient safety arena; and adequate screening and assessment to prevent aggression, avoid seclusion and restraint, and improve inadequate screening/treatment for alcohol.

Workgroup on Research Training

The workgroup reported that they are working with APF to find new funding sources for research fellowships. The Research Colloquium is ongoing, although the funding source alternates every other year between NIMH and the National Institute on Minority Health and Health Disparities.

Workgroup on Health Services Research

The workgroup participated in a Health Services Research track at the 2012 IPS meeting. Research funding is difficult to obtain, especially with clinical, interventions, and services research. The Patient-Centered Outcomes Research Institute, which is charged with funding patient-centered outcomes research ($500 M annually), is a potential source of research funding.

Workgroup on Neuroimaging Markers of Psychiatric Disorders

The Council approved a revision of the resource document submitted by the workgroup, “Consensus Report of the APA Work Group on Neuroimaging Markers of Psychiatric Disorders,” which included the addition of a substance use disorders section. An executive summary of the report will be published in the American Journal of Psychiatry.

Workgroup on HIV/AIDS

The workgroup provided a written update of the activities of the Office of HIV Psychiatry and the Steering Committee on AIDS, which include national and regional trainings; a minority medical student elective in HIV psychiatry; the 12 City Project Video Series; an HIV mental health care provider education program; and discussions of current research.

Workgroup on Gender Identity Disorder

William Byne, M.D, Chairperson of the former Task Force on Gender Identity Disorder, reported that the task force report has been published in the Archives of Sexual Behavior. The report had recommended that there was significant enough evidence for clinical practice guidelines in this area but acknowledged that there was limited capacity for development. Dr. Byne proposed that a subset of the task force would continue as a workgroup reporting to the council that would develop a resource document that would make treatment recommendations for psychiatrists.

Task Force to Revise the Practice of ECT

The task force reported that final recommendations have not yet been released by the Food and Drug Administration (FDA) regarding ECT. The FDA is working to identify a panel of experts to confer with and has asked APA to be able to recommend experts, who would be expressing their own beliefs and not speaking for the association on request.

Standards and Survey Procedures

Yad Jabbarpour, M.D., provided a written and oral report of his activities. He is chairperson of the Joint Commission Professional and Technical Advisory Committee on behavioral health, and in this role attends Board of Commissioners meetings. Behavioral health homes are a current area of focus. Two symposia were planned for the 2012 IPS meeting: Suicide Risk Assessment to a Never Event (inpatient); and Wellness in Behavioral Health Care.