APA Council Reports

The Council on Addiction Psychiatry

Frances R. Levin, M.D., Chairperson

The Council on Addiction Psychiatry is committed to providing psychiatric leadership in the study, prevention, and treatment of substance use disorders. The component provides recommendations to the APA on research, 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), National Institute on Drug Abuse (NIDA), National Institute on Alcohol Abuse and Alcoholism (NIAAA), the Center for Substance Abuse Treatment (CSAT), and the Veterans Health Administration (VHA) to participate in its meetings. Physician training on treatment of substance use disorders (SUD), prescription drug monitoring programs, accessibility and availability of services, budgetary challenges, research priorities, and opportunities for APA to contribute meaningfully to important government initiatives are among the issues addressed by the group.

The national epidemic of prescription drug and heroin abuse remains a major area of focus. Through its collaboration with APA’s Division of Government Relations, the Council remains abreast of policy proposals and informs the Association’s advocacy efforts. Additionally, it offers a variety of training opportunities for psychiatrists and other interested clinicians. Waiver-eligible courses on office-based treatment of opioid use disorder with buprenorphine are offered at APA’s Annual Meeting and the Institute on Psychiatric Services, and an on-line course is available at www.APAeducation.org. The courses are augmented by a monthly webinar series that is conducted by the Association as a partner organization in the SAMHSA-funded Providers’ Clinical Support System for Medication Assisted Treatment (PCSS-MAT). The highly evaluated webinars offer free continuing medical education credit and attract large audiences. A clinical mentoring system further enhances training by providing opportunities for psychiatrists and other physicians to consult with members who have recognized expertise in evidence-based medication-assisted treatment of opioid use disorder. The mentoring system can be accessed from the program’s dedicated website, www.pcssmat.org.

The Council chair and vice chair represent the APA and actively participate in an AMA-convened 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 over-prescribing of opioids and utilize evidence-based practices in treating pain and substance use disorders. Led by Dr. Patrice Harris, AMA Chair-Elect and a former member of APA’s Board of Trustees, the Task Force is undertaking initiatives to 1) address substance use disorder as a medical condition; 2) enhance physician training on evidence-based treatment of pain and addiction; 3) increase physicians’ use of prescription drug monitoring programs and provide guidance to policymakers about program features that will ensure provision of clinically significant information; 4) reduce the stigma of substance use disorders; and 5) address overdose prevention through advocacy for increased access to naloxone.

An additional area of Council focus is tobacco use, which is a serious public health problem that disproportionately affects individuals with psychiatric illness. People with mental illness consume nearly half of all cigarettes sold in the U.S. and carry a disproportionate share of the medical burden. A Workgroup on Tobacco Use Disorder was established and includes clinical experts and representatives of integrated care, public and community psychiatry, child and adolescent psychiatry, and residency education.

The Workgroup’s vision is that mental health and addiction treatment should include treating tobacco use disorder with the impact being improved mental health and addiction recovery, improved wellness, reduced health disparities, and substantial reduction in tobacco use disorder rates by individuals with psychiatric disorders. In the future, the APA will be a leader in providing education and leadership not only to help psychiatrists develop the skills and knowledge to identify and treat tobacco use disorder but also work with other health care and public health organizations to eradicate tobacco use disorder.

In early 2015, the Robert Wood Johnson Foundation’s Smoking Cessation Leadership Center (SCLC) awarded APA a grant to support the Workgroup’s initial projects. Meeting monthly, the group produced a strategic plan for the APA to address psychiatrists’ educational needs regarding tobacco use disorder and improve psychiatric practice by integrating evidence-based approaches for assessment and treatment of tobacco use disorder. Additionally, it developed an APA position statement on tobacco use disorder, conducted a workshop at the Annual Meeting that introduced a training curriculum for clinicians, presented a webinar on treatment approaches, and fielded a pilot survey to examine APA members’ current tobacco use assessment and management practice patterns. In the future, the Workgroup intends to compile a wide variety of educational, clinical, and patient resources that will be accessible on APA’s website. Additionally, the Workgroup plans to increase the number and quality of APA-sponsored educational and training activities on tobacco use disorder, as well as engage key clinical leaders in APA’s District Branches and State Associations to mentor, train, and coach other psychiatrists into becoming opinion leaders around the country and in various health care systems.

Members of the Council also reviewed and undertook revisions to several existing APA position statements. The Position Statement on Residency Training Needs in Addiction Psychiatry for the General Psychiatrist and an accompanying resource document were approved by the Board of Trustees in November 2014. Statements currently in the approval process address Tobacco Use Disorder, Substance Use Disorders in Older Adults, and Opioid Overdose Education and Naloxone Distribution, which is a joint statement of the APA and the American Academy of Addiction Psychiatry.

The Council on Advocacy and Government Relations

Barry Perlman, 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 Committee on Government Relations, and the 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 the APA’s member-led coordinating body for advocacy activities involving federal and state government. Its responsibilities include analyzing problems and opportunities, anticipating needs for advocacy policies, planning government relations strategies, collaborating with district branches/state associations on state matters affecting individuals with mental illness and the profession, providing expert input to APA Administration staff, and actively collaborating with allied groups with shared goals to improve access to quality mental health care.

High-profile events and the continued challenges of access to psychiatric care have fostered intense interest in these issues on the Hill, within the Obama Administration, and in state governments. The Council remained active helping to advance a number of APA advocacy priorities and guiding APA lobbying activities.

Comprehensive Mental Health Reform

As interest in comprehensively addressing our nation’s broken public mental health delivery system has intensified, the Council has worked closely with the APA Administration to proactively develop advocacy strategies and policy recommendations that advance priority legislative areas for our members and our patients. H.R. 2646, the Helping Families in Mental Health Crisis Act, was reintroduced earlier this year by Representatives Tim Murphy, Ph.D. (R-PA) and Eddie Bernice Johnson (D-TX). The Council was pleased that this legislation would better coordinate federal mental health resources, address the critical psychiatric workforce shortage, substantially improve enforcement of the Mental Health Parity and Addiction Equity Act, increase funding for the National Institute of Mental Health, and support funding for innovative models of care. APA has expressed its strong support for H.R. 2646 and, at the time of this writing, United States Senators Chris Murphy (D-CT) and Bill Cassidy (R-LA) are developing similar comprehensive mental health reform legislation, which we anticipate will be introduced before the Senate’s August recess.

Implementation of the Medicare Access and CHIP Reauthorization Act (MACRA)

This spring, the flawed Medicare Sustainable Growth Rate formula was repealed and replaced by Congress through the APA-supported Medicare Access and CHIP Reauthorization Act of 2015. This was the culmination of over a decade of lobbying from APA and organized medicine. In summary, MACRA merges current Medicare incentive and penalty programs into one payment system, and it provides incentives for physician participation in alternative payment models. The Council reviewed the legislation with APA Administration staff in collaboration with other APA components and provided strategic lobbying guidance and recommendations. More recently, the Council has identified practical challenges, opportunities, and implications for regulatory advocacy on behalf of psychiatry within the Centers for Medicare and Medicaid Services so that our members can better work within the evolving system’s requirements.

Insurance Industry Consolidations

Amid the flurry of announced mergers in the health insurance industry this year, the Council focused its attention on how these proposed consolidations would impact physician practices and access to care for our patients. Concerns that are under discussion include the likely influence that a highly concentrated insurance industry could wield, including implications for network adequacy, pricing power, and criteria for treatment coverage. At the time of this writing, the proposed major mergers have generated discussions and Council activity leading to APA Administration and APA Board of Trustees assessment of consolidation implications for psychiatry and our patients. APA is expected to work closely with our house of medicine colleagues to advocate for appropriate access to treatment and promote nondiscriminatory coverage of psychiatric disorders.

Endorsement of Principles for the Provision of Mental and Substance Abuse Treatment: A Bill of Rights

The Council has begun work to update the 1996 APA’s Endorsement of the “Principles for the Provision of Mental Health and Substance Abuse Treatment Services: A Bill of Rights,” which was reaffirmed by APA in 2007. The Council has established a work group comprised of members from related APA components in developing an amended modernized statement that better aligns with APA polices, member interests, and the changes in health care delivery and health care law since APA’s original endorsement of the Principles.

Other Cross-Functional Policy Development Work

The Council continues its cross-functional policy development work with other councils under the direction of the APA Board of Trustees. Recently, the Council has collaborated on issues including regulation of direct to consumer advertising (DTC), the threat of multiple copayments being charged to patients for single prescriptions, and patient access to treatments (including off-label treatments) prescribed by their physicians. Per instruction from the Joint Reference Committee, the Council will shortly begin consideration of issues including the promotion of military cultural competence among psychiatrists, emergency department boarding of individuals with psychiatric disorders, and appropriate locations of civil commitment hearings.

State Advocacy Leadership Conference

I am excited that APA will be bringing back the State Advocacy Leadership Conference this fall. The conference will be held in Florida and will be the first of its kind in the last 15 years. The goal of the event is to mobilize state psychiatric leadership in order to address top legislative and regulatory priorities related to mental health and psychiatric practice. APA members in attendance will have the opportunity to share best practices and will be provided training and guidance on effective legislative lobbying strategies, winning communication plans, and successful ways to navigate regulatory obstacles. The Council has coordinated with APA government relations staff in order to provide strategic input to contribute to what I’m expecting to be a successful and informative conference.

Committee on Advocacy and Litigation Funding

Originally created in 2002 and re-established in 2009, the Committee on Advocacy and Litigation Funding (Jeff Akaka, M.D., Chairperson) is charged with reviewing requests 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. With increased legislative activity and greater focus on state government responsibilities in the changing environment of health care reform, the Council has worked with APA in ensuring support to eligible and approved district branches and state associations as they seek to bolster their advocacy apparatus.

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

The PAC raised an estimated $325,000 from APA members during the 2014 election cycle. APAPAC has currently raised $144,763 so far in 2015, a 10% increase from where we were at this point in 2014 (an election year) and a 39% increase from 2013 (the previous nonelection year for comparison). Increasing this number is the top priority of APAPAC. Strengthening our political voice is vital to the APA’s advocacy efforts and crucial to the future of our specialty and our patients. APA is near the bottom of physician specialties in money raised. APAPAC has recently introduced the APAPAC Operative Program. The APAPAC Operative Program is designed to increase the participation rate among APA members by using peer support at the district branch/state association level. An APA member will represent his or her district branch/state association by educating fellow district branch/state association members on the importance of APAPAC and how contributions enhance the APA voice in Congress.

I look forward to the Council’s upcoming work through the remainder of this year and into 2016.

The Council on Children, Adolescents, and Their Families

Joseph Penn, M.D., Chairperson

The work of the Council is directed toward maximizing the effectiveness of APA in addressing the mental health needs of children, adolescents, and their families. Its charge is primarily carried out through workshops, position statements, and liaison with allied children and adolescent organizations.

Following are highlights of Council activities in 2015:

The Council on Communications

Arshya Vahabzadeh, M.D., Chairperson

The Council of Communications is dedicated to educating and informing the public about the importance of psychiatry and the leadership role psychiatrists play in mental health and overall health care. The Council is also active in increasing effective communications among members of the American Psychiatric Association with the aim of engaging them in the outreach efforts of the APA.

Under the supervision of the Council, the findings and recommendation of the Porter Novelli communications audit were fully implemented in the second half of 2014, creating an integrated Communications Division, with overall responsibility for communications, public affairs, integrated marketing, the APA brand, member communication, and Psychiatric News. The combined team has been staffed up and is working collaboratively and cross-functionally to achieve “One Clear Voice” for the APA on key issues of member and public concern. An organization-wide 6-month editorial calendar is in place so that, three months out, the full team is aware of the communications needs and work of the organization and can deliver the organization’s products and messages in a coordinated, high-impact way. And design services have been brought in house, saving APA money and supporting the effort to consistently brand APA.

Over the past several months, APA staffers under the guidance of the Council and the Foundation have worked together to lay the groundwork for APA President Renee Binder’s vision of an annual premier mental health event in DC. The event, titled the American Psychiatric EXcellence (APEX) Awards, will take place in April 2016, in conjunction with a summit on the criminalization of people with mental illness. Dr. Steven Sharfstein has been selected as a cochair of the APEX Awards Host Committee, and the Mayflower Hotel has been secured as the site. Sufficient funds have been raised to assure that the event will at least break even.

On May 17, 2015, the new brand of the APA was launched at the opening session of the Annual Meeting in Toronto. APA staffers gave a presentation on the new brand to the Council prior to the overall launch. The brand was developed between December 2014 and March 2015, relying on extensive research among the Council members, APA leadership, membership, the Administration, district branches, and the public. The Board’s goal in adopting the new brand was to demonstrate a consistent look and clear value to members about all that APA does and to curb the competing marks, fonts, and colors evident in APA’s then-current approach to branding. As of this writing, the brand is almost fully implemented, now appearing on our journals, letterhead, business cards, some facilities, and most of our business units, like Publishing and the PAC.

Council members have shared much insight with APA staffers on improving APA’s news media function. We can report that the news media function has improved dramatically, earning APA a share of voice on key issues like veterans’ mental health, interrogation and torture, and LGBT issues (including, for example, the mental health effects of marriage equality and our stance against conversion therapy). News releases are now issued quickly after the precipitating event; as one example, APA President Renee Binder was widely quoted following the Obergefell Supreme Court case, where we were able to issue our release 39 minutes after the court’s decision was announced.

Using in-house expertise and talent, APA produced a parity rights poster to inform patients of their rights under the Mental Health Parity and Addiction Equity Act. The poster is written in clear, easy-to-understand (9th-grade reading level) language and notes the steps to take when violations are suspected. The poster has been distributed nearly 200,000 times, and many psychiatrists have downloaded the poster for display in their offices, clinics, and hospitals. APA also had the poster professionally translated into Spanish and is now distributing that version as well. Several district branches have also cobranded the poster, and some have built coalitions of support to distribute the poster, such as with their state hospital association or with patient advocacy groups.

Boosting Online Engagement

Boosting online engagement is probably the Council’s biggest area of focus and will remain so in the coming year. Seeing that online and e-mail engagement is crucial to the organization’s business operations and future, APA completed an audit of our e-mail, listserv, and online engagement. As a result, we have boosted open rates on our emails by 50% over the past year, while making sure the targeted audiences are appropriate, helping to increase the relevance of the messages we send and reducing the chance of opt-outs from our communications platforms. Additionally, on social media, our audit revealed that we were significantly behind other organizations in the mental health space; today we have grown our presence by 45%. Moreover, previously we ranked behind Scientology, one of our fiercest critics, while today we beat them by about 13,000 followers.

Launching and Helping Support Sales of the Consumer Guide

In May 2015, APA launched “Understanding Mental Disorders: Your Guide to DSM-5,” the consumer companion book to the DSM. The Council was apprised of the communications efforts for this important resource. In April, to prepare media for the forthcoming publication, APA hosted a major launch event at the National Press Club in Washington, DC, which included reporters from U.S. News, Kaiser Health News, Health Affairs, Politico, and many others. APA also conducted a satellite television media tour with APA President Renee Binder and Patrick Kennedy, reaching six key TV markets around the country.

APA has strengthened its communication to employees by creating an internal campaign called “APA Values: You,” celebrating the 10 values that the Administration relies on most in order to work productively and collaboratively. The values include Diversity, Dependability, and Responsiveness. The campaign has included professional development opportunities and team-building activities.

The Council intends to build upon this success in the coming year. We believe, working closely with Communications staffers at the APA, we can boost member engagement and raise the organization’s profile.

The Council on Geriatric Psychiatry

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

The Council on Geriatric Psychiatry provides leadership in the field of geriatric psychiatry and serves as an expert resource to the APA in issues pertaining to the mental health care of older adults. In order to fulfill this responsibility, the Council creates position statements and resource documents, organizes and presents programs at the Annual meetings, creates educational material, assists the APA in its advocacy efforts at the state and federal level, works to raise the level of interest of medical students and residents in the field of geriatric psychiatry, selects and recommends honorees for APA awards in geriatric psychiatry, and serves as a point of contact between the APA and other subspecialty organizations interested in the care of older adults.

Substance use disorders are increasingly prevalent among older adults and are currently underdiagnosed and undertreated. Last year, the Joint Reference Committee (JRC) asked the Council to work with the Council on Addictions to develop a position statement on “Substance Use in the Elderly.” A workgroup consisting of volunteers from both councils worked on the request and submitted a final product to the JRC for approval and referral to the Assembly. The Council was also charged with reviewing existing APA position statements on the “Quality of Mental Health Care in U.S. Nursing Homes,” on “The Role of Psychiatrists in Assessing Driving Ability,” and on “The Role of Psychiatrists in End-of-Life Care.” The last of these takes on special significance in light of recent legislative activity around the country on the topic of “death with dignity” and related debates on the appropriateness of physicians providing the means for patients to end their lives under certain circumstances. The Council is working closely with other components, most notably the Council on Psychiatry and Law, to develop materials that will assist the APA and its members in understanding and responding to this timely and complex issue. The Council is also in the final stages of revising a position statement on Use of Antipsychotics for the Treatment of Behavioral Disturbances in Persons with Dementia. This is occurring as the Practice Guidelines Committee is receiving public comment on a new Practice Guideline on the Use of Antipsychotic Medications for the Treatment of Agitation and Psychosis in Dementia. It will be of critical importance that the practice guideline and position statement be harmonious. Members of the Council felt that the statement should acknowledge the reality that these medications—despite the controversies surrounding their use—are often needed in the treatment of the severely symptomatic patients referred to psychiatrists for care.

Since the Council regularly collaborates with the American Association of Geriatric Psychiatrists (AAGP) on various projects that are of common interest to the members of both organizations, the President-Elect and the Executive Director of the AAGP regularly attend and provide reports to the Council meetings in May and September. At the last meeting, the Council and the AAGP president-elect discussed various ways to improve AAGP and APA interactions. The Council members agreed that greater AAGP and geriatric psychiatry presence at the APA Annual Meeting would benefit the recruitment efforts to the field and would provide valuable educational opportunities for psychiatrists. Several strategies were discussed, including having a booth at the Annual Meeting promoting AAGP and encouraging general psychiatrists to attend the AAGP Annual Meeting. AAGP may consider offering a special discount to APA members who attend the AAGP Meeting for the first time.

At the time of writing this report, the Council is preparing its response to the Centers for Medicare and Medicaid Services’ comprehensive overhaul of long-term care facility requirements. This is the first amendment of its scale and scope in nearly 20 years, and the proposed regulations outline new quality and ethics rules for facilities that participate in the Medicare and Medicaid program. Among many other provisions, the proposed rule touches on staffing adequacy and training, psychotropic medication administration and oversight, the discharge process, and a variety of lifestyle issues.

The Council is also charged with recommending honorees for APA Geriatric Awards: the Jack Weinberg Award in Geriatric Psychiatry and Hartford-Jeste Award for Future Leaders in Geriatric psychiatry. The Jack Weinberg Award recognizes psychiatrists who have made noteworthy contributions to geriatric psychiatry as researchers, mentors, leaders, and clinicians over a course of their careers. The 2015 award recipient was Dr. Robert G. Robinson. The recently established Hartford Jeste Award recognizes an early-career geriatric psychiatrist who has made significant contributions to the field of geriatric psychiatry through excellence in research, teaching, clinical practice, and community service and has demonstrated the potential to develop into a future leader in the field. The 2015 awardee was Dr. Michelle Conroy.

The Council on Healthcare Systems and Financing (CHSF)

Harsh K. Trivedi, M.D., Chairperson

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

Mental health parity continues to be a prominent concern. Despite the passage of MHPAEA, the ACA provisions, and the recent CMS proposed rule implementing parity in Medicaid managed plans, enforcement remains a critical issue. Work has been done to provide the Department of Labor, which is charged with enforcing parity, with an understanding of the importance of full disclosure of plan policies pertaining to both mental health and medical/surgical care to enable legitimate enforcement of parity. There have also been continuing discussions with MCOs and state enforcement agencies.

The Council is also actively involved in an exploration of alternative payment models, which will enable the provision of collaborative care. This includes review of a background paper on Accountable Care Organizations (ACOs) and how they related to psychiatry prepared by OHSF staff.

In an effort to fulfill the duties laid out in the Council’s charge, the Council maintained the following issue-specific workgroups: the Ad Hoc Work Group on APA Health Care Reform; the Workgroup on the Seriously Mentally Ill; and the Workgroup on Integrated Care.

The Ad Hoc Work Group on APA Health Care Reform issued its report in March 2015 with a number of recommendations to the APA BOT that relate to the work of the Council and the APA as a whole. These include recommendations in the following categories: Financing—establishing an advocacy and communications strategy supporting the value of psychiatry; Integrated Care—designing a plan of action to define and advocating for sustainable integrated care payment models with CMS; Quality—defining quality measures for psychiatric care; Research—influencing the national research agenda for behavioral health services and related sciences; Health Information Technology—levering the APA’s position to stimulate advances in technology that will allow for the creation of EMRs and apps that better support the needs of psychiatrists; and Workforce and Education—developing a national strategy that highlights the role of psychiatrists in organized systems of care and included behavioral health and allied professionals.

The Workgroup on the Seriously Mentally Ill, chaired by Grant Mitchell, M.D., was established in May 2015, replacing the former Work Group on Medicaid/State Mental Health Programs, has begun reviewing and promoting new program and payment models that can support services that have not traditionally been funded, such as housing, transportation, and respite care. It is coordinating its work with the Assembly Committee on Public and Community Psychiatry.

The Workgroup on Integrated Care, chaired by Lori Rainey, M.D., is continuing its leadership role within the APA and with other stakeholders in encouraging psychiatrists to become part of providing integrated patient-centered care. Emphasis has been on the evidence-based Collaborative Care Model developed in Washington state. Largely through the efforts of the APA, this model was singled out in the 2016 Proposed Rule on the Medicare Fee Schedule as something that CMS deems worthy of support. APA will be providing comments in support of its adoption by CMS, noting the necessity for alternative payment models that can support this kind of care.

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

The Committee on RBRVS, Codes, and Reimbursements, Gregory Harris, M.D., Chairperson, continues its work with the AMA CPT Editorial Panel and the AMA RVS Update Committee (RUC). While representing the APA on the CPT Editorial Panel and at the RUC in discussions of other coding changes that may influence the way psychiatry is practiced in the future, committee members also have continued to provide one-on-one assistance to APA members on coding and documentation through the APA’s CPT Coding Network, which is maintained through the Practice Management HelpLine. The committee has also provided expertise on ongoing issues that have arisen with numerous payers.

The Council on International Psychiatry

Michelle Riba, M.D., Chairperson

The Council on International Psychiatry is focused on generating opportunities to enhance education and training on global mental health and international psychiatry and developing strategies for international membership growth. Council members are experts with experience in global mental health and are broadly representative (geographically and culturally) of the APA international body.

Education and Training

In order to support international education and training at Annual Meetings, the Council facilitates the submission of quality abstracts that incorporate diverse perspectives on topics relevant to global mental health and international psychiatry. This includes promoting participation at Annual Meeting events such as the International Poster Sessions, which feature research findings presented by international psychiatrists and which has shown significant growth over the past 3 years to almost 200 submissions, and the International Lecture Series, which showcases psychiatric experts and leaders from around the world.

The Council supports select sessions in the scientific program at the Annual Meeting falling under the topic “Global Mental Health & International Psychiatry,” such as the following sessions organized by Council members:

The Council is currently involved in identifying global mental health training issues and working to pull together information from various perspectives and resources for presentation.

As part of the Council’s initiative to develop opportunities for international education, the Council is developing a strategy to promote participation by APA members in international meetings such as those listed below.

Membership

The Council has tracked a 26% rate of growth in international membership over the past year to over 2,000 international members from over 100 countries. The Council works closely with the Membership Committee on various international membership initiatives and participated in a comprehensive review of existing membership categories, activities, and benefits for international members in order to assess their effectiveness and develop appropriate strategies to support additional recruitment and retention.

This past year, the Council participated in a review of several initiatives, including the development of a membership category for international resident psychiatrists and a proposal for international group membership.

The Council recognizes the importance of generating strong working relationships with international psychiatric organizations and special interest groups in the United States with connections to psychiatric organizations in other countries. The Council is currently in the process of identifying opportunities to work together with various organizations including, but not limited to, the World Psychiatric Association, Association of Chinese American Psychiatrists, Association of Korean American Psychiatrists, Indo American Psychiatric Association, Nigerian American Psychiatrists Association, Philippine Psychiatrists in America, Turkish American Neuropsychiatric Association, Arab American Psychiatric Association, American Society of Hispanic Psychiatry, and the Black Psychiatrists of America.

The Council on Medical Education and Lifelong Learning

Richard Summers, M.D., Chairperson

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

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

Integrated Care

The Council continued its initiative to advance education and training of psychiatrists for new roles in integration with primary care. The initiative includes:

Interspecialty Collaboration

As follow-up to a meeting convened in summer 2014 of the Education Directors of Specialty Societies, the Council led a symposium at the 2015 APA Annual Meeting on interspecialty collaboration in education entitled “Educating Psychiatrists for Work in Integrated Care: Focus on Interdisciplinary Collaboration.”

Undergraduate Education/PsychSIGN

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

Graduate Medical Education (GME)

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

IOM Report on GME Financing

The Council and the Ad Hoc Work Group on Education and Training provided input for the APA response to the House Energy and Commerce Committee request for stakeholder comments concerning the IOM’s GME report, funding of the GME system, and the future of GME in general.

Lifelong Learning

The Council serves as consultant to the CME activities of APA and to the overall CME program. The Council is involved in shaping APA education, in needs assessment for CME activities, and in identifying psychiatrist knowledge gaps. The Council provided oversight in the development of educational programs that assist members in their pursuit of self-assessment and lifelong learning and fulfillment of requirements for maintenance of certification.

Patients at Risk of Violent Behavior

The Council responded to the Assembly action about Psychiatric Education with Respect to Patients at Risk of Violent Behavior. The Council noted that education on this topic was available. The Council discussed the issue of violent patients in 2011 in the context of resident safety. AADPRT has developed de‐escalation guidelines along with training director and resident protocols to respond to a traumatic event in residency. An outline of a 10-hour course of essential components of violence management is available from the AADPRT website and is intended to be taught in the first year of residency training.

The SPC added a topic “Aggressive Behaviors: Etiology, Assessment & Treatment” in the online abstract submissions system. The topic was available to 2015 Annual Meeting abstract submitters. This action allowed interested parties to prepare submissions on the topic and permit attendees at the Annual Meeting to quickly locate sessions on that topic either in the Program Guide topic index or by using the Annual Meeting mobile/tablet APP. In addition, the SPC encouraged the development of a session from the practice guideline group working on the assessment of risk for aggressive behaviors for the 2015 Annual Meeting. At the 2014 Annual Meeting, there were two seminars and one symposium directly related to this topic. Seminars are submitted using the same criteria required for a 4-hour course but do not require the attendee to pay an additional fee to attend them. Seminar packets are available online for anyone wishing to attend the session. The course committee chair was made aware of the interest in providing this information for Annual Meeting attendees. The need has also been met by new educational resources in the field, including a curriculum written by Robert Feinstein entitled “Violence Prevention Education Program for Psychiatric Outpatient Departments” (Academic Psychiatry, July–August 2014).

Education Awards

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

Mentors of Year Awards

The first Mentors of Year Awards were given in 2015. The awards were created to reward outstanding mentors in the psychiatric community. Awardees have had a sustained career commitment to mentoring, a significant positive impact on their mentees’ careers, fostered the careers of students and colleagues, and through their mentees have advanced research and patient care in the field of psychiatry. One Mentor of the Year winner was selected in these mentorship categories: Academic Educator, Administration and Leadership, and Clinical Practice.

The Council on Minority Mental Health and Health Disparities

Christina Mangurian, M.D., Chairperson

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

In 2015:

The Caucus of Religion, Spirituality and Psychiatry, chaired by John Peteet, M.D., falls under the purview of the Council. Of the seven scientific sessions at the May 2015 Annual Meeting on the subject of religion and psychiatry, the Caucus presented three sessions, including a symposium on the Integration of Spirituality in Health Care: Research and Clinical Reports.

Five of the seven award lectures under the Council’s purview also occurred at the Annual Meeting:

The 2015 Oskar Pfister Award Lecture (Religion and Psychiatry) will be delivered by Allan Josephson, M.D., at the October 2015 IPS meeting. Actress Laverne Cox was selected as the 2015 John Fryer Awardee for her activism on behalf of transgender people.

Also at its May meeting, Council members bid farewell to outgoing resident fellows assigned to the Council from the various APA resident fellowship programs. These residents were acknowledged for their active support and participation in Council deliberations and projects.

The Council on Psychiatry and the Law

Steven Kenny Hoge, M.D., Chairperson

Debra Pinals, M.D., Vice 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 focuses on legislation, regulation, and case law that has the potential to influence the provision, quality, or availability of mental health care and services, alter the psychiatrist-patient relationship, affect confidentiality or the rights of patients, or that will otherwise regulate the practice of psychiatry in the public or private sector. This past year, the Council has been heavily involved in a wide range of topics, including assisted outpatient treatment position paper and resource document, psychiatric boarding, death with dignity, civil commitment hearings, and college mental health, to name a few.

At the September 2014 Components meeting, the Council on Psychiatry and the Law had a joint meeting with the Committee on Judicial Action on “The Civil Rights of Institutionalized Persons Act, Americans with Disabilities Act and the Department of Justice Investigations as Tools to Reform State Mental Health Services.” Dr. Robert Bernstein, from the Bazelon Center for Mental Health Law, and Dr. Ezra Griffith, APA Member, both gave presentations. The Council had a lively discussion that involved areas where it may be useful for APA involvement with CRIPA/Olmstead Litigation cases along with discussing how the APA overall can focus on care delivery and treatment.

The Council on Psychiatry and the Law worked closely with the Council on Geriatric Psychiatry on the Clinical Guidelines for Interacting with Caregivers. The document can be found on the APA website (http://www.psychiatry.org/psychiatrists/search-directories-databases/library-and-archive/resource-documents). Additionally, the Council also tackled the issue of gun control by reviewing current APA documents and developing a new position statement and resource document. Both were passed in 2014 and are available at www.psychiatry.org. The Workgroup on Persons with Mental Illness in the Criminal Justice System, as a subset workgroup of the Council, has worked with American Psychiatric Association Publishing to have the updated “APA Guidelines Psychiatric Services in Correctional Facilities” printed. The book is now available for purchase through American Psychiatric Association Publishing.

The Committee on Judicial Action, a component of the Council on Psychiatry and the Law, has overseen APA consideration of involvement as a friend of the court in many cases at every level of the judicial system. The committee continues to review cases and to recommend to the APA Board of Trustees APA involvement in a number of cases that cover a range of topics. In addition, the committee works with district branches to provide guidance and input, and in some cases recommends financial support for amicus briefs held at the state level. The Isaac Ray Committee also reports to the Council on Psychiatry and the Law. The committee met at the Annual Meeting in May to select a recipient for the 2016 award.

The Council on Psychosomatic Medicine

David Gitlin, M.D., Chairperson

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 wellbeing of our profession. The Council’s major priority areas include:

The Council continues to cultivate a strong partnership with the Academy on Psychosomatic Medicine. In this vein, the Council and the Academy created the APA-APM Joint Workgroup on the Dissemination of Integrated Care. Starting in February 2015, the Council convened a series of productive conference calls resulting in an outline of a report, a review of literature for integrated care models, and a draft of the report to be submitted to the Council for its approval in September 2015. At the conclusion of the first workgroup meeting, there was considerable interest to produce a report that highlighted the importance of primary care integration through traditional collaborative care models, while also identifying for further study an adoption of best practices in the field of “reverse integration.” The report was discussed at the September Components Meeting and will be forwarded to other APA governing bodies for review, and it is expected that the report will include a roadmap to implementation for APM and APA. It is anticipated that the workgroup may conclude its activities by winter 2015.

The Council on Psychosomatic Medicine recently added APA HIV/AIDS activities under its charge and is closely working with the APA’s Steering Committee on HIV. The APA Steering Committee reported back to the Council at the meeting this past May that it is looking to compile previous position statements to make a comprehensive position statement related to HIV. The APA Steering Committee on HIV also partnered with the Council on drafting a letter to the White House Office of National AIDS Policy regarding possible revisions to the National HIV/AIDS Strategy, which resulted in a substantial increase in focus on mental health issues in the Policy, formally unveiled in July 2015.

The Council has rapidly responded to several health care policy initiatives or papers around integrated care. These papers include several policy papers from various medical associations focused on primary care and family medicine. The Council also submitted feedback to NIDA’s Strategic Plan, which was available for public comment. In its comments, the Council encouraged NIDA to increase its focus on the comorbidity of substance use disorders, medical illnesses, and trauma and urged NIDA to support collaborative research between psychiatry and medicine addressing comorbidities and the development of effective interventions.

The Council was also referred an action paper by the Joint Reference Committee (JRC) to develop a position statement on the elimination of the conditions contributing to emergency department boarding of individuals with psychiatric disorders. In drafting the position statement, the Council sought input from the Council on Advocacy and Government Relations and the Council on Psychiatry and the Law before creating a finalized position statement. The Council will be forwarding the position statement to the JRC for its review in October 2015. In addition to this position statement, the Council on Psychosomatic Medicine is creating a resource document on the psychiatric implications of bariatric surgery.

The Council on Quality Care

Joel Yager, M.D., Chairperson (2013–2015)

Grayson Norquist, M.D., Chairperson (2015–2017)

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

Choosing Wisely Campaign

The APA’s recommendations for the Choosing Wisely Campaign, a national effort promoting clinician-patient conversations about appropriate care, were released on September 20, 2013. Information about this initiative and APA’s development can be found on the APA website (http://www.psychiatry.org/psychiatrists/practice/quality-improvement/choosing-wisely). As a follow-up to this effort, the Council on Quality Care worked with the Council on Geriatric Psychiatry to update the statement that involves caring for patients with dementia. The statement now reflects current literature.

Strategic Discussion on an APA-Supported Registry

The Councils on Research, Quality Care, and Health Systems and Finance continued their strategic discussion on an APA-supported registry at the Council on Quality Care Meeting on May 19, 2015. The Council-charged workgroup formalized in May 2014 presented a report of recommendations outlining how the APA should move forward with an APA-supported registry. The report addressed why APA might wish to insert itself into the registry arena and how it might do so by acknowledging how health care reform is increasing the focus on quality measures and patient outcomes, which can be well captured and reported by registries. Advances in information technology, including electronic data capture and infrastructure to link physicians nationwide, have made large-scale efforts more feasible and have led many specialty associations to explore opportunities to develop and support registries. The workgroup’s report answered questions regarding what an APA registry might focus on that would be unique, meaningful, and relevant to members (for example, informing practice guidelines, quality assessment for payment, research, and tracking treatment outcomes). Dr. Greg Dalack, Chairman of the Registry Workgroup, presented this report to the Board of Trustees on July 11, 2015. As a result of this report, the Board of Trustees requested a business plan be developed for future presentation.

Steering Committee on Practice Guidelines

The Committee continues to focus on developing evidence-based practice guidelines that are intended to assist psychiatrists in clinical decision making. The new development process was adopted in 2011 to align with recommendations of the Institute of Medicine, and the first set of the guidelines developed under the new process, Practice Guidelines on Psychiatric Evaluation for Adults, was approved by the APA Board of Trustees in December 2014. The full guidelines are now freely available at psychiatryonline.org (http://psychiatryonline.org/guidelines), and an executive summary of the guidelines was published in the American Journal of Psychiatry in August 2015. The Guideline Writing Group is currently working on a new guideline that addresses appropriate use of antipsychotics to treat agitation or psychosis in patients with dementia. The guideline is based on a systematic review of the available evidence and opinions of experts in the field. Guideline statements (i.e., recommendations, suggestions) are based on balancing possible benefits versus harms of the recommended actions. The hope is that these clearly described recommendations can inform quality improvement activities and improve clinical care. In addition to the two evidence based guidelines, a Guideline Watch was published on psychiatryonline.org earlier this year to accompany the 2007 APA’s Practice Guideline for the Treatment of Patients With Alzheimer’s Disease and Other Dementias. The Watch provides a brief review and update of important research evidence and developments since the 2007 publication of the guideline.

With support from a grant by the National Library of Medicine, the Committee is working on developing an evidence database to make systematic reviews more efficient for future APA guideline development. Guidelines are also being developed using systematic reviews available from the Agency for Healthcare Research and Quality (AHRQ). An AHRQ-contracted evidence-based practice center is currently conducting a systematic review on treatment of bipolar disorder, which was a topic nominated by APA. A draft review is expected to be available in September. An AHRQ review on schizophrenia, a topic also nominated by APA, will be initiated later this year. Other reviews that AHRQ is developing or has already published should also be of interest to APA, including de-escalating aggressive behaviors, binge-eating disorder, and nonpharmacological interventions for the behavioral symptoms of dementia. The Council and Committee continue to discuss some of the strategic directions and questions that pertain to APA’s guideline development process (e.g., increased capacity within the guideline project.)

Committee on Mental Health Information Technology

The Committee on Mental Health Information Technology (CMHIT) continued to explore topics of importance to the field, such as technical data standards, health information exchange, and telemedicine. The group convenes monthly by conference call to oversee various activities. For example, this year the group responded to a call for public comment on the 2015 Proposed Rules for EHR Meaningful Use, as well as EHR Certification standards. The group maintains discussions with MHIT interest groups (e.g., SAMHSA, the ONC, etc.) regarding coordination of HIT for behavioral health and also endeavors to develop robust dialogue with national EHR vendors about the scope and EHR needs of the behavioral health community. Most recently, the group has convened a Behavioral Health “apps” task force that seeks to identify a set of criteria that may be used by psychiatrists to evaluate mental health-oriented applications for smart phones/tablets.

Quality Improvement and Quality Measurement

The Council discussed issues and priorities facing the Association with regard to performance measure development and implementation and educating members about these increasingly influential topics, including the future changes at the federal level including MACRA (the Medicare Access and CHIP Reauthorization Act) and its associated Merit-Based Incentive Payment System (MIPS). The Council acknowledged APA collaborations with other entities through national initiatives, such as the AMA-supported Physician Consortium for Performance Improvement (PCPI), and considers measure concepts internally through the practice guideline development process. Health reform will require psychiatry to define quality measures, as health care is moving toward pay-for-quality. It is crucial for the APA to be involved in defining quality measures to avoid crucial measures pertaining to psychiatry being defined by commercial or other nonmedical groups. There are different philosophical approaches to measure development: developing focused measures on specific psychiatric disorders versus measures that are global to psychiatry (e.g., psychiatric evaluation) or to all of health care (e.g., care coordination, medication reconciliation). In support of this effort, a proposal to develop a Committee on Performance Measurement was discussed at the Council on Quality Care’s meeting on May 19, 2015. Establishment and development of this committee was subsequently approved by the Board of Trustees at their meeting on July 11, 2015.

Reporting Workgroups

Several other workgroups developed under the Council are newly active or have received approval to continue to convene. The Patient Safety Workgroup continues to focus on transitions of care that occur when patients are discharged from inpatient care, given that increased rates of suicide occur shortly after discharge from hospitals. The Standards and Survey Procedures Workgroup continues to address policy and standards development that include activities with national organizations (e.g., The Joint Commission). The Gender Dysphoria Workgroup’s commission has been extended and plans to continue developing resource documents focusing on gender dysphoria treatment. The second meeting of the Caucus on Psychotherapy occurred at the APA Annual Meeting in May 2015; this group convenes psychiatrists interested in any form of psychotherapy and psychosocial treatment.

The Council on Research

Dwight Evans, M.D., Chairperson

The Council on Research carries out activities to ensure that the substance and significance of research on mental health/illness remain integral parts of the APA mission and in the forefront of the national health agenda. The Council embodies the Association’s commitment to advance psychiatric knowledge through the conduct of research by physician scientists across a broad range of research fields and issues: basic science, clinical diagnosis and assessment, treatment research, epidemiology, health services, prevention research, and research training. These areas are represented by the committees and task forces under the Council’s jurisdiction.

The following is a brief report of the May 2015 meeting of the Council on Research.

Caucus on Alternative and Complementary Medicine

Members of the Diagnostic Treatment and Markers Workgroup have been working with the Caucus on a review paper on S-adenosylmethionine. A draft is planned for completion later this year.

APA Patient Registry

The APA Patient Registry Workgroup has drafted and presented to the APA Joint Reference Committee and Board of Trustees a report summarizing their activities and discussions. The primary issues framed by the report include the following: the need for patient-reported self-assessment data from patients age 12 years and older; more engagement of third-party payers to help the group determine how a registry might feed into different reimbursement models; the importance of making the registry APA-specific and not developed in partnership with other organizations; and prioritizing the inclusion of patient and family groups. The Workgroup is currently vetting outside vendors to develop the registry and is considering possible proof-of-concept initiatives they can pursue to assess the registry’s ease of data entry and to determine what structural changes will need to be made to optimize its use.

APA Registry With AllTrials

The APA has electronically signed the petition as a supporting organization for AllTrials, an international registry to make public findings from all clinical trials. Along with the Royal College of Psychiatrists, the APA is the largest psychiatric society to sign and the largest American specialty society to sign, as of Summer 2015.

Committee on Psychiatric Dimensions of Disaster

The Committee reported on its recent revisions to the APA website on disaster psychiatry, which were made to improve its accessibility and resource listing. There has been ample activity in response to the earthquake tragedy in Nepal, including development of materials for dissemination over FM radio and mobile telephone. The Committee also is working with a new APA committee convened around global warming and its potential impact in terms of increasing the risk of natural disasters. The Council discussed the increasing importance of disaster psychiatry and that the issue of psychological trauma from disasters is a public health problem that has been historically neglected. Members discussed possible strategies to increase public awareness of the APA’s response efforts and to make the APA a more prominent source of mental health information for the general public.

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

An update on the status of the Task Force to Revise the Practice of ECT was presented to the Council. It appears highly likely that the Food and Drug Administration will form a separate study section on brain stimulation and neuromodulation categories, but they have not yet revealed possible panel members. The Task Force’s Guidelines and Recommendations for ECT book, which is being published by American Psychiatric Association Publishing, is nearing the editing stage, and completion of the text is anticipated to occur imminently.

Diagnostic Treatment and Markers Workgroup

The Diagnostic Treatment and Markers Workgroup recently submitted a meta-analysis on ketamine to the American Journal of Psychiatry, where it was accepted with minor revisions and appears in this issue of the Journal. The Workgroup continues to develop a manuscript about rTMS for depression. A similar paper will be developed by the Clinical TMS Society, and the Workgroup is determining whether or not it will be possible to work with the Society to merge the two into one comprehensive paper or whether publication of two separate manuscripts will be necessary. Three additional manuscripts are being developed by members of the Workgroup: one on genetic predictors of antidepressant response; one on the use of imaging and EEG for antidepressant response; and a third on inflammatory and endocrine predictors of antidepressant response. The group has identified collaborators on all three papers.

Workgroup on Research Training

The Workgroup on Research Training reported on the status of the research colloquium, which was well-attended. The three topics to be offered at next year’s colloquium include molecular translation and neuroscience research; clinical psychobiology: from diversity to personalized medicine; and clinical treatment: from health disparities to personalized medicine.

Corresponding Committee on Research Awards

The Council was updated on the status of the APA Award for Research in Psychiatry, APA Research Mentorship Award, and the upcoming Judd Marmor Award lecture, which will be presented at the 2015 IPS: The Mental Health Services Conference in New York, this October.