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APA Council Reports

Published Online:1 Nov 2022https://doi.org/10.1176/appi.ajp.22179009

At the September 2022 Components Meeting of the American Psychiatric Association, 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

Smita Das, M.D., Ph.D., Chairperson

The Council on Addiction Psychiatry (CAP) is committed to providing psychiatric leadership in the study, prevention, and treatment of substance use disorders. The component provides recommendations to APA on training, treatment, and public policy. To facilitate effective collaboration and communication, the Council invites representatives of the White House Office of National Drug Control Policy (ONDCP), the National Institute on Drug Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Substance Abuse and Mental Health Services Administration (SAMHSA), to participate in its meetings.

The Council has focused on physician training on treatment of substance use disorders, confidentiality of substance use disorder for patient records, accessibility and availability of services, budgetary challenges, research priorities, and opportunities for APA to contribute meaningfully to important government initiatives. Through its active collaboration with APA’s Department of Government Relations and Department of Policy, Programs, and Partnerships, the Council has provided guidance on the Association’s legislative and regulatory advocacy efforts regarding the national opioid crisis and trends in substance use disorders.

The Council provided feedback and recommendations to ONDCP after the release of the Administration’s drug policy, encouraged the increase of education and training in medical schools, the development of a standardized, interdisciplinary core curriculum on substance use disorders, supported the use of effective integrated care models, including the collaborative care model (CoCM), and the support of legislation and policies that promote equity and improve the social and structural determinants of substance use and substance use disorders. Members of APA and the Council have recognized inequities in access to and quality of health care, which are primary drivers of the disparate clinical outcomes among individuals with substance use disorders; these inequities are either directly or indirectly affected by social and structural determinants of health including race.

APA is a partner in the SAMHSA-funded Providers’ Clinical Support System (PCSS), a project developed to address the appropriate use of opioids in the treatment of chronic pain, as well as the recognition and treatment of opioid use disorder. More than a dozen medical specialty and stakeholder organizations provide free continuing medical education in case vignettes that can be accessed through the APA’s Learning Center and the program’s dedicated website (www.pcss-o.org). The Council is also involved in a variety of training opportunities for psychiatrists and other interested clinicians.

Waiver-eligible courses on offce-based treatment of opioid use disorder with buprenorphine are offered online given the inability to do in-person trainings during APA’s Annual Meeting in May 2019. The waiver-eligible courses were augmented by a monthly webinar series conducted by the APA as a partner organization in the PCSS network. The highly rated webinars provide free continuing medical education credit.

Council members represent the APA and actively participate in the American Medical Association’s Task Force to Reduce Opioid Abuse, which is comprised of representatives of state medical associations and medical specialty societies. The member organizations recognize that to address the epidemic of prescription drug abuse effectively, physicians should develop and implement strategies to reduce the harm caused by overprescribing of opioids and utilize evidence-based practice in treating pain and substance use disorders.

The Council on Advocacy and Government Relations

Katherine Kennedy, M.D., Chairperson

Federal Affairs

Mental health parity.

In 2020, Congress passed, and the President signed into law, parity enforcement legislation developed by the APA. This law gave the U.S. Department of Labor (DOL) new powers to regulate ERISA plans found to be out of compliance with existing parity law, and applied similar criteria to state plans, even if states had not passed model parity legislation. APA is now advocating for additional funding to implement this law through 1) the appropriations process for DOL and 2) new legislation authorizing parity implementation grants for state insurance departments. Specifically, APA developed the Parity Implementation Assistance Act, H.R. 3753/S.1962, introduced in the House by Representatives Tony Cárdenas (D-CA) and Brian Fitzpatrick (R-PA) and Senators Chris Murphy (D-CT) and Bill Cassidy (R-LA). The bill makes grants available for state insurance agencies to enforce parity at the state level. APA is leading lobbying efforts in Congress on this legislation including a letter to the bill coleads signed by 46 groups of the Mental Health Liaison Group. Earlier this year, the bill passed out of committe and, in June, was folded into a larger mental health package (H.R. 7666), which passed the House of Representatives by a bipartisan vote of 402-20. The package also included closing the parity loophole for nonfederal governmental entities, which APA supported. The APA is now lobbying the U.S. Senate to take up and pass H.R. 7666.

Telehealth.

The APA is working with coalition partners to extend current COVID-related telehealth flexibilities by at least 1 year after the public health emergency (PHE) expires, including those allowing for use of audio-only telehealth services when clinically appropriate. Earlier this year, Congress passed legislation to include a 5-month extension of the telehealth flexibilities after the end of the PHE, including extending the delay of the 6-month in-person requirement that was enacted in December 2020 and takes effect once the PHE ends. The APA worked with Congress and currently supports legislation (H.R. 4058/S. 2061) introduced by Representatives Doris Matsui (D-CA) and Bill Johnson (R-OH), and Senators Bill Cassidy (R-LA), Tina Smith (D-MN), Ben Cardin (D-MD), and John Thune (R-SD) that specifically removes the 6-month in-person requirement for mental health. The APA also supports H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act of 2021, introduced by Representatives Liz Cheney (R-WY), and Debbie Dingell (D-MI). The legislation passed the House of Representatives in July by a bipartisan vote of 416-12 and would extend the current telehealth flexibilities until January 2025.

Health equity.

The APA has advocated on several fronts to address health equity related to mental health and substance use disorder services. The APA worked with Representatives Bonnie Watson Coleman (D-NJ) and John Katko (R-NY), as well as other stakeholders to reintroduce and pass H.R. 1475, The Pursuing Equity in Mental Health Act, through the House of Representatives in May 2021. The APA is also working with Senator Robert Menendez (D-NJ), who leads the companion legislation in the Senate, S.1795. This legislation would reauthorize and double the funding for SAMHSA’s Minority Fellowship Program, increase authorized funding levels for the National Institute on Minority Health and Health Disparities by $650 million per year for 5 years, increase authorized funding to NIH for data collection and clinical research to address health disparities in mental health and substance use disorders, authorize grants for education and outreach to address stigma around mental health and substance use disorders in minority communities, and provide the Department of Health and Human Services with grant authority to develop best practices around health disparities. In addition, APA worked in coalition with other mental health specialties to include in H.R. 7666, mentioned earlier, an increase in the Minority Fellowship Program’s funding authorization to $25 million (from $12.6 million) over a 5-year reauthorization for fiscal years 2023 through 2027.

Psychiatric collaborative care model.

Representatives Lizzie Fletcher (D-TX) and Jamie Herrera Beutler (R-WA) introduced APA-developed legislation (H.R. 5218, the Collaborate in an Orderly and Cohesive Manner Act) which enhances the integration of behavioral health with primary care through the collaborative care model. The legislation would: authorize 1) grant funding for primary care practices to establish collaborative care arrangements; 2) funding for national and regional technical assistance centers; and 3) funding for research into other promising integrated care models. The APA is leading lobbying efforts in Congress and secured the support for the legislation from 44 national groups representing physicians including primary care and the American Medical Association, mental health and substance use disorder patient advocates, employers and payors. Major components of the legislation, including grants to primary care and technical assistance to implement the CoCM were included in H.R. 7666, mentioned earlier. APA Administration, along with other stakeholders, are lobbying the U.S. Senate to include the CoCM provisions from H.R. 7666 as part of any future mental health legislative package.

House appropriations.

Throughout the fiscal year 2023 appropriation process, APA has continued to advocate for adequate funding of priority mental health and substance use disorder programs. Thanks in part to those efforts, draft spending bills in both the House and Senate include significant funding increases for several of APA’s priority programs including mental health parity enforcement at EBSA; the HRSA Substance Use Disorder Treatment and Recovery Loan Repayment Program; the new 988 crisis line; and the SAMHSA Community Mental Health Services Block Grant. Though bicameral and bipartisan negotiations over a final package are ongoing, the proposed funding increases suggest mental health is a priority for both the House and Senate.

State Affairs

Legislative Representatives Forum.

The Council continues to host its Legislative Representatives Forum, a regular virtual meeting of district branch legislative representatives, district branch presidents, and district branch executive directors, to discuss pertinent state legislative advocacy matters. CAGR members and APA staff attend and facilitate these forums. The Council has hosted forums focused on safe prescribing, the collaborative care model, and prior authorization. All district branches are invited to participate.

Legislative activities.

APA continues to partner with district branches and state psychiatry associations across the country in responding to district branch priority legislation, utilizing the experience of CAGR members where appropriate. In 2022, state-led initiatives included supporting mental health parity, the psychiatric collaborative care model, prior authorization, and opposing unsafe prescribing.

Parity.

APA previously developed model legislation designed to require transparency and accountability from insurers and state regulators pertaining to compliance with federal MH/SUD parity law as another proactive solution to ameliorate access-to-care problems. APA’s state model parity legislation has been signed into law in 17 states (Arizona, Colorado, Connecticut, Delaware, Georgia, Illinois, Indiana, Kentucky, Massachusetts, Maryland, Montana, Nevada, New Jersey, Oklahoma, Oregon, Tennessee, and West Viriginia) and Washington, DC. Georgia and Massachusetts’s bills were signed into law this year. Several other states have enacted partial versions of this law, while Louisiana, Mississippi, and Texas have enforced parity laws through the regulatory process. APA continues to partner with states to help them achieve full parity compliance.

Psychiatric collaborative care model.

To safely increase further access to care, APA has developed model collaborative care legislation for the states, which would require insurers to cover the codes for the collaborative care model. So far, six states (Conneticut, Illinois, Louisiana, Massachusetts, Montana, and New Jersey) have signed APA’s model bill into law, while Texas passed legislation requiring Medicaid to cover the collaborative care codes, and Colorado and Pennsylvania passed bills allocating grant funding to primary care practices interested in expanding the model. APA is working closely with several district branches interested in pursuing the collaborative care model in the 2023 legislative session.

Prior authorization.

Responding to APA member feedback about how prior authorization limits timely access to treatment, APA developed legislation to reform the process and eliminate prior authorization for some medications, implement a faster appeals process, and require reviews be conducted by physicians who specialize in the treatment under review. In 2022, APA-drafted bills have been introduced in Maryland and New Jersey. Over 20 state legislatures introduced a version of prior authorization reform legislation; bills were successfully passed in Colorado, Michigan, and Oklahoma. This fall, APA will develop comprehensive prior authorization model legislation and an accompanying advocacy toolkit for district branches interested in partnering on this issue.

Safe prescribing.

In 2022, state legislatures have seen over 50 pieces of legislation from nurse practitioners and physician associates seeking new authorizations to practice without any physician involvement. APA has worked closely with over 30 district branches this year to oppose unsafe prescribing legislation and to provide talking points, educational comparison charts, and other important data. APA continues to oppose psychologist prescribing and the practice of medicine by psychologists, who lack medical training. To support district branches expecting these types of bills, APA commissioned polling to determine the public’s stance. Each psychologist prescribing bill has been defeated so far this year.

Committee on Advocacy and Litigation Funding.

As part of APA’s state advocacy efforts, the Committee for Advocacy and Litigation Funding (CALF), chaired by Dr. Patrick Aquino, reviews district branch/state association grant requests for specific public affairs challenges on the state level. Due to limited budgets in many of APA’s district branches/state associations, CALF grants are heavily relied upon by states when confronting new legislative challenges. Once CALF approves an initial request from a district branch/state association, the request is sent to voting members of CAGR to approve, and the Board of Trustees makes the final determination to award a grant. Between September 2021 and July 2022 of this year, CALF, CAGR, and the Board approved CALF grants to Maine and Wyoming.

The Council on Children, Adolescents, and Their Families

Anish Dube, M.D., M.P.H., Chairperson

The Council works to maximize the APA’s effectiveness in addressing the mental health needs of children, adolescents, and their families. The Council carries out its charge by developing position statements and resource documents for members and collaborating with other APA Components and allied children’s mental health organizations, including the American Academy of Child and Adolescent Psychiatrists. The Committee on Women’s Mental Health, the Caucus on College Mental Health, and the Caucus on Psychiatrists Treating Person with Intellectual Disabilities report to the Council.

In the last year, Council members have worked to respond to several governance referrals related to children’s mental health. They revised position statements on 1) police interactions with children and adolescents in mental health crisis, 2) vaping, and 3) psychiatric hospitalization of children and adolescents. The Council also collaborated with other components on a position statement regarding references to suicide in communications and media as well as a resource document on emotional support animals.

Other accomplishments from the group include publishing a resource document on approaches to youth in mental health crisis, as well as a resource document on the migration emergency and human rights of Haitians. Council members wrote a Psychiatric News article to accompany the release of the document on Haitian migrants. Furthermore, Council members developed “Immigration Toolkit: Displacement, Trauma and Mental Health Among Migrant Youth and Their Families,” which can complement the other fact sheets and toolkits available on the APA website to support culturally competent psychiatrists.

Following a request from APA, the Council drafted a response to the declaration from the American Academy of Pediatrics, American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association on the National Emergency in Children’s Mental Health. Two members of the Council, Dr. Tresha Gibbs and Dr. Lisa Fortuna also participated on the Presidential Task Force on Social Determinants of Mental Health. The Council submitted and published a few APA blog posts, including “The Mental Health Needs of Those Impacted by the End of the War in Afghanistan Continue: Resources for Ongoing Efforts,” and “10 Steps to Help Your Child Prevent and Address Cyberbullying.”

The Council continues its mentorship program, involving mentors (council members) being assigned mentees (council fellows). The pairs review a mentorship guide, outlining expectations and approaches, identify three goals, and sign an agreement to stay connected and meet regularly. Mentors and mentees document their progress quarterly through a survey they fill out. Results are reviewed by the full Council.

The Council’s agenda for the coming year will be divided between four workgroups:

Suicide Prevention in Youth
Pediatric Digital Psychiatry
Immigration
LGBTQIA+

Workgroups are expected to meet outside of the monthly Council calls to develop work products for the whole group to review or respond to relevant issues as they arise.

Committee on Women’s Mental Health

Ludmila Barbosa De Faria, M.D., Chairperson

The Committee on Women’s Mental Health continues to take the lead on issues relating to women’s mental health across the lifespan. Specifically, the Committee has led several components in the creation of a toolkit on mentorship across the psychiatrists’ career, which will be added to the APA website over the next few months. Members of the Committee submitted an APA blog entry on Texas’ controversial abortion law and a Psychiatric News article on the effects of COVID-19 on women’s careers. The group has reviewed numerous position statements as part of APA’s 5-year review process, notably revising the position statement on intimate partner violence (formerly domestic violence against women). Looking ahead, the Committee will collaborate with the National Center on Domestic Violence, Trauma, and Mental Health on intersecting areas, including maintaining access to care while protecting privacy, especially in situations of domestic violence the criminalization of SUD, particularly in the perinatal population.

Recently, as a response to the Supreme Court’s Dobbs v. Jackson ruling overturning Roe v. Wade, the Committee has mobilized to draft an APA blog. Members of the committee were also interviewed by Psychiatric News on the issue. Dr. Ludmila De Faria, the Committee Chair, and Dr. Nancy Byatt, a committee member, participated in a reproductive rights and mental health Twitter chat hosted by APA. The Committee will be working on a fact sheet on reproductive rights and mental health as a member resource and continues to brainstorm ideas to educate the public on this important and timely topic, through op-eds, resources, and social media outreach.

The Council on Communications

Isabel Norian, M.D., Chairperson

The Council on Communications sought approval for a proposed resource document on reference to suicide in communication and media. The document was coauthored by a group of members of the Council on Children, Adolescents, and Their Families, with Dr. Steven Adelsheim serving as the main liaison from that council. The resource document seeks to encourage and reinforce the use of research informed media guidelines for responsible reporting on suicide and suicide attempts among the APA and its members, allied organizations, and partners in news and entertainment media. The resource document was approved by the JRC.

The Workgroup on Spanish Language Communications has been an invaluable resource for APA communications outreach efforts to Spanish-speaking people in America. Members of the working group have volunteered to serve as media spokespeople for APA to the Spanish-speaking press and have already secured several interviews with outlets like Telemundo, Univision, and a myriad of local Spanish-language radio stations. The group has also helped to edit and refine Spanish-language scripts for animated explainer videos on obsessive-compulsive disorder, climate change, anxiety, and substance use disorders. Their efforts have helped ensure that the videos are accessible and relatable to the vast majority of Spanish-speaking people in the U.S., who share a common language but come from an array of unique ethnic and cultural backgrounds.

Thanks to the efforts of the workgroup, the APA is close to launching LaSaludMental.org, an online portal for all of the Spanish-language resources and content created by the workgroup. This site will be a repository of relatable, culturally relevant, and evidence-based information on mental health and substance use disorders targeted at the Spanish-speaking population of the United States. The workgroup will meet on a regular basis and the work will continue indefinitely.

The Workgroup on Social Media is serving both as a sounding board and active participants for CCPA’s monthly themed social media campaigns. Members of the workgroup are actively sharing and boosting CCPA social content and providing feedback and review on items such as infographics and other assets when requested. Council members have also begun to increase their activity in interactive events like Twitter chats, Instagram Live, and other similar platform specific events. Drs. Howard Liu and Christina Girgis also recently hosted a video discussion on social media and children’s mental health on YouTube.

The Council continues to coordinate with the Office of Communications on a weekly basis to amplify APA events and materials through council members’ social media channels and professional networks. The Council is striving to do its part in addressing structural racism, such as through its recent pilot of circulating weekly antiracism conversation starters to its members to help facilitate broader antiracist conversations and message amplification. The Council reviewed and provided feedback on the draft immigration toolkit as well as the draft position statement on communicating with the public in public health emergencies. A fellow member of the Council has been appointed to represent the Council on the JRC’s recently formed workgroup on IMGs and members of international origin. The Council will continue to explore opportunities for its members to educate, mentor, and collaborate, including through releases in the fellows’ newsletter, a partnership with the Committee on Women’s Health, and potential development of a coordinated communications curriculum.

The Council on Consultation-Liaison Psychiatry

Maria Tiamson-Kassab, M.D., Chairperson

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

For decades, consultation-liaison psychiatry has been at the forefront of treating patients with comorbid psychiatric and physical conditions. As more psychiatrists become involved with the integration of physical and mental health care, those in consultation-liaison psychiatry will provide valuable insight and expertise. The Council serves as an important resource to the APA administration on best practices for integrating behavioral health with medical care and is active in identifying ways to educate medical students and residents about the field. A new caucus has been approved under the Council, in order to address the challenges with pain management.

The Council is continuing its work on a series of Psychiatric News articles on a series of topics including:

Consultation-liaison psychiatry and complementary and alternative therapies
Consultation-liaison psychiatry and palliative care psychiatry
The role of consultation-liaison psychiatry training for other disciplines
Culturally informed consultation-liaison psychiatry
Managing pain and consultation-liaison psychiatry

The Council, in coordination with the Academy of Consultation-Liaison Psychiatry, held a webinar on June 26, 2022, “Applying to Consultation-Liaison Fellowships in 2022: A Virtual Q&A.” There were 136 people registered for the webinar, an increase from previous years. A link to the webinar can be found on the APA’s Consultation-Liaison Psychiatry page. Finally, the Council is working to finalize a resource document on medication-assisted therapy for opioid use disorders in hospitals.

The Council on Geriatric Psychiatry

Maria D. Llorente, M.D., Chairperson

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

Position Statements

In collaboration with the Council on Addictions, the Council is in the process of completing an extensive revision of the position statement on substance use in older adults. The revised statement will be submitted to the Joint Reference Committee.

The Council was tasked to review and provide input on the existing position statement on the role of psychiatrists in assessing driving ability to determine if it should be retained, revised, or retired. After a thorough review of the document, and in consultation with several other councils—Ethics, Psychiatry and the Law, Quality Care, Government Relations and Advocacy, and legal counsel—the Council agreed to recommend that the statement be retired. This recommendation will be submitted to the Joint Reference Committee for approval.

Council Response to COVID-19

The COVID-19 pandemic has continued to impact older adults profoundly and selectively, particularly those with mental illness. To provide guidance to clinicians currently working with older adults, the Council completed a book, Geriatric Mental Health Care: Lessons from a Pandemic in time for this year’s annual meeting and which is currently available thru the APA Bookstore. In addition, three Council members, Drs. Roca, Dugue and Llorente coauthored a review article, “Special Report: Lessons from a Pandemic—How Geriatric Psychiatrists Adapted to Meet the Needs of a Vulnerable Population,” published in Psychiatric News July 20, 2022.

Telehealth, Audio Only Codes, and Medicare

As part of the COVID-19 adaptations, being able to offer continuity of care to seniors via audio-only services has been critical and served to keep our most vulnerable patients safer. In addition, psychiatrists were also able to continue to provide services to rural elderly with limited or no Internet availability, as well as those who do not have the equipment to use audio-visual platforms. It has been particularly helpful that Medicare and many other payers have been willing to reimburse for audio-only clinical encounters. The Council is grateful that the APA has been and remains a strong advocate for continued insurance and Medicare coverage of these audio only visits to expand access to care for elderly Americans in need of mental health treatment.

The Intersection Between Geriatric Psychiatry and Child Psychiatry

The Council welcomed a new fellow to serve as liaison from the Council on Children, Adolescents, and their Families. The Council discussed the interface of geriatric and child psychiatry from several perspectives, including the management of aging persons with intellectual disabilities and grandparent/child relationships (kinship care). The Councils are exploring opportunities to collaborate on future joint projects.

Resource Document on Impact of Racism Among Older Adults

A final draft of this resource document, “The Impact of Racism on Older African American Adults,” was reviewed by the Council of Minority Mental and Health Disparities (CMMHD), approved with no further comments, and confirmed by the Geriatric Council at its meeting at the APA Annual Meeting. The final document will now be submitted to the JRC for approval to become an official resource document during its October meeting.

Appropriate Use of Antidepressants in Long-Term Care

Members of the Council voiced concerns regarding a recent article published in Annals of Long-Term Care that advocated for abrupt discontinuation of antidepressants in that setting, with very short term follow up. Several Council members are actively working on a review article to serve as guidance for clinicians to assess antidepressant use in long-term care, make determinations as to when it is appropriate to discontinue these medications, and offer recommendations on gradual reductions, as well as long-term follow up to quickly identify recurrent depressive symptoms.

2022 APA SAMHSA Summer Medical Student Program

Dr. Roane, a member of the Council, volunteered to serve as a mentor as part of this program.

AAN Geriatric Neurology Standing Measure Development Worgroup

Dr. Nash is representing the Council and the APA as this workgroup updates the dementia quality measures.

Council of Geriatric Psychiatry Awards

The Harford-Jeste Award was presented to Dr. Brendan Yarns during the APA annual meeting in collaboration with the AAGP Presidential session. The Jack Weinberg recipient, Dr. Kristen Wilkins, was honored in the APA Convocation Book.

The Council on Healthcare Systems and Financing

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

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

CHSF members continue discussions on timely issues in psychiatry ranging from the long-term effects of the COVID-19 pandemic in practice settings, improving access to mental health care through innovative models, such as the collaborative care model and the use of telepsychiatry to advocate for increased payment for psychiatry, address network adequacy, and the need to enforce the Mental Health Parity and Addiction Equity Act. Council members provide advice to the administration, compare experiences, and monitor these issues.

The Council has continued reviewing and revising existing APA policies referred to them by the Joint Reference Committee, as well as addressing concerns raised by the Assembly action paper process. This includes revising the position statement on telemedicine in psychiatry to include language regarding interstate licensure and quality considerations. In addition, members reviewed the position statements on the use of jails to hold persons without criminal charges who are awaiting civil psychiatric hospital beds, and remuneration for psychiatrists’ time performing utilization review. The Council also produced a detailed 3-year plan, which was passed by the JRC. The action paper “Peer Review Organization Professionalism & Fairness” was referred to the Council. The Council has formed a workgroup to review relevant APA policy and draft a position statement regarding the interface between psychiatry reviewers and treating clinicians.

CHSF and the Council on Quality Care hosted a roundtable for each Council and their Committees’ Chairs. The chairs updated each other on what their components have been working on and the group discussed areas of possible overlap and collaboration. They plan to meet biannually to maintain open lines of communications and work collaboratively on initiatives relevant to both Councils.

The Council oversees the work of four Committees: Committee on Integrated Care, Committee on RBRVS, Committee on Reimbursement for Psychiatric Care, and Committee on Telepsychiatry. Each of these groups collaborate with the Council on projects, while also furthering their respective agendas.

Committee on Integrated Care

Benjamin Druss, M.D., Chairperson

The Committee on Integrated Care developed guidance on the payment for treatment of smoking cessation during outpatient psychiatric visits, which highlights the impact smoking has on those with mental illness or addictions and illustrates, through the use of case examples, options available for billing for smoking cessation services. Seventy five percent of individuals with either addictions or mental illness smoke cigarettes, compared with 22% of the general population. Nearly half of all cigarettes consumed in the United States are by individuals with a psychiatric disorder. Smoking is the single most preventable cause of premature death and disability in our country. The Committee reviewed the position statement on the role of psychiatrists in reducing physical health disparities in patients with mental illness and is giving consideration to updating the information and converting it into a member resource document. The Committee has established two workgroups that will develop resources for APA members related to the integration of physical and medical care, as well as development of patient-facing information related to integrated/coordinated/collaborative care.

Committee on RBRVS, Codes, and Reimbursement

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

The Committee has been focused on developing additional educational resources on E/M code selection criteria and documentation following an increase in audits by private payers. Educational resources will be updated to include 2023 changes to code selection criteria and documentation of services provided in facility settings as well as residential care. Members of the Committee have continued in their roles as APA representatives to the AMA reimbursement related committees—the AMA CPT Editorial Panel and the AMA/Specialty Society RVS Update Committee (RUC). This effort has included advising and advocating for changes to E/M codes used in other settings including inpatient and nursing facility services set to take effect in January 2023; and reviewing CPT coding proposals related to digital health. The Committee has weighed in on issues related to coverage for telehealth services and continues to support the Practice Management Helpline by responding to CPT coding and documentation queries.

Committee on Reimbursement for Psychiatric Care

Laurence Miller, M.D., Chairperson

Members of the Committee contributed to an article, “The Impact of COVID-19 on Financing of Psychiatric Services” in the March 2022 edition of Psychiatric Clinics. Members of the committee worked collaboratively with members from the Council on Quality Care to provide expertise to CMS regarding concerns about the MIPS episode-based cost measures under development. The Committee has been monitoring the 988 implementation and is in process of developing a position statement related to advocacy for sustainable sources of funding.

Committee on Telehealth

Shabana Khan, M.D., Chairperson

The Committee on Telehealth continues to provide feedback to APA staff on letters to the Administration regarding the changing federal regulations pertaining to telehealth. The Committee has continued to meet jointly with the Committee on Mental Health IT for their monthly calls. As the use of technology in clinical practice continues to evolve, both Committees recognized the benefit of meeting jointly to continue to identify areas of potential overlap between the two groups. Together, they developed online member resources and a resource document on telehealth services in the context of intimate partner violence (IPV) addressing potential risks to safety and security. Finally, the Committee is collaborating with ATA to develop a best practices in videoconferencing-based document available in fall 2022.

The Council on International Psychiatry and Global Health

Pamela Y. Collins, M.D., M.P.H., Chairperson

The Council on International Psychiatry and Global Health facilitates understanding of problems facing international psychiatrists and their patients. The Council Chair is Dr. Pamela Collins and the Chair of the Caucus on Global Mental Health and Psychiatry is Dr. David Baron.

Immigrant and Refugee Mental Health

During the 2022 APA Annual Meeting in New Orleans, La., the Council met in-person to discuss immigrant and refugee mental health. This included a discussion on 1) the mental health impact of displacement due to conflict and violence on individuals and families, 2) identifying what groups are the most impacted by displacement, and 3) how organizations can better support mental health treatment and care of displaced persons. The Council invited representatives from the World Psychiatric Association, the European Psychiatric Association, and the Royal College of Psychiatrists to participate in the discussion. The topic was also raised by the Joint Reference Committee after meeting with other APA councils developing resources on specific immigrant and refugee groups, and following APA’s responses to migration issues and refugee resettlement in the U.S. The Council on International Psychiatry and Global Health is coordinating with the APA Office of International Affairs to review APA’s existing resources intersecting areas relevant to migration and mental health to determine if there’s an opportunity for collaboration with other Councils and allied organizations to ensure such resources are inclusive of all displaced populations.

Mental Health Care in West Africa

Upon recommendation by the Council on International Psychiatry and Global Health and the Chester M. Pierce Human Rights Award Nominating Committee, the APA Board of Trustees approved the recipient of the 2022 APA/APAF Chester M. Pierce Human Rights Award as Grégoire Ahongbonon, founder of Association Saint-Camilles-de-Lillis. Saint-Camilles provides mental health services and support to the mentally ill and their families via treatment and recovery centers across the Ivory Coast, Benin, and Togo. As the inaugural recipient of the newly endowed Chester M. Pierce Human Rights Award, Mr. Ahongbonon received funding to travel to the 2022 APA Annual Meeting to present the lecture “Person-Oriented Psychiatry: Changing the Way People with Mental Illness are Viewed and Treated in West Africa,” and met with various groups and components during the conference, including the Council on International Psychiatry and Global Health, to discuss their work. As the award is now endowed, it will move under the APA Foundation for future selection and approval. More information about Dr. Chester M. Pierce can be found on the APA website.

IMG Psychiatrists and Psychiatrists of International Origin

Following the establishment of the Joint Reference Committee Workgroup on Addressing Unique Needs of International Medical Graduate (IMG) Members and Members of International Origin, the Council on International Psychiatry and Global Health was invited to identify two representatives to serve on the workgroup which met for the first time at the 2022 APA Annual Meeting. The workgroup is comprised of IMG members and will review issues impacting IMGs and psychiatrists of international origin to determine how to best address them through education, advocacy, and other resources.

Caucus on Global Mental Health and Psychiatry

The Caucus on Global Mental Health and Psychiatry has established several workgroups, including an advisory group of past caucus chairs, which meets regularly to help guide the work of the Caucus. Additionally, workgroups have been established to address mentorship opportunities for international residents and trainees, global mental health education and resources, primary care collaboration, and climate change. The Caucus met in-person during the 2022 APA Annual Meeting and continues to work toward the development of educational resources and programs through its workgroups. The Caucus is also working closely with members and components of the World Psychiatric Association as appropriate.

2022 International Poster Engagement Program

The 2022 APA International Poster Engagement Program included 12 submissions from the following countries: Bangladesh, Canada, Egypt, Pakistan, South Korea, Tunisia, and the United States. The program is coordinated by the Council on International Psychiatry and Global Health and focuses on expanding networks, professional enrichment, and bilateral learning with participants being typically comprised of medical students, residents, and early career psychiatrists accepted to present their research during the APA Annual Meeting international poster sessions. Program reviewers consist of members of the Council on International Psychiatry and Global Health and the Caucus on Global Mental Health and Psychiatry to provide feedback on the format, layout, scientific content, method, analysis, communication, and presentation of their research poster. Individuals had the opportunity to participate in the program in-person at the 2022 APA Annual Meeting or virtually. Participants who attended the 2022 APA Annual Meeting in-person were invited to share their research at the Council’s in-person meeting.

2022 APA Annual Meeting International Sessions

The following are a selection of sessions relevant to international psychiatry and global mental health that were part of 2022 APA Annual Meeting program:

Social Determinants of Mental Health: Perspectives from the World Psychiatric Association
Social Factors in Proactive Consultation-Liaison Psychiatry: Experience in the US and UK
Mental Health During the COVID Pandemic: A View from Four World Regions
Leaning from the Global South: Psychiatrist Task-Sharing, Community Empowerment, and Population Impact
Meaning-Making, Transformation, and Structural Racism: Global Lessons Learned from the COVID-19 Pandemic
Public Mental Health in the United Kingdom
Global Mental Health—Its Meaning Has Changed
International Social Determinants of Health as Displayed in Psychiatric Emergency Services
Scaling-Up Comprehensive Mental Health Care Using Digital Tools Can Decrease Global Mental Health Disparities and Associated Social Determinants

The Council on Medical Education and Lifelong Learning

Art Walaszek, M.D., Chairperson

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

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

Climate-Related Psychiatric Education Needs

The Council on Research and the Committee on Climate Change and Mental Health was charged with looking at the current state of knowledge on the subject and determine if it was sufficient to create a curriculum and, if it was, what CMELL’s role should be. After reviewing the literature and consulting with the subject matter experts, the workgroup recommended that the development of curricula at the UME, GME, and CME levels is best done by experts in the field rather than members of CMELL given that this is a highly specialized area with evolving knowledge.

The workgroup determined that CMELL can best fulfill its role by the following actions:

Advocate for plenary sessions and tracks in the APA and IPS annual meetings to encourage further research in the field. These can include educational sessions on climate change and its relationship with mental health issues, treatment of acute and chronic environmental stress, and education on advocacy opportunities.
Engage with experts in the field within APA and other professional groups to encourage the development of online model curricula. Potential partners might include ADMSEP for UME, AADPRT for GME, and experts within APA for CME.
Partner with other branches of medicine through American Medical Association (AMA) to share resources and make mental health education and resources available to nonpsychiatric physicians.
Provide links to existing and new curricula on APA website.

As a follow-up, the Council sent official letters to APA Scientific Program, ADMSEP, AADPRT, AAP, AACDP, and AMA, encouraging further work and education in the area of climate change and mental health.

Enhancing the Learning Experience About Jail and Prison Psychiatry in General Psychiatry Residency Programs

CMELL was charged with reviewing an action paper that highlighted the prevalence of mental health issues in correctional populations, the shortage of trained psychiatrists in the correctional setting, and the fact that psychiatrists will increasingly encounter patients with a history of incarceration. The author proposed that “the APA representative member of the ACGME Psychiatric Review Committee advocate to require a correctional experience in the general psychiatry residency. This may include either didactic instructions or a clinical rotation in a jail or prison.” With respect to the resolution that the APA advocate for prison psychiatry, the Council clarified that the APA nominates members to serve on the Psychiatric Review Committee of the ACGME, but that these members do not represent the APA. The Council recommended that the author of the action paper contact ACGME directly and submit feedback when there is an open call period for comments on the revision of residency requirements.

Strengthening Equivalent Pathways for Maintaining Board Certification

The council was charged with reviewing an action paper that wanted the APA to recognize the National Board of Physicians and Surgeons (NBPAS) as an alternative pathway for maintaining certification based on lifelong learning. APA currently lists both NBPAS and ABPN as pathways to Maintenance of Certification (https://www.psychiatry.org/psychiatrists/education/certification-and-licensure). The action paper also requested that a psychiatrist representative from NBPAS join CMELL as corresponding member. The Council is interested in learning more about how NPBAS can support APA members through the board recertification process and has invited a psychiatrist from the organization to speak to CMELL members before voting on the action paper.

CMELL comments on ACGME Common Program Requirements

CMELL submitted comments on ACGME Common Program Requirements, strongly recommending keeping wording regarding diversity as it now exists. The comments stated that adoption of the CPR revision will make it more difficult for medical schools to fulfil this LCME accreditation standard “to achieve mission-appropriate diversity outcomes among its students, faculty, senior administrative staff, and other relevant members of its academic community,” since LCME and ACGME accreditation standards will not be aligned. Alignment fosters synergistic and more efficient and transparent recruitment and retention of critically needed “faculty, senior administrative staff, and other relevant members of its academic community” for both GME and UGME.

Mental Health Innovation Exchange

The Innovation Committee, which reports to the Council, brought back the Mental Health Innovation Zone, rebranded as the Mental Health Innovation Exchange. The event, which took place on August 18–19, 2022, is APA’s showcase and catalyst for advancing technologies in psychiatry, dedicated to answering the question “what’s next in mental health technology?” The event was delivered virtually in 2022, as a reintroduction of the program which has not taken place since 2019 due to the global pandemic. The committee will begin work on planning for the 2023 event, which is to be included as part of the APA Annual Meeting in San Francisco.

Committee on Physician Burnout and Wellbeing

The Committee on Physician Burnout and Wellbeing Committee completed survey on burnout and depression among 1,500 psychiatrists. The completed data analysis demonstrating that lack of control over schedule, being female, and discrimination are associated with an increased risk of burnout and depression among psychiatrists. The Committee is in the final steps for publishing the data from their survey. Badr Ratnakaran, M.D., also created an online educational program, “Physician Burnout & Wellbeing,” which is available for free.

Position Statement on Medical Supervision of Psychiatry Residents and Fellows

The Council developed a position statement that psychiatry residents and fellows should be supervised in medical diagnosis and treatment by physicians, board certified or eligible, and not solely by advanced practice providers. The skills of the clinician supervising residents and fellows must be consistent with the care being supervised. In the process of developing this position statement, the Council reviewed the language of the Accreditation Council for Graduate Medical Education (ACGME) Psychiatry Requirements and reached out to the ACGME for clarification of the existing requirements. The following position statement was approved: “The APA commits to ensuring that psychiatry residents and fellows are supervised by psychiatrists in conducting psychiatric diagnostic evaluations, managing psychiatric emergencies, and managing psychiatric conditions with medications and not solely by advanced practice providers.”

Development of a Toolkit on Mentorship Across a Psychiatrist’s Career

The Council has been collaborating with Committee on Women’s Mental Health, Caucus on Leadership and Entrepreneurship, Council on Minority Mental Health and Health Disparities, Council on Geriatric Psychiatry, and Council on Research to develop a toolkit for mentorship across a psychiatrist’s career. The product was approved by the Joint Reference Committee (JRC), and the JRC commended the workgroup on this cross-collaborative effort.

Proposal for a New APA Caucus on Medical Humanities in Psychiatry

Dr. Vincenzo Di Nicola and Dr. Andrei Novac brought a request to the Council to support a proposal for a new APA Caucus on Medical Humanities in Psychiatry. The medical humanities in psychiatry are an important complement to psychiatry’s basic sciences and clinical mission, yet they do not have a clear voice at the APA. This Caucus is a great opportunity to provide a space for them. Given the relevance of humanities in various stages of training, especially around soft skills, it would be a good fit to house this new Caucus under the wing of CMELL. This action was approved to move forward.

Education Awards of the Council

The Council reviews nominations for APA’s education awards, the Nancy C.A. Roeske, M.D., Certificate of Excellence in Medical Student Education, Irma Bland Award for Excellence in Teaching Residents, and the Vestermark Psychiatry Educator Award Recognizing Excellence.

The Council on Minority Mental Health and Health Disparities

Walter Wilson, M.D., Chairperson

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

2021–2022 CMMH/HD Accomplishments and Initiatives

The following Positions Statements were developed by CMMH/HD and approved by APA Board of Trustees from 2021:

• Racism and Racial Discrimination in the Psychiatric Workplace

The following positions statements and resource documents were sent to the CMMH/HD for review in 2022:

Resource documents

• Impact of Racism on Older African American Adults
• References to Suicide in Communications and the Media
• Ethical and Practical Implications of Psychedelics

Position statements

• Structural Racism in Psychiatric Research Careers: Eradicating Barriers to a More Diverse Workforce
• Addressing Discriminatory Policies Which Prevent Access to Housing and Employment
• Affirmative Action
• Discrimination Against International Medical Graduates
• Resolution Opposing Any Restriction on The Number of IMGs Entering Graduate Medical Training
• Diversity
• Psychiatrists From Underrepresented Groups in Leadership Roles

National Association of Insurance Commissioners

Dr. Walter Wilson, Chairperson of the Council on Minority Mental Health and Health Disparities, represented mental health parity workgroup of the National Association of Insurance Commissioners (NAIC) on the mental health and racial structural barriers preventing patients from receiving care, how insurance companies can help promote health equity, and what both providers and patients go through when trying to join an insurance network.

NIDA Racial Equity Action Plan

CMMH/HD was invited by the APA Administration to provide feedback on NIDA’s Racial Equity Action plan. The Council provided specific feedback around including structural racism education across all the organization.

Committee on Judicial Action: Amicus Brief

The Committee on Judicial Action requested input from the Council on Minority Mental Health Disparities on an amicus brief in the case of Tyrie Washington v. State of Maryland, a case involving a young Black man’s flight from police.

Council on Psychiatry and the Law

Richard Martinez, M.D., Chairperson

The Council on Psychiatry and Law is responsible for evaluating legal developments of national significance that affect the practice of psychiatry and the availability and quality of mental health care, including case law, legislation, regulation, and all other forms of legal regulation of psychiatric practice. It includes a focus on practice areas such as correctional psychiatry, the interface of addictions and the law, child and adolescent psychiatry, and the subspecialty of forensic psychiatry. In the past year, the Council has worked on a wide variety of issues. This report highlights some of the topics covered from 2021-2022.

Emotional Support Animals

An emotional support animal (ESA) is an animal of any species that is not trained to perform a specific task, but rather alleviates a person’s psychiatric disability through companionship. ESAs are different from service animals and other disability-related assistance animals. Psychiatrists may be asked to write a letter supporting a patient’s request for an ESA. Laws about ESAs vary across federal, state, and local jurisdictions. As this is an evolving area of law, it is essential for psychiatrists to stay up to date with laws in their jurisdiction. The Council on Psychiatry and Law created this resource document to provide an overview of the clinical, ethical, and legal considerations that a psychiatrist should consider when asked to write an ESA letter for a patient. This resource document was approved by the Joint Reference Committee in June 2022 and is available at https://psychiatry.org/getattachment/3d42da2a-9a4d-4479-869f-4dd1718f1815/Resource-Document-Emotional-Support-Animals.pdf.

Consent for Voluntary Hospitalization of Minors

In nearly all states, if a physician determines that hospitalization of a minor is medically indicated and their parent or guardian consents to the hospitalization, then the minor is admitted. These admissions are typically characterized as “voluntary” admissions, even though the minor may be objecting. State statutes differ as to whether a minor above a designated age should be permitted to consent to psychiatric hospitalization without parental consent. Similarly, in some states, parental consent for psychiatric admission is not sufficient if the youth is older than a certain designated age. This resource document seeks to lay out several key issues related to the rules governing the psychiatric hospitalization of minors so that psychiatrists can be better informed when rendering their judgment in particular cases. This resource document was approved by the Joint Reference Committee in January 2022 and is available at https://www.psychiatry.org/getattachment/6dd28cc3-fdf2-46a4-bb29-d2ce62bc5321/Resource-Document-Consent-for-Voluntary-Hospitalization-of-Minors.pdf.

Civil Commitment of Minors

In July 2020, APA adopted a position statement on voluntary and involuntary hospitalization of adults with mental illness, stating that when persons with mental illness who need inpatient care are unwilling to consent to voluntary admission, some form of involuntary hospitalization should be available. The Council on Psychiatry and Law drafted this position statement on civil commitment of minors to extend those principles to minors who require involuntary hospitalization. The position statement asserts that in any case in which a minor has been determined to need inpatient hospitalization, and neither the minor nor a parent or guardian has provided valid consent under state law, the minor should be admitted in accordance with the principles and procedures laid out in the position statement on voluntary and involuntary hospitalization of adults with mental illness. This position statement was approved by the APA Board of Trustees in December 2021 and is available at https://www.psychiatry.org/getattachment/5c61e4a5-4a42-46a5-9efc-aeacb0a76c25/Position-Civil-Commitment-of-Minors.pdf.

Committee on Judicial Action

Reena Kapoor, M.D., Chairperson

The Committee on Judicial Action is a component of the Council that considers and recommends APA involvement as a friend of the court in cases at every level of the judicial system and covering a range of issues. APA has recently joined briefs in the following cases:

Corbitt v. Taylor, advocating against Alabama Law Enforcement Agency’s Policy Order 63 prohibiting transgender individuals from getting a license that accurately reflects their gender without sex reassignment surgery.
Planned Parenthood South Atlantic et. al. v. Wilson et. al., advocating against South Carolina’s attempt to ban nearly all abortions after six weeks gestation.
Thomas. E. Dobbs, M.D., M.P.H. et. al. v. Jackson Women’s Health Organization et. al., asserting that Mississippi’s attempt to ban nearly all abortions after fifteen weeks of pregnancy is at odds with the provision of safe and essential health care and medical ethics.
The United States of America v. The State of Texas et. al., opposing Texas S.B. 8 (“the Texas Heartbeat Act”), which bans abortion after the detection of embryonic or fetal cardiac activity.
Maxwell Kadel, et al. v. Dale Folwell, et al., requesting summary judgment for the plaintiff in a lawsuit challenging North Carolina’s barring of coverage of gender-affirming care for state employees and their dependents.
State of Georgia, et al. v. President of the United States, et al., supporting the COVID-19 vaccination mandate for federal contractors given the public interest in promoting public health and ending the COVID-19 pandemic.
Joseph R. Biden, Jr., President of the United States, et al. v. Missouri, et al. and Xavier Becerra, Secretary of Health and Human Services, et al. v. Louisiana, et al., supporting the Secretary of Health and Human Services’ regulation requiring facilities that participate in Medicare and Medicaid to ensure that their employees are vaccinated against COVID-19.
National Federation of Independent Business, et al. v. Department of Labor, Occupational Safety and Health Administration, et al., Ohio, et al. v. Department of Labor, Occupational Safety and Health Administration, supporting the Occupational Safety and Health Administration’s COVID-19 vaccination mandate for employers with at least 100 employees.
Paul A. Isaacson, M.D., et al. v. Mark Brnovich, et al., opposing Arizona Senate Bill 1457, which forbids physicians from providing an abortion if they have some uncertain level of knowledge when patients seek such care motivated by a state-defined prohibited reason.
Dylan Brandt, et al. v. Leslie Rutledge, opposing Arkansas Act 626, which prohibits Arkansas healthcare providers from providing or referring patients under the age of 18 for evidence-based treatments for gender dysphoria.
Jane Doe, et al. v. Greg Abbott, et al., opposing enforcement of the Abbott Letter, which directed the Texas Department of Family Protective Services to determine whether some gender confirmation surgeries for transgender children constitute child abuse under existing state law.
Planned Parenthood Minnesota, North Dakota, South Dakota, et. al. v. Kristi Noem, Governor, et. al., Alpha Center, et. al., challenging provisions that require patients to submit to involuntary interviews at a pregnancy help center before having an abortion
Rev. Paul A. Eknes-Tucker, et al. v. Kay Ivey, et al., opposing Alabama Senate Bill 184, which prohibits healthcare providers from providing or referring patients under the age of 19 for critical, evidence-based treatments for gender dysphoria.
Students for Fair Admissions, Inc. v. President and Fellows of Harvard College and Students for Fair Admissions, Inc. v University of North Carolina, et al., urging the Court to take no action that would disrupt holistic review in the college and medical school admissions process.
Additionally, the Committee wrote its own amicus brief in the case of David Wit, et al., v. United Behavioral Health, explaining that managed care organizations tightly control access to psychiatric care by applying ‘medical necessity' criteria that are inconsistent with generally accepted standards of care.

The Council on Quality Care

Carol Alter, M.D., Chairperson

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

Committee on Mental Health Information Technology

The Committee on Mental Health Information Technology (CMHIT), chaired by Dr. John Torous, continues to provide feedback to APA staff on letters to the Administration on federal regulations pertaining to digital health.

The Committee on Mental Health IT has continued to meet jointly with the Committee on Telepsychiatry for their monthly calls. As the use of technology in clinical practice continues to evolve, both Committees recognized the benefit of meeting jointly in order to continue to identify areas of potential overlap between the two groups. Together, they will develop member resources for psychiatry.org, while remaining separate Committees under two different Councils.

The Committee also continues to provide guidance to APA App Advisor on its activities. The App Advisor group is in the process of writing a best practices in mental health guidance and resource document, which will be reviewed by the full CMHIT later this year. Drs. John Torous, Darlene King, Nicole Benson, Steven Chan, and Julia Tartaglia, all members of CMHIT, are also on App Advisor, and are facilitating this effort. The Committee also continues to expand upon the telepsychiatry toolkit on psychiatry.org.

The Committee is also developing a position statement on psychiatry and social media, which hopes to address concerns that are emerging in the media and in draft legislation. The committee hopes to have this position statement completed by next year.

The Committee has also developed a resource document on telehealth services in the context of intimate partner violence (IPV), addressing potential risks to safety and security. After Joint Reference Committee approval, a brief will be posted on psychiatry.org and the resource will be disseminated.

Finally, the Committee is collaborating with ATA to develop a best practices in videoconferencing-based document. The document is currently in its final draft stages.

Committee on Practice Guidelines

The APA practice guideline for the treatment of patients with eating disorders was approved by the Assembly on March 21 and by the Board of Trustees on April 6. The guideline covers anorexia nervosa, bulimia nervosa, binge eating disorder, night eating syndrome, and avoidant/restrictive food intake disorder (ARFID). The draft was sent to the Assembly for electronic review and vote. The Assembly had 2 weeks to discuss the guideline and there were two “office hour” calls to answer any questions. The approved guideline is posted on the APA web site with the final copy set version available later this year.

The writing group that worked on eating disorders, chaired by Dr. Cathy Crone, has started work on a delirium guideline, based on a systematic review by the Pacific Northwest Evidence-Based Practice Center. The writing group chaired by Dr. George Keepers has started work on a revised and updated guideline for the treatment of borderline personality disorder based on a systematic review by RTI-UNC Evidence-Based Practice Center. The writing group chaired by Dr. Victor Reus will be developing an updated guideline for the treatment of bipolar disorder based on an Agency for Healthcare Research and Quality (AHRQ) systematic review, along with supplemental reviews and an expert survey.

The Committee was considering treatment resistant depression as the next topic but learned that the Department of Veterans Affairs (VA) was updating major depressive disorder. The VA shared their evidence review and the Committee is discussing if it can serve as the basis for a treatment resistant depression guideline. In the meantime, work on the generalized anxiety disorder review has continued with a completed systematic review due this summer.

The Committee now reviews other guidelines and materials for inclusion on the web page and has three VA guidelines, including the recent revision on major depressive disorder, and one ASAM guideline as well as several resource documents posted. We will continue to review other materials that may be appropriate. If you know of a practice guideline or other document you think would be helpful for APA membership, please send information to [email protected].

Committee on Quality and Performance Measurement

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

With support from CQPM members, the APA is working to identify and prioritize topics for quality measurement. This has provided the CQPM with a strategy on which to base APA comments for developers of quality measures (e.g., Mathematica, RAND, NCQA, etc.); the National Quality Forum; and federal and state policy makers and quality program administrators who rely on quality measures as tools to operationalize the goals and strategies set forth by national and state regulations. This prioritization effort will also aid in the drafting of APA’s comments during future public comment periods for CMS quality programs (Medicare and Medicaid). This includes CMS’s Inpatient Psychiatric Facility Quality Reporting Program, the Long-Term Care Hospital Quality Reporting Program, the Merit-Based Incentive Payment System (MIPS), and other programs. The effort will also inform the Committee’s guidance regarding measures included in APA’s PsychPRO registry.

Building on APA’s recent measure development efforts, the CQPM will be working on activities to inform and educate APA members about measurement-based care and use of related measures in their own practices.

Reporting Workgroups and Other Work With Member-Experts

The Council oversees the work of the following workgroups:

Patient Safety Workgroup.

This workgroup, chaired by Dr. Jacqueline Hobbs, has completed a resource document addressing considerations in the use of seclusion versus restraint in inpatient settings and will be implementing a dissemination plan to promote the product and build awareness on the issue. The workgroup is planning for work on issues related to suicide risk reduction (i.e., ligature risk, observation, suicide risk screening and assessment), medication safety, and development of member education materials (i.e., patient safety tips).

Workgroup on Implementation of Measurement-Based Care.

The workgroup, chaired by Drs. Kathryn Ridout and Erik Vanderlip, has been meeting on a regular basis over the year and has developed a draft of a resource document. The document focuses on implementing measurement-based care (MBC) in solo or small practices. It covers topics such as implementation, technology, and reimbursement, along with challenges and solutions. The draft is in its final stages and will be presented to the Council for review at the September meeting. The workgroup presented a workshop at the 2022 APA Annual meeting in May and will be presenting a workshop at the 2022 Mental Health Services Conference in October.

Workgroup on Quality Communications.

The workgroup chaired by Drs. Maga Jackson Triche and Bonnie Zima, in coordination with APA administration, has been examining ways to promote increased awareness of APA’s work related to quality, including practice guidelines, measurement activities, and other efforts, through improved communication strategies and innovative approaches to disseminating information. The workgroup has met with the APA Communications Office to develop a communication plan focused primarily on APA members, for use in promoting work products of the Council.

Technical Advisors

Members of the Council on Quality Care, with support from its component groups, continue to serve in leadership and advisory roles with external quality measurement groups, including the National Quality Forum and the Core Quality Measures Collaborative. These multistakeholder panels are responsible for defining national quality measurement strategies, developing meaningful quality measurement tools, recommending appropriate use of quality measures and how institutions will be surveyed for behavioral health care. These appointments afford the APA an authoritative voice in the national quality enterprise.

The Council on Research

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

The Council on Research continues to help ensure that research on mental health remains integral to the APA’s mission and in the forefront of the national health agenda. The Council embodies APA’s commitment to advance psychiatric knowledge through the conduct of research by physician scientists across a broad range of research fields and issues: basic science, clinical diagnosis and assessment, treatment research, epidemiology, health services, computational psychiatry, and research training. These areas are represented by the committees, workgroups, and caucuses under the Council’s jurisdiction. The following is a brief report of the May 2022 meeting of the Council on Research and its plans.

APA Registry Discussion

The Council continues to help guide and support the refinement and scaling of APA’s mental health registry, PsychPRO, with input on quality measurement and patient assessment, including SDOH. Recent registry activity includes onboarding participants to the new registry technical vendor, Arbor Metrix. Participation stands currently at just over 70 practices (including three large systems: Sheppard Pratt, Cambridge Health Alliance, and Hackensack Meridian) with approximately 750 clinicians (i.e., psychiatrists, psychologists, social workers, therapists, nurse practitioners, and physician associates). Data file specification and safe and secure data transfer processes were finalized allowing for streamlined onboarding. New data file specs and transfer processes also allow for better data quality control and mapping to the registry database infrastructure.

PsychPRO is envisioned to provide quality data and information for APA to have a greater voice advocating for the profession and advancing the psychiatric care landscape. Informatics expertise and a next-generation registry platform are planned to empower the APA to advance health care through data science. As such, the PsychPRO registry is being built on a next-generation registry solution including collaborations with several MBC focused technologies, allows for flexibility and scalability, and will enhance clinician and patient engagement. As we continue to grow, PsychPRO will provide for a high-quality data enclave for the purposes of quality measurement-based care as well as clinical research and development of learning health care systems and networks. For more information about the registry, please go to www.psychiatry.org/psychiatrists/registry.

Component Updates

Workgroup on Research Training.

The Council’s Workgroup on Research Training, chaired by Charles Nemeroff, M.D., Ph.D. and Steven Siegel, M.D., Ph.D., met to discuss the 2022 Research Colloquium for Junior Psychiatrist Investigators (Colloquium). The Colloquium was held on May 21–22 before the APA Annual Meeting. This year, 36 applicants were selected to attend the Colloquium including five international awardees from Brazil (2), France (2), and Mexico (1). On day one of the Colloquium, mentees participated in didactic presentations from senior researchers on topics such as work life balance, mentorship, and grantsmanship. On day two of the Colloquium, mentees broke into small groups and discussed topics such as managing a research team, working with special populations, and other hot topics in psychiatric research. Presentations from representatives of the Brain and Behavior Research Foundation, National Institute on Drug Abuse (NIDA), and the American Foundation for Suicide Prevention offered information of research funding for early research career psychiatrists. Finally, participants broke into breakout groups of 3–4 mentees based on six research areas of interest (i.e., neuroscience, treatment, clinical psychobiology, substance abuse research, health services/health disparities research, and military mental health) where they presented their research and received feedback from their assigned team Senior Research and Statistics/Methodology mentors.

The workgroup is planning the Colloquium Booster Session which will be held on Saturday, December 3, 2022, before the American College of Neuropsychopharmacology (ACNP) Annual Meeting in Phoenix, Arizona. Mentees from 2022 and those who deferred from 2021 will be invited to participate in the session.

The Colloquium continues to be jointly funded by the APA Foundation, a NIDA R-13 grant, and through our partnership with ACNP. Additionally, the Medical Technology and Educational Consortium (MTEC) has provided 3-year partial funding to cover research on military mental health including posttraumatic stress disorder, traumatic brain injury, and suicide.

We continue our work to expand the Research Colloquium to include more international early research career psychiatrists. International mentees are selected and sponsored by their institution, country’s psychiatric association or branch of SOBP, or are self-funded.

Research awards and fellowships.

The Award for Research in Psychiatry, the highest award for research given by the APA, was presented to Dr. Ned Kalin. In addition, the Judd Marmor Award, established in 1999 to honor an individual who has made a substantial contribution to advancing the biopsychosocial model of psychiatry, was awarded to Dr. Robert Rohrbaugh. Several other prominent researchers were recognized this year for their outstanding contributions to psychiatry and psychiatric research: Dr. Charles Nemeroff received the Mrazek Award in Psychiatric Pharmacogenomics; Dr. Robert Sweet received the APAF/American Association of Chairs of Departments of Psychiatry Research Mentorship Award; and Dr. Joseph Coyle received the Nasrallah Family Award for Advances in Psychiatric Neuroscience. Dr. Bradley Gaynes received the 2022 APA Health Services Research Senior Scholar Award, and Dr. Alison Hwong received the 2022 APA Health Services Research Early Career Award.

The 2022 Psychiatric Research Fellowship was awarded to Dr. Kevin Xu. Dr. Xu’s research will investigate the systems and prescribing practices that lead to inequitable treatment for patients with substance use disorders. His research plan is to conduct the first national characterization of comparative effectiveness for OUD medication (MOUD) among pregnant women using insurance claims. Dr. Xu’s fellowship begins in July 2022 and will end in June 2024.

Committee on Psychiatric Dimensions of Disaster

Joshua Morganstein, M.D, Chairperson

The Committee on Psychiatric Dimensions of Disaster coordinated with the APA Communications Department to reach out to the district branches and state associations affected by recent tragic events, including floods and tornadoes in Kentucky, and the multiple mass shootings in New York and Texas. Committee members have led special webinars on disaster psychiatry topics and participated in interviews through major media outlets. Committee members led a two-part course on disaster response during the APA Annual Meeting. The Committee has been engaged in supporting APA’s response to the U.S. withdrawal from Afghanistan and resulting refugee crisis as well as the war in Ukraine.

Committee on Climate Change and Mental Health

Elizabeth Haase, M.D., Chairperson

The Committee on Climate and Mental Health has been engaged in creating a roadmap for the climate change response of the APA. We have worked with the APA annual meeting and finance committees, given presentations, and passed an action paper that will result in a workgroup to make the APA’s practices more sustainable across the board, focused initially on greening the carbon footprint of how we hold meetings, with recommendations for how members can reduce their carbon footprint to meet 2030 targets underdevelopment. We have worked with Council on Medical Education and Lifelong Learning to establish an ongoing collaboration between our two committees for curriculum development and link the climate curriculum targets we are establishing as APA standards to other national climate health education initiatives through Group for the Advancement of Psychiatry gaps, Climate Psychiatry Alliance, Global Consortium on Climate and Health Education, and Medical Societies Consortium on Climate and Health. We have held several meetings with national leaders from the Substance Abuse and Mental Health Services Administration and the United States Department of Health and Human Services to determine what grant, community, and collaboration efforts are possible to ensure mental health needs are included in national policy efforts to combat the ill effects of climate change. The Committee has worked with the APA’s media and government relations groups on a number of press releases on APA’s response to extreme heat and other climate emergencies as well as to produce a media kit for Earth Day highlighting the impacts of climate change on social media.

Diagnostic and Novel Treatments Workgroup

Charles Nemeroff, M.D., Ph.D., Chairperson

The Diagnostic and Novel Treatments Workgroup (Biomarkers WG) completed manuscripts on schizophrenia and substance use, the neuropsychiatric sequelae of COVID-19, technology and mental health, and biomarkers of autism, which have all been submitted for publication. In addition, the workgroup is developing papers on additional topics including the treatment of posttraumatic stress disorder, ketamine, psilocybin, MDMA, an update on the use of pharmacogenomics in prescribing antidepressants, and structural racism and supporting diversity in psychiatric research (workforce issues). The Council’s Biomarkers WG chair worked in collaboration with Dr. Gregory Barber, fellow on the Ethics Committee, and Dr. Steven Siegel to describe a case report that addresses potential untoward consequences of psilocybin use. This manuscript has been accepted for publication in the American Journal of Psychiatry. The workgroup, in collaboration with the Council on Addiction Psychiatry, completed a position statement on the use of psychedelic agents for mental health.

Health Services and Health Disparities Workgroup

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

The workgroup commentary on climate change and psychiatric workforce needs was published in Psychiatric Services, and its manuscript on climate change and mental health, which focused on gaps in research, was published in Lancet Planetary Health. The workgroup plans to develop papers on topics such as research on suicidality and suicide safety planning, particularly among traditionally unrepresented groups, integrated care for individuals with serious mental illness, and gun violence.

The Council has developed a manuscript, “Structural Racism in Psychiatric Research Careers: Eradicating Barriers to a More Diverse Workforce,” led by Dr. Alik Widge, that is currently under review for consideration for publication in AJP.

DSM Steering Committee

Paul S. Appelbaum, M.D., Chairperson; Kenneth Kendler, M.D., and Ellen Leibenluft, M.D., Vice-Chairs.

The DSM Steering Committee, its Subcommittee on Minor Changes, and its five Review Committees have been working on multiple dimensions of the DSM since the last report in October 2021. This year’s major accomplishment has been the finalization and publication of DSM-5-TR in March 2022. The text revision involved the addition of new diagnoses (prolonged grief disorder, stimulant-induced mild neurocognitive disorder, and the restoration of the diagnosis of unspecified mood disorder). In addition, it contained clarifying modifications to the criteria sets for more than 70 disorders. Symptom codes for suicidal behavior and non-suicidal self-injury, and a code for no diagnosis or condition were added to the chapter Other Conditions That May Be a Focus of Clinical Attention. Four cross-cutting review groups (Culture, Sex and Gender, Suicide, and Forensic) as well as a Workgroup on Ethnoracial Equity and Inclusion reviewed DSM-5-TR text to ensure appropriate attention to risk factors such as racism and discrimination and the use of non-stigmatizing language.

Several proposals for the addition, deletion, or modification of diagnostic criteria were received and reviewed by the DSM Steering Committee through its online portal. The addition of a symptom code for impairing emotional outbursts was approved by the Steering Committee, Neurodevelopmental Disorders Review Committee and the APA’s Assembly and Board of Trustees. The code will be added to the next editions of DSM-5-TR and is effective October 1, 2022. In addition, the DSM Steering Committee continues to harmonize the ICD-10-CM codes in the DSM with the coding updates published by the National Center for Health Statistics (NCHS) to help streamline their use by clinicians on a daily basis.

Volume 179
Issue 11

November 01, 2022
Pages 865-880

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History

Published online 1 November 2022

Published in print 1 November 2022

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APA Council Reports

The Council on Addiction Psychiatry

The Council on Advocacy and Government Relations

Federal Affairs

Mental health parity.

Telehealth.

Health equity.

Psychiatric collaborative care model.

House appropriations.

State Affairs

Legislative Representatives Forum.

Legislative activities.

Parity.

Psychiatric collaborative care model.

Prior authorization.

Safe prescribing.

Committee on Advocacy and Litigation Funding.

The Council on Children, Adolescents, and Their Families

Committee on Women’s Mental Health

The Council on Communications

The Council on Consultation-Liaison Psychiatry

The Council on Geriatric Psychiatry

Position Statements

Council Response to COVID-19

Telehealth, Audio Only Codes, and Medicare

The Intersection Between Geriatric Psychiatry and Child Psychiatry

Resource Document on Impact of Racism Among Older Adults

Appropriate Use of Antidepressants in Long-Term Care

Council of Geriatric Psychiatry Awards

The Council on Healthcare Systems and Financing

Committee on Integrated Care

Committee on RBRVS, Codes, and Reimbursement

Committee on Reimbursement for Psychiatric Care

Committee on Telehealth

The Council on International Psychiatry and Global Health

Immigrant and Refugee Mental Health

Mental Health Care in West Africa

IMG Psychiatrists and Psychiatrists of International Origin

Caucus on Global Mental Health and Psychiatry

2022 International Poster Engagement Program

2022 APA Annual Meeting International Sessions

The Council on Medical Education and Lifelong Learning

Climate-Related Psychiatric Education Needs

Enhancing the Learning Experience About Jail and Prison Psychiatry in General Psychiatry Residency Programs

Strengthening Equivalent Pathways for Maintaining Board Certification

CMELL comments on ACGME Common Program Requirements

Mental Health Innovation Exchange

Committee on Physician Burnout and Wellbeing

Position Statement on Medical Supervision of Psychiatry Residents and Fellows

Development of a Toolkit on Mentorship Across a Psychiatrist’s Career

Proposal for a New APA Caucus on Medical Humanities in Psychiatry

Education Awards of the Council

The Council on Minority Mental Health and Health Disparities

2021–2022 CMMH/HD Accomplishments and Initiatives

National Association of Insurance Commissioners

NIDA Racial Equity Action Plan

Committee on Judicial Action: Amicus Brief

Council on Psychiatry and the Law

Emotional Support Animals

Consent for Voluntary Hospitalization of Minors

Civil Commitment of Minors

Committee on Judicial Action

Other Topics

The Council on Quality Care

Committee on Mental Health Information Technology

Committee on Practice Guidelines

Committee on Quality and Performance Measurement

Reporting Workgroups and Other Work With Member-Experts

Patient Safety Workgroup.

Workgroup on Implementation of Measurement-Based Care.

Workgroup on Quality Communications.

Technical Advisors

The Council on Research