APA Council Reports

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 the 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), the American Academy of Addiction Psychiatry (AAAP), and the Substance Abuse and Mental Health Services Administration (SAMHSA) to participate in its meetings. The Council has focused on the accessibility and availability of services, evidence-based care, budgetary needs, research priorities, and opportunities for APA to contribute meaningfully to important government initiatives. With the impacts COVID-19 has had on substance use and substance use disorders, the CAP was especially active over the last year.

The Council provided input on the Office of National Drug Control Policy’s (ONDCP) 2022 National Drug Control Strategy and recommended supporting the increase of education and training in medical schools and the development of a standardized, interdisciplinary core curriculum on substance use disorders (SUDs), improving access to care using evidence-based models, improvement of transition planning from inpatient care to the community, and raising awareness on pregnant and parenting women with SUD as a public health issue.

The Council developed a Resource Document on Education and Training for Substance Use Disorders, and developed an advocacy brief that emphasizes the need for more education and training around substance use. Following changes to the DATA Waiver requirements, the document has been used to advocate for comprehensive SUD education and training that is available to all medical students. The Council is also involved in a variety of training opportunities for psychiatrists and other interested clinicians.

In collaboration with AAAP, the Council and developed a two-part webinar that provided an overview and updates on cannabis use in patients, mental health impacts and clinical practice recommendations based on the latest research and answered attendee questions on cannabis in psychiatry/addiction psychiatry patients based on the latest research. As more states legalize cannabis use and access increases, we must carefully consider the impact on children and adolescents. Risk perception around the harms of cannabis is decreasing among youth, another cause for concern. Expansion in medical uses of marijuana, despite lack of scientific evidence, FDA approval, and regulation, introduces access to a potential comfort therapy for life threatening and severely debilitating conditions, but this access must be weighed against the risks of introducing an addicting substance into a still-developing brain. Over 1000 people registered for each of the webinars.

In December, two online toolkits were released by the Council focused on tobacco smoking cessation and cannabis for both patients and clinicians. The toolkits include information on various aspects of treating tobacco use disorders and cannabis use disorders, including clinical, training, and policy considerations. There are plans to create toolkits on additional subjects of interest.

To better understand the impact of COVID-19 on treating patients with substance use disorders, the Council developed a COVID-19 addiction clinician survey from the group, which focuses on the lifted restrictions on substance use treatment and barriers that providers have encountered. The survey was completed in October and was disseminated among the Council’s networks. An advocacy document was developed using the survey results to highlight some practice and treatment considerations from lessons learned during the COVID-19 pandemic.

The Council on Advocacy and Government Relations

Katherine Kennedy, M.D., Chairperson

Federal Affairs

Mental health parity.

Congress included APA’s signature parity compliance legislation in its 2020 December end of year package, the Consolidated Appropriations Act (CAA). APA’s legislation, which is now law, gives the U.S. Department of Labor (DOL) new powers to regulate ERISA plans that are found to be out of compliance with the parity law and applies those same criteria to plans in every state, whether or not they have passed the model parity legislation. APA is now advocating for additional funding to implement enforcement of the law through the appropriations process for DOL and through new legislation authorizing parity implementation grants for state insurance departments. Specifically, APA has developed the Parity Implementation Assistance Act, H.R. 3753/S.1962 that was introduced in the House by Reps. Cardenas (D-CA) and Fitzpatrick (R-PA) and Sens. Murphy (D-CT) and Cassidy (R-LA). The bill makes grants available for state insurance agencies to enforce parity at the state level. APA led a letter to the bill coleads signed by 46 groups of the Mental Health Liaison Group in support of H.R. 3753/S.1962. APA is also advocating for additional funding through the annual appropriations process for DOL to enforce the parity law with ERISA plans.

Telehealth.

In the December 2020 Consolidated Appropriations Act (CAA), Congress included provisions to expand telehealth by permanently removing geographic and site-of-service restrictions in Medicare and allowing mental health services in a patient’s home. Previously, substance use disorder and co-occurring psychiatric services were exempt from these Medicare restrictions, but not mental health alone. Unfortunately, a provision within the CAA also passed that requires an in-person visit within six months of a telehealth visit for mental health-only, which APA and other coalition partners are advocating to repeal. The newly enacted long-term expansion for mental health services goes into effect after the Public Health Emergency (PHE) ends, though APA is working with coalition partners to extend current COVID-related telehealth flexibilities by at least one year after the PHE expires, including those for audio-only. The APA is also supporting legislation (H.R. 4058 / S. 2061) that specifically removes the 6-month in-person requirement for mental health, which was introduced by Reps. Dorris 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).

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 Bob Menendez (D-NJ), who leads the companion legislation in the Senate. This legislation would reauthorize and double the funding for the Minority Fellowship Program (MFP); increase authorized funding by $650 million per year for five years to the National Institute on Minority Health and Health Disparities; 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 (HHS) with grant authority to develop best practices around health disparities.

Psychiatric collaborative care model.

APA has developed new legislation to enhance the integration of behavioral health with primary care and is working with Reps. Lizzie Fletcher (D-TX) and Jamie Herrera Beutler (R-WA) to introduce it. The legislation would encourage greater uptake of the Psychiatric Collaborative Care Model (CoCM) by 1) authorizing grant funding for primary care practices to establish Collaborative Care arrangements; 2) authorizing funding for national and regional technical assistance centers; and 3) authorizing funding for research into other promising integrated care models. APA staff are also working with Senate offices to secure introduction of companion CoCM legislation. In addition to the APA, CoCM legislation is supported by the American Academy of Child and Adolescent Psychiatry, American Academy of Family Physicians, American College of Physicians, Association for Behavioral Health and Wellness, Meadows Mental Health Policy Institute, National Alliance of Healthcare Purchaser Coalitions, National Association of Social Workers and the National Council for Mental Wellbeing.

House appropriations.

Throughout the fiscal year 2022 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, in July the U.S. House of Representatives passed a “minibus” package consisting of seven appropriations bills which proposed significant increases for mental health and substance use programs, some at unprecedented high levels. Highlights of that package include a 50% increase for SAMHSA, new funds for the federal enforcement of mental health and substance use parity requirements, and significant resources directed toward research into both health disparities and firearm injury and mortality prevention. The legislation also proposed to more than double funding for the Mental Health Block Grant with a $825 million increase, and simultaneously boost the crisis services set-aside from 5% to 10% of block grant funds. The report on the bill credits a subcommittee hearing, at which APA, represented by Dr. Charles Dike, was the lead witness, for a proposed new $100 million pilot program to support mental health mobile crisis response in lieu of police.

Federal Advocacy Conference.

APA hosted its 2021 Federal Advocacy Conference virtually the first week of June, featuring a record 126 member participants. Attendees spent the day on June 5th with organization leadership and staff learning about APA priority issues at the federal level, including equity in mental health, implementation of the Collaborative Care Model and funding to enforce the mental health parity law. Then, on June 10th, attendees brought psychiatry’s message to 150 congressional offices to advocate on these and other issues important to psychiatry. As a result of efforts made by participating APA members, more than 30 congressional offices signed on as cosponsors of APA priority legislation.

State Affairs

District Branch Advocacy Collaboration Workgroup.

The Council established the District Branch Advocacy Collaboration Workgroup, charged with identifying new pathways of support for district branch state legislative efforts. The workgroup innovated the 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 Forum meetings. The first Forum meeting was held in June 2021 and the next is scheduled for September 2021. 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 2021, state-led initiatives included supporting telemedicine, mental health parity, the Psychiatric Collaborative Care Model, and opposing unsafe prescribing.

Telemedicine.

Last year, many states made positive, but temporary, changes to telemedicine; APA developed model legislation to make these temporary changes permanent. APA provided draft telemedicine legislation to 25 district branches in 2020 and 2021. So far this year, 26 states have enacted positive telehealth laws, and Georgia and Oklahoma both adopted APA’s model telehealth legislation. APA continues to work with district branches who wish to secure positive telehealth coverage and access laws.

Parity.

APA 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 fifteen states (Ariz., Colo., Conn., D.E., Ill., Ind., K.Y., Md., M.T., N.V., N.J., Okla., Ore., Tenn., W.V.) and DC. Kentucky, Montana, Nevada, and Oregon’s bills were signed into law this year. Several other states have enacted partial versions of this law. APA continues to partner with states to help them achieve full parity compliance.

Psychiatric collaborative care model.

As another means to safely increase 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. Collaborative Care legislation was signed into law in Montana in May, and Texas signed into law legislation requiring Medicaid to cover Collaborative Care codes. New Hampshire and New Jersey also introduced such legislation this year. APA is working closely with several other district branches that are interested in pursuing the Collaborative Care Model in the next legislative session.

Safe prescribing.

In 2021, state legislatures have seen over 65 pieces of legislation from nurse practitioners (NPs) and physician assistants (PAs) seeking new authorizations to practice without any physician involvement. APA has worked closely with at least 30 district branches this year to oppose this kind of legislation, and has shared talking points, educational comparison charts, and other important data with all district branches. In June, the American Academy of Physician Assistants’ Assembly voted to change the “physician assistant” title to “physician associate.” APA issued a statement in opposition to the change due to the confusion it would cause patients. APA continues to oppose psychologist prescribing in the states. Each psychologist prescribing bill was defeated so far this year, and APA will continue to work with district branches to oppose the practice of medicine by psychologists, who lack medical training.

Committee on Advocacy and Litigation Funding (CALF).

As part of APA’s state advocacy efforts, the Committee for Advocacy and Litigation Funding (CALF), currently chaired by Dr. Bhasker Dave, reviews district branch/state association grant requests for specific public affairs challenges on the state level. Due to limited budgets in many of APA’s district branches/state associations, CALF grants are heavily relied upon by states in confronting new legislative policy challenges. Once CALF approves an initial request from a district branch/state association, the request is sent to voting members of CAGR to approve, and the Board of Trustees (BOT) makes the final determination to award a grant. Between September 2020 and July 2021 of this year, CALF, CAGR, and the BOT had approved CALF grants to Kentucky, New Jersey, North Dakota, Pennsylvania, and Utah.

The Council on Children, Adolescents, and Their Families

Gabrielle Shapiro, M.D., Chairperson

The Council on Children, Adolescents, and Their Families 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 primarily through regular meetings, developing policies and educational resources, and collaborating with other APA components and allied children and adolescent organizations, including the American Academy of Child and Adolescent Psychiatrists.

Educational Resources and Policies

The Council and its components developed the “Resource Document on How Psychiatrists Can Talk with Patients and Their Families About Race and Racism,” which the APA approved. It was developed following discussions with Cheryl Wills, M.D., Chair, APA Presidential Task Force on Addressing Structural Racism Throughout Psychiatry on how the Council could support the work of the Task Force. This document involves several of the Council’s workgroups and members, including APA/APAF Fellows. It incorporates background information, guidelines for clinical work, questions for starting a dialogue with patients about race and racism, tools for assessing experiences of racial groups and discrimination, clinical vignettes, and resources for providers, children, and their families. Several Council members also developed a Psychiatric News article highlighting the importance of the Resource Document.

The Council and its components also developed and supported the development of the following position statements, which the APA approved:

• Position Statement on Suicide Among Black Youth in the United States

• Position Statement on the Impact of Cannabis on Children and Adolescents

• Position Statement on Medicaid Coverage for Maternal Postpartum Care

• Position Statement on Growing Fear Over Coronavirus Spread & Mental Health Impact in ICE Detention Centers

• Position Statement on Screening and Treatment of Mood and Anxiety Disorders During Pregnancy and Postpartum

• Position Statement on Sexual Abuse of Migrants in ICE Custody

• Position Statement on Abortion and Women’s Reproductive Health Care Rights

• Position Statement on Misogyny and Gender Bias and Their Adverse Effects on the Health of Women

The Council and its components developed and supported the update and development of the following position statements and resource document which were in the approval process at the writing of this report:

• Position Statement on Recognizing Childhood Trauma in the Setting of the COVID-19 Pandemic and Race-Related Challenges to Human Rights

• Position Statement on Need to Train Psychiatrists in Provision of Care and Support to Individuals with Differences of Sex Development and Their Families

• Position Statement on Adolescent Substance Abuse

• Position Statement on Psychiatric Hospitalization of Children and Adolescents

• Position Statement on Sexual Harassment

• Position Statement on College and University Mental Health

• Position Statement on Trial and Sentencing of Juveniles in the Criminal Justice System

• Position Statement on Youth Vaping Epidemic

• Position Statement on Reference to Suicide in Communications and Media

• Position Statement on Police Interactions with Children and Adolescents in Mental Health Crisis

• Resource Document on Approaches to Youth in Mental Health Crisis

The Council developed the “Resource Document on Approaches to Youth in Mental Health Crisis” to complement the “Position Statement on Police Interactions with Children and Adolescents in Mental Health Crisis.” The Resource Document overviews contemporary models for approaching youth in a mental health crisis with a practical, solution-oriented focus and emphasizes de-escalation and rapid linkage to clinical evaluation services. It supports the APA goal of ensuring young people in mental health crises and their families receive support from first responders who are appropriately trained to address their needs.

The Council coordinated with AACAP to review and update the Joint AACAP/APA ADHD Parents’ Medication Guide. The guide is an initiative to have information for parents on all types of psychiatric illness medication for children and adolescents. The Council reviewed and updated the following public education webpages on the APA website: ADHD, Intellectual Disability, Autism, Disruptive and Conduct Disorders and Specific Learning Disorder.

Council members presented in ten sessions and two poster presentations during the virtual 2021 APA Annual Meeting. Presentation topics included social media, collective trauma, learning gaps, racial injustice, LGBTQ, ethics, and telepsychiatry. The Council uses social media to disseminate its work to the public and through articles in Psychiatric News.

Council Collaborations

Several components report to the Council, including the Committee on Women’s Mental Health, the Caucus on College Mental Health, and the Caucus of Psychiatrists Treating Persons with Intellectual Disabilities. In addition to coordinating with these components on the above work, along with other groups and individuals, the Council and its component members work in collaboration in the following areas:

• Advancing Equality in Medicine: The Committee on Women’s Mental Health and the Caucus on College Mental Health are supporting efforts, along with several other components, including Council Members, following the approval of the Assembly Action Paper on Advancing Equality in Medicine. This includes developing a mentorship toolkit incorporating aspects of the Council’s mentorship program and input from other components.

• Immigrant Mental Health: Council members participated in a cross-Council workgroup to review and consolidate position statements addressing immigrant mental health, including children, adolescents, and their families, which are currently undergoing the approval process.

• Telehealth and Audio Only Care: Council members participated in a cross-Council workgroup to better understand the current landscape and develop an advocacy agenda with recommendations based on existing data for audio-only care.

Additionally, the Women’s Committee has been working on position statements and presentations on maternal psychiatry and collaborating with AACAP and the American College of Obstetricians and Gynecologists to set a new standard of care to evaluate depression in women during health screenings. As the APA is part of the Higher Education Mental Health Alliance, the College Mental Health Caucus works with the ten organizations represented in the alliance to create guides on college mental health issues to educate campus partners.

The Council also recently reviewed and updated its workgroups to focus on the following topics within Child and Adolescent Psychiatry:

• Disparities and Suicide Prevention in Youth

• Crisis Response

• Early Access to Care, Identification of Social Determinants, and Prevention

• Digital Medicine and social media

• Immigration

The Council continues to discuss current developments impacting these and other areas and identifies opportunities for collaboration and partnership.

Mentorship Program

As the development of mentorships and sponsorship programs and opportunities expands across the organization, the Council is available to provide input and guidance following a successful mentorship program in the Council pairing the APA/APAF Fellows on the Council with Council members. The mentorship program involves mentors and mentees reviewing a mentorship guide outlining expectations and approaches, mentees identifying three goals to accomplish with the support of mentors, both mentors and mentees signing an agreement to stay connected, and an opportunity for mentors and mentees to share feedback, through a survey every 3-months, about their experiences and areas for improvement.

The Council on Communications

Isabel Norian, M.D., Chairperson

The Council on Communications presented two action items for the consideration of the Joint Reference Committee in June. The first was a recommendation to retire the 2016 position statement on Direct-to-Consumer Advertising. The second is a proposed position statement on Reference to Suicide in Communications and Media, drafted in a joint effort with the Council on Children, Adolescents and their Families.

In response to JRC Feedback, the Council is working on a revision to the 2016 position statement on Direct-to-Consumer Advertising. The Council will seek feedback from other APA components before submitting a draft, with the revised position statement targeted for presentation to the JRC in late 2021.

The JRC also recommended that the Council on Communications and Council on Children, Adolescents & Their Families collaborate on an effort to turn the proposed position statement into a resource document on Reference to Suicide in Communications and Media. This effort is currently ongoing with a target date of early 2022.

Additionally, the Council was asked to provide feedback regarding an Action Paper calling for a Task Force to explore the possibility of APA’s undergoing a name change. The Council offered its support for the asks of this Action Paper, with the following additional comments:

• The Council takes no position on whether or not APA should indeed undergo a name change.

• For a proposal as largescale as the potential change of the organization’s name, a robust structure for research, exploration, and decision-making is indicated.

• Despite considerable financial and human resources cost implications, a Task Force is the most fitting structure to take on this question and report its findings back to the membership.

In March, the Council submitted a collection of resources to the Clearinghouse Committee of the Task Force to Address Structural Racism, for consideration for the “Recommended Reading” section of the Task Force web page. The Council has approved an equity lens affirmation to be included at the outset of all meetings, which charges it with considering the potential impact, both benefits and harms, of the Council’s and the APA’s policies and practices on people of marginalized groups.

Other recent Council business has focused on a Social Media 101 webinar that was piloted for APA Fellows and then presented in a slightly altered format for APA On Demand at the 2021 Annual Meeting. Plans are underway to develop a Part II of this Webinar to offer members more advanced training on professional social media use. The initial webinar has also led to other workshops, such as an Intro to Opinion Writing session that the Council presented to APA Fellows as part of the new Professional Development Series. The Council has plans to carry out another virtual training before the end of 2021. Further trainings on a variety of topics are being planned out for the 2022 calendar year with the assistance of APA staff.

The Council is in the process of undertaking page reviews of the Patient & Family section, the Social Media section, and the Media and Communications section on Psychiatry.org. The Council continues to coordinate with the Office of Communications to amplify APA events and materials through Council members’ social media channels and professional networks.

The Council on Consultation-Liaison Psychiatry

Sejal Shah, M.D., Chairperson

The Council on Consultation-Liaison (C-L) 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.

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 trained in Consultation-Liaison Psychiatry can provide valuable insight and expertise. The Council serves as an important resource to the APA administration on best practices for integrating behavioral health into medical care, and is active in identifying ways to educate medical students and residents about the field. To encourage more medical residents to join the subspeciality, the Council, in collaboration with the Academy of Consultation-Liaison Psychiatry (ACLP), hosted a webinar for the second year focused on how to apply for a Consultation-Liaison Psychiatry Fellowship during COVID-19. Work is underway to plan a follow-up webinar focused on identifying career opportunities in Consultation-Liaison Psychiatry. The Council members and the ACLP continue to look for opportunities to work together and coordinate work.

The Council continues its series of articles for Psychiatric News to help members understand the work of Consultation-Liaison Psychiatrists following its name change from Psychosomatic Medicine. Published articles include:

Articles in the que waiting to be published include:

In addition, the Council formed a workgroup of experts in Addiction and C-L Psychiatry to develop a new Resource Document for psychiatrists, focused on treatment of opioid use disorders (OUD) in the general hospital setting. The workgroup held a virtual meeting on December 2, 2020, to learn from societies of other medical specialties about the challenges of working with patients with OUD in the general hospital setting; specifically, to learn more about specialty-specific approaches to patients with OUD, barriers for using medication treatment (buprenorphine, methadone, naltrexone) for OUD in the hospital, and the best role for in-hospital psychiatrists to support their colleagues across specialties.

C-L Psychiatrists have been at the forefront of supporting front-line workers deal with the emotional strain of COVID-19. As cases have risen beyond capacity in some places in the US, healthcare workers have been stretched to the limits of their abilities and forced to consider triaging valuable resources, such as ventilators.

The HIV Steering Committee, which is overseen by the Council on C-L Psychiatry, was able to move its Medical Student Elective to a virtual program and expand the number of participants. The program provides fourth year medical students an opportunity to participate in a month-long clinical elective in HIV psychiatry at one of several prominent universities across the country. The elective includes an intensive, four (4) week online training Monday, August 30 – Friday, September 25, 2021, covering topics such as neuropsychiatric complications of HIV, sociocultural aspects of HIV and health disparities, somatic complaints, mood disorders, treating co-occurring substance use disorders, and more. The heart of the program is in establishing a mentoring relationship at one of several virtual sites, becoming involved with a cohort of medical students interested in HIV medicine/psychiatry, participating in an interactive didactic/experiential online learning program, virtual journal discussions, case vignettes, and process groups, and moving students toward high achievement in HIV-related mental health research or psychiatric services. The program pays specific attention to issues related to diversity, equity, and inclusion.

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 undertook an extensive revision of the position statement on “Substance Use in Older Adults.” The revised statement was approved by the Joint Reference Committee (JRC) and the APA Assembly and is awaiting final approval from the APA Board of Trustees.

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, the Council agreed to retain the statement. Council requested that these additional councils – Ethics, Psychiatry and Law, Quality Care, Government Relations and Advocacy, also review the position statement for their input before submission to the JRC for approval.

The Council was asked by the Research Council to provide feedback on the use of Emotional Support Animals in psychiatric populations. Council noted that there is currently no formal certification process to qualify an individual for use of an animal as an ESA, and suggested that the statement could offer recommendations to individual clinicians who receive requests to authorize ESAs.

Telepsychiatry As A Means of Increasing Access to Mental Health Services for Older Adults

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

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

ICD-10-CM

In 2019, a group of leading geriatric psychiatrists, including several Council members, submitted a proposal to the CMS requesting a revision of existing codes and the creation of new codes for specific conditions that occur in association with dementia. The National Minority Quality Forum Executive Summary: 8.F Page 4 of 5 spearheaded this effort on behalf of psychiatrists and neurologists, asking for enhanced specificity in coding to capture the severity of dementia and the particular noncognitive behavioral and psychological symptoms of dementia for which they are providing treatment. Dr. Maureen Nash reported about the March 2021 meeting where she presented the proposal with neurologists. The presentation was well received by the coders present at the meeting, as well as APA and AAN representatives. Dr. Michael First, APA liaison to the ICD harmonization process, also supported the proposal. More updates are forthcoming for the council members.

The Intersection Between Geriatric Psychiatry and Community Psychiatry

During the 2019 Fall Component Meeting, the Council discussed the interface of geriatric psychiatry with community psychiatry. A new Fellow on the Council suggested that the Council reach out to trainees interested in community psychiatry to highlight the opportunities at this interface so that they might consider training in geriatric psychiatry. Several Council members have worked at and written about this interface and offered to work on the project. Council published its first article on this topic in Psychiatric News.

Council Response to COVID-19

The COVID-19 pandemic is having a profound impact on older adults, particularly those with mental illness. Inspired by the experience of having published “Culture, Heritage, and Diversity in Older Adult Mental Health Care” (American Psychiatric Association Press, 2019), the Council has pulled together the lessons of the current pandemic this year and developed a volume on pandemic preparedness for older adults. Drs. Robert Roca, Micheline Dugue and Maria Llorente, are the editors of the book. Final drafts of all chapters were submitted by the authors, and editors reviewed them. All chapters have now been finalized and sent to APPI Press for formatting and publishing.

Resource Document on Impact of Racism Among Older Adults

During the 2020 Fall Component Meeting, Dr. Cheryl Wills informed the Council about the work that the APA Taskforce on Structural Racism was doing. Dr. Wills provided the background on the task force's development and presented the taskforce's goals and objectives. She invited the Council to join the efforts and contribute to the cause. The Council’s 2020 Chair, Dr. Roca discussed the potential idea of developing a document on how to talk about racism with patients who are older adults. Council took that year to draft a resource on The Impact of Racism in Older Adults. A working group (Drs. Dahl, Roca, Llorente and Ali) was formed to brainstorm different ideas and decide on the content and outline of a proposed document. The work group aims to develop the draft document before the 2021 Fall Component Meeting.

Mentorship Toolkit Workgroup

Dr. Maria Llorente is representing the Council on the workgroup that is charged to develop a mentorship toolkit for the APA. Other components of the workgroup include Committee on Women’s Mental Health, Council on Medical Education and Lifelong Learning (CMELL), Caucus on Leadership and Entrepreneurship, Council on Minority Mental Health and Health Disparities, and Council on Research. Dr. Llorente reported that the program was initiated by the women’s committee and was inspired by the shortage of mentorship opportunities for women residents and psychiatrists, as well as individuals from minority groups. The toolkit covers topics such as introduction to mentoring, role of mentors and mentees, administrative mentoring, mentoring in research, mentoring women, ethnically diverse and underrepresented minority psychiatrists in medicine. The JRC has reviewed the toolkit and is pleased with the product.

The workgroup will meet to finalize the toolkit by the September Components meeting.

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 a number of 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 healthcare reform, quality and payment reform.

The Council convened a work group on independent practice/supervision with members from the Council on Quality, the Council on Government Relations, and the Council on Psychiatry and the Law. Members of the Council also participated in a work group led by the Council on Advocacy and Government Relations focused on drafting a Resource Document on Advocating for Anti-Racist Mental Health Policies. In addition, CHSF has also been involved in a multicomponent group tasked with revising APA’s Telemedicine in Psychiatry policy, in the wake of the COVID-19 pandemic.

CHSF members continue discussions on timely issues in psychiatry ranging from the long-term effects of the COVID-19 pandemic in practice settings, to Collaborative Care Model legislation and legislation on network adequacy, to the availability of mental health counseling at CVS clinics. Council members provide advice to the administration, compare experiences, offer insight, and monitor these issues.

Aside from these projects, 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.

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, Henry Chung, M.D., Chairperson

The Committee on Integrated Care, developed a guide on The Role of Psychiatrists in the Equitable Distribution of the COVID-19 Vaccine, along with an article published in Psychiatric News to highlight a case study on successfully vaccinating people with serious mental illness in an inpatient psychiatric unit. APA used the document to advocate, both at the federal and state levels, the need to prioritize vaccinating people with mental illness and substance use disorders. The Committee worked with members of the APA Committee on Psychiatric Dimensions of Disaster, Council on Communications, Council on Minority Mental Health and Health Disparities, and Council on Healthcare Systems and Financing to develop the document.

Lastly, a workgroup was formed to develop guidance on how to bill add-on codes for smoking cessation. 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.

Committee on RBRVS, Codes and Reimbursement, Gregory Harris, M.D., M.P.H., Chairperson

Following successful advocacy to reduce burdensome documentation and increase reimbursement, members of the Committee have been focused on developing educational resources on the recent changes to the outpatient evaluation and management (E/M) codes that went into effect January 1, 2021. In addition, 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; 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

The Committee submitted revised the existing position statement on Core Principles for Alternative Payment Models to reflect the need for models to address health equity. Members provided feedback on the advocacy efforts directed to ensure appropriate coverage and reimbursement for psychiatric services during the COVID-19 Public Health Emergency (PHE). This included providing feedback and support to member volunteers who wrote an article on the financing of psychiatric services during the PHE. In addition, members continue to monitor emerging alternative payment models and participate in discussions with the Council on Quality Care and the Administration on the impact on access to care of proposed episode-based cost measures under MIPS.

Committee on Telepsychiatry, Jay Shore, M.D., Chairperson

The Committee on Telepsychiatry, chaired by continued to add resources to its Telepsychiatry Toolkit. Over the past year, the Committee has focused on developing new content for the Toolkit in response to the COVID-19 Public Health Emergency, as well as video interviews with Committee members detailing their experiences using telepsychiatry.

COVID-19 ushered in broad changes to the regulatory and legislative landscape around telehealth, and the Committee worked with APA staff to respond to these changes at the federal and state levels, advocating for continued flexibilities around telehealth practice (e.g., licensure, electronic prescribing via telehealth, audio-only telepsychiatry) and reimbursement. Additionally, the Committee worked with APA's Department of State Government Relations to develop model telehealth legislation. As a result, this model legislation has been adopted in part or in whole by 26 states as of July 2021.

The Committee also worked with members of APA's College Mental Health Caucus to publish College Mental Health, Telepsychiatry: Best Practices, Policy Considerations, & COVID-19, offering guidance on licensure, prescribing, billing, and other issues to psychiatrists on practicing telepsychiatry with college students.

The Council on International Psychiatry and Global Health

David C. Henderson, M.D., Chairperson

The Council on International Psychiatry and Global Health facilitates understanding of problems facing international psychiatrists and their patients. The Council Chair is Dr. David Henderson, the Chair of the Chester M. Pierce Human Rights Award Nominating Committee is Dr. Michelle Durham, and the Chair of the Caucus on Global Mental Health and Psychiatry is Dr. David Baron.

WACP Statement on COVID-19 and Vulnerable Populations

The Council met with the leadership of the World Association for Cultural Psychiatry (WACP), including WACP President, Dr. Roberto Lewis-Fernandez, and Dr. Francis Lu to discuss APA supporting the recently developed WACP statement addressing the impact of COVID-19 on the mental and physical health and economic well-being of vulnerable populations around the world, as well as calling on governments to address the mental health and social impacts of the pandemic. The WACP Statement on COVID-19 and Vulnerable Populations overlapped in content and intent with the APA Guidance Document on COVID-19 and the APA Board of Trustees approved a commendation of the WACP Statement on COVID-19 and Vulnerable Populations which is available from the WACP website.

Council Name and Charge Update

The Council met with APA President, Dr. Jeffrey Geller, to discuss a proposal to change the Council name and charge, incorporating population health into the charge and name. The Council and the Caucus reviewed and updated the proposal and the Joint Reference Committee conducted a survey of the Council’s activities receiving feedback from other APA components. The APA Board of Trustees approved changing the name of the Council on International Psychiatry to the Council on International Psychiatry and Global Health and incorporated language to bring global perspectives of individual, family, culture, and population-based approaches for understanding mental health, well-being and the treatment and prevention of psychiatric illnesses to the mission of the APA. The updated charge also emphasizes a focus on international membership, developing partnerships with national and international organizations, supporting the transformation of psychiatric education to a global setting and promoting human rights advocacy. To see the full charge of the Council, go to the APA website under “Councils.”

2021 APA Annual Meeting

Council and Caucus members presented as part of the 2021 APA Annual Meeting in the following sessions in the virtual program and/or the APA OnDemand product:

• - Dr. Xiaoduo Fan: “US-China Collaboration to Advance Mental Health Service and Research in China”

• - Dr. Bernardo Ng: “Latinx/Hispanic Communities and Mental Health: Identifying Barriers to Access and Potential Solutions During Unsettled Times”

• - Dr. Samuel Okpaku: “Predicting the Future of Global Mental Health: Implications During COVID-19 and Post COVID-19”

• - Dr. Ed Pi: “Asian American Mental Health and Racism During and Post Covid-19”

World Psychiatric Association (WPA) leadership, in coordination with APA leadership, were also accepted to present “WPA’s and APA’s Response to the COVID-19 Pandemic–Parts 1 and 2.”

During the Annual Meeting, the Council met virtually with the leadership of the following international psychiatric organizations to discuss the mental health impact of COVID-19 and identify potential opportunities for collaboration and partnership as well as areas of focus for consideration by the Council.

• - Dr. Afzal Javed, President, World Psychiatric Association

• - Dr. Adrian James, President, Royal College of Psychiatrists

• - Dr. Bernardo Ng, President, Mexican Psychiatric Association

• - Dr. James Griffith, President, Society for the Study of Psychiatry and Culture

The Council also met with psychiatrists part of the African Global Mental Health Institute and the APA International Poster Engagement Program including Dr. Anusha Lachman of Stellenbosch University in South Africa and Dr. Marlon Edu Saavedra Delgado of the Mexican Psychiatric Association.

The 2021 APA International Poster Engagement Program, coordinated by the Council, was conducted virtually, due to the APA Annual Meeting being virtual, and included 17 submissions from the following 12 countries:

• - Argentina

• - Bangladesh

• - Brazil

• - Canada

• - Finland

• - India

• - Italy

• - Mauritius

• - Mexico

• - Russia

• - Thailand

• - United States

The program focuses on expanding networks, professional enrichment, and bilateral learning. Participants include medical students, residents, and early career psychiatrists accepted to present their research during the APA Annual Meeting international poster sessions. Program reviewers consist of Council and Caucus members to provide feedback on the format, layout, scientific content, method, analysis, communication, and presentation of their research poster. The Council hopes to continue to increase the number of participants in the program next year and conduct the program in-person during the 2022 APA Annual Meeting.

Global Mental Health

Council members supported the update of the APA Global Mental Health webpage which includes global mental health resources to support education and training on global mental health topics for medical students, residents, and psychiatrists. It includes a link the “Resource Document on Developing a Global Mental Health Curriculum in Psychiatry Residency Programs” developed by the Council last year as well as other resources relevant to COVID-19 and global mental health from various international institutes and organizations. The webpage can be accessed at www.psychiatry.org/globalmentalhealth.

Under the previous Caucus Chair, Dr. Samuel Okpaku, the Caucus on Global Mental Health and Psychiatry, continued an advisory group of past Caucus Chairs including Drs. Milton Wainberg, Eliot Sorel, Khurshid, Vincenzo Di Nicola, Gabrielle Ivbijaro, and Geetha Jayaram. It was decided that the tenure of the Caucus Chair will be two years and that the advisory group will become the leadership of the Caucus. The 2021 election of the new Caucus Chair included Dr. Marsal Sanches and Dr. David Baron with Dr. Baron receiving the majority of votes to become the new Caucus Chair. Dr. Baron has begun coordinating with the past Caucus Chairs and the Council to identify priorities for the Caucus during his term as Chair.

World Psychiatric Association

In October 2020, Dr. Afzal Javed, a consultant psychiatrist at the United Kingdom National Health Service (NHS) and Honorary Chairman of the Pakistan Psychiatric Research Center, assumed the role of WPA President, launching the WPA 2020–2023 Action Plan. Dr. Danuta Wasserman of the Karolinska Institute in Sweden was elected as WPA President-Elect along with the following Council members who were elected to the WPA Executive Committee and Board:

• WPA Secretary for Finances: Dr. Paul Summergrad

• WPA Secretary for Scientific Meetings: Dr. Ed Pi

• WPA Zone 2 (United States) Representative: Dr. Bernardo Ng

The Council continues to stay connected with WPA on its activities through its representatives and work together with its leadership and components on various topics, including developing policy and guidance on the use of psychiatric institutions for the commitment of political dissenters.

Chester M. Pierce Human Rights Award

At its December 2020 meeting, upon recommendation by the Council, the APA Board of Trustees approved awarding the 2021 APA Chester M. Pierce Human Rights Award to the following individuals:

• Patrisse Cullors is a New York Times bestselling author, educator, artist, and abolitionist. Cofounder of the Black Lives Matter Global Network Foundation, Patrisse has been on the frontlines of abolitionist organizing for 20 years. Since she began the Black Lives Matter movement in 2013, it has expanded into a global foundation supporting Black led movements in the US, UK, and Canada and she was nominated for the 2021 Nobel Peace Prize. A full bio is available at patrissecullors.com.

• Alicia Garza believes that Black communities deserve what all communities deserve - to be powerful in every aspect of their lives. An innovator, strategist, and organizer, she is the cocreator of the Black Lives Matter Global Network, an international organizing project to end state violence and oppression against Black people. A full bio is available at aliciagarza.com.

• Opal Tometi is feminist freedom-fighter, a global icon, and one of the most influential human rights leaders of our time. She is one of the three women cofounders of the Black Lives Matter movement. The award-winning advocate, strategist and writer has used her voice to ensure that race, immigration, and gender justice remain at the forefront of global conversations. A full bio is available at opaltometi.org.

The Board of Trustees also approved having the award be presented to either an individual or organization in alternating years. The 2022 award will be presented to an organization promoting the human rights of populations with mental health needs. Dr. Michelle Durham was appointed as the new Chair of the Chester M. Pierce Human Rights Award Nominating Committee and additional appointments to the Committee are being finalized.

Additionally, in April 2021 a work group of members including Council and Caucus members began working with the APA Foundation on an endowment campaign to fund the award. While award recipients have been recognized with a plaque at the APA Annual Meeting, an endowment would provide award recipients with an APA Annual Meeting lectureship, honorarium, and related expenses. The campaign seeks to secure $100,000 in pledge commitments by September 2021. To learn more about Dr. Chester Pierce, including the multiple roles he held throughout his career impacting health disparities and global mental health, go to the APA website under “Awards” and review his bio.

The Council on Medical Education and Lifelong Learning

Eindra Khin, M.D., Chairperson

The Council on Medical Education and Lifelong Learning monitors emerging issues in psychiatry education and facilitates the development of education resources and programs. The purview of the Council includes medical education, graduate medical education for residents and fellows in psychiatry (both basic education and subspecialty areas), psychiatric aspects of graduate medical education for other medical specialists, and postgraduate continuing medical education and lifelong learning. The Council acts in an advisory role to the APA Division of Education in the development of continuing education programs and initiatives.

To facilitate collaboration and communication, the Council serves as a convening body for the allied psychiatry education organizations, including the American Association of Directors of Residency Training (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 Workgroup 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:

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.

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 Council is currently working on the revised position statement based on the Board of Trustees’ feedback.

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 draft was submitted to the Joint Reference Committee (JRC), and the JRC commended the workgroup on this cross-collaborative effort. The multi-Council workgroup is submitting the revised draft back to the JRC based on its official feedback.

APA Response to the ABMS Draft Standards for Continuing Certification

The Council convened a workgroup to assist the APA leadership in developing an assessment and response to the American Board of Medical Specialties (ABMS) Draft Standards for Continuing Certification. The ABMS released the draft standards on April 21, 2021, with the call for comment ending on July 8, 2021. The workgroup examined each of the 20 recommendations but also all the standards as a whole. The workgroup identified two main issues (cost and lack of evidence) associated with the revised standards.

This same workgroup led the Council’s effort to develop survey questions designed to collect information on APA members’ attitudes and beliefs about the current ABPN Maintenance of Certification (MOC) process. The survey was sent to a stratified sample of APA members in collaboration with Division of Research. The survey results are to be published in Psychiatric News.

Presidential Task Force to Address Structural Racism Throughout Psychiatry

The Council collaborated with the Council on Children, Adolescent, and Their Families, who has developed a training document on how to have discussion about race relations with patients and families. The Council assisted in the dissemination of the resource document to our allied education groups (ADMSEP, AADPRT, AAP, AACDP).

Impact of COVID-19 on Psychiatric Education

As a convening body for Allied Psychiatry Education groups, the Council is continuing to monitor and discuss the impact and the opportunities in psychiatric education at all levels due to COVID-19.

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 would be a great opportunity to provide a space for them at the APA. 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.

Request by American Society of Clinical Psychopharmacology (ASCP) to Join CMELL

Dr. Mark Rappaport brought a request to the Council to consider American Society of Clinical Psychopharmacology (ASCP) to join CMELL as an affiliate organization. ASCP has one of their major missions as education with seven different editions of curriculum being used by many programs across the country. Since 1992, they have also had a training program to train investigators. ASCP is committed to midlevel career advancement as well. The Journal of Clinical Psychiatry is the journal of ASCP, with the focus on education, not only for medical students and residents but also for academics. Given this, this collaboration would contribute well to the missions of both the Council and ASCP. This action was approved to move forward.

Education Awards of the Council

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

The Council on Minority Mental Health and Health Disparities

Walter Wilson, M.D., Chairperson

Overview of Council

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

2020–2021 CMMH/HD Accomplishments and Initiatives

The following Positions Statements were developed by CMMH/HD and approved by APA Board of Trustees from 2020 to 2021:

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

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

• Xenophobia, Immigration, and Mental Health, 2020

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

The following Position Statement was sent to the CMMH/HD for review in 2021:

• Position Statement on Sexual Harassment, 2021

APA Strategic Plan Pillar Revision

The Council on Minority Mental Health and Health Disparities reviewed the third pillar of APA’s strategic plan and suggested revisions to expand the third pillar. The JRC reviewed and approved the revisions.

Racism in Black Mental Health

The Council on Minority Mental Health and Health Disparities produced the CME Module Racism in Black Mental Health. The learning module prepares contemporary psychiatrists to practice with an antiracism framework in the care of all patients, especially African Americans.

AB-1094 Sexual Orientation and Gender Identity Data Collection Pilot Project

The Council on Minority Mental Health and Health Disparities reviewed and approved the APA’s endorsement of AB Sexual Orientation and Gender Identity Data Collection Pilot Project to collect data on violent deaths from data sources, including, but not limited to, death certificates, law enforcement reports, and coroner or medical examiner reports.

Draft Letter to DHS regarding J-1 Visa Proposed Rule

The CMMH/HD reviewed and approved the draft letter by the APA to regarding a recent Department of Homeland Security proposed rule establishing a fixed time period of admission and an extension of stay procedures for individuals in F, J and I status.

CAAPS Position Statement on Rapid Onset Gender Dysphoria

The Council on Minority Mental Health and Health Disparities reviewed and approved the Position Statement on Rapid Onset Gender Dysphoria.

Immigration Joint Workgroup

The Council on Minority Mental Health served on a workgroup with Council on Quality Care, Council on Children and Their Families to identify PS’s that relate directly to the issue of mental healthcare for immigrant detainees and consolidate statements that can be combined. The consolidation is complete and will be presented to the June JRC.

Faith Communities and the Well-Being of LGBT Youth Commendation: Caucus on Religion, Spirituality, and Psychiatry

After reviewing the document from the Council on Minority Mental Health and Health Disparities voted to approve support of the Group for the Advancement of Psychiatry (GAP) 2020 publication Faith Communities and the Well-Being of LGBT Youth commendation. The publication serves as a resource for faith communities to educate their members about the heightened risks for serious mental health consequences faced by LGBT youth and ways to mitigate those risks.

The Council on Psychiatry and the Law

Debra A. Pinals, M.D., Chairperson

The Council on Psychiatry and Law is responsible for evaluating legal developments of national significance that affect the practice of psychiatry and the availability and quality of mental health care, including case law, legislation, regulation, and all other forms of legal regulation of psychiatric practice. It includes a focus on practice areas such as correctional psychiatry, the interface of addictions and the law, 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 2020–2021.

Non-Emergency Involuntary Medication for Mental Disorders in U.S. Jails

The use of nonemergency involuntary medication is a clinical and legal process by which a psychiatric patient is administered medication after they have declined acceptance of prescribed medication for the ongoing treatment of a serious mental illness despite adequate efforts to encourage voluntary acceptance of the medications. Psychiatrists who work in jail settings will encounter patients for whom the administration of nonemergency involuntary medication is clinically indicated for the stabilization of their serious mental illness. The Council on Psychiatry and Law created this resource document to guide psychiatrists in decision-making about nonemergency involuntary psychiatric medication administration in U.S. jails by providing background information and highlighting issues for consideration. This resource document was approved by the Joint Reference Committee in October 2020 and is available at https://www.psychiatry.org/psychiatrists/search-directories-databases/library-and-archive/resource-documents.

Mental Health Courts

Mental health courts (MHCs) are one of a range of “problem-solving courts” operated on the premise that the criminal law can be used to therapeutic ends to the benefit of both individual defendants and society as a whole. Other examples of problem-solving courts include drug courts, homelessness courts, veterans’ treatment courts, and domestic violence courts. Many psychiatrists are unfamiliar with MHCs despite their rapid expansion in recent years. The Council on Psychiatry and Law created this resource document to describe the concepts behind and operations of MHCs and review their role and effectiveness. This resource document was approved by the Joint Reference Committee in October 2020 and is available at https://www.psychiatry.org/psychiatrists/search-directories-databases/library-and-archive/resource-documents.

Safe Consumption Facilities

In the context of the ongoing opioid overdose crisis, psychiatrists must be aware of the full range of policy, organizational, and public health strategies impacting the lives of people who use drugs. The Council on Psychiatry and Law and the Council on Addiction Psychiatry collaborated to create this resource document aiming to inform psychiatrists about one such strategy: Safe Consumption Facilities (SCFs, also known as “supervised consumption sites”), an approach that has long been a feature of harm reduction efforts in certain countries and that has attracted increasing attention in the United States. This resource document was approved by the Joint Reference Committee in February 2021 and is available at https://www.psychiatry.org/psychiatrists/search-directories-databases/library-and-archive/resource-documents.

Use of the Term “Excited Delirium” and Appropriate Medical Management in Out-of-Hospital Contexts

Police responses to calls for behavioral health crises have been known to result in tragic outcomes, including injury or death. The concept of “excited delirium” (also referred to as “excited delirium syndrome (ExDs)”) has been invoked in a number of cases to explain or justify injury or death to individuals in police custody, and the term excited delirium is disproportionately applied to Black men in police custody. The Council on Psychiatry and Law drafted a position statement asserting that acute medical conditions, including delirium, always require an appropriate medical response; therefore, it is the position of the APA that the term “excited delirium” (ExDs) is too nonspecific to meaningfully describe and convey information about a person. “Excited delirium” should not be used until a clear set of diagnostic criteria are validated. This position statement was approved by the APA Board of Trustees in December 2020.

Orchiectomy or Treatment With Anti-Androgen Medications as a Condition of Release From Incarceration

Since 1996, several states have enacted legislation that allows courts to require orchiectomy (i.e., surgical removal of the testicles) or treatment with antiandrogen medications as a condition of release from incarceration for individuals who have been convicted of certain sex offenses. The Council drafted a Position Statement opposing laws that require orchiectomy or treatment with antiandrogen medications as a condition of release from incarceration. The position statement asserts that orchiectomy or treatment with antiandrogen medications is appropriate only in cases where a psychiatrist has diagnosed a paraphilic disorder for which such treatment is indicated and where the patient has provided informed consent (https://www.psychiatry.org/home/policy-finder?k=ORCHIECTOMY).

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

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

SisterSong Women of Color Reproductive Justice Collective, et al., v. Brian Kemp, asserting that the Georgia House Bill 481 effectively eviscerates the constitutional right to abortion; Bristol Regional Women's Center, P.C., et al., v. Herbert H. Slatery III, et al., claiming that the mandatory waiting period of Tennessee Code Ann. § 39–15–202(a)-(h) was correctly held unconstitutional because it impermissibly obstructs patients’ ability to access abortion care safely and in a timely manner according to their treating physician’s best medical judgment; Planned Parenthood South Atlantic and Julie Edwards, v. Thomas Clark Phillip, Jr., stating that South Carolina’s attempt to exclude Planned Parenthood South Atlantic from its Medicaid program would be detrimental to public health; and Brandt v. Rutledge, advocating against House Bill 1570 that prohibits health care providers from treating patients at risk of or suffering from gender dysphoria with gender-affirming care. 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.

Other Topics

The Council continues to work on an array of topics, including correctional and telepsychiatry issues, discriminatory policies preventing access to housing and employment, medical euthanasia, racism and social determinants of health and inequities, restrictions on patient access to personal items while psychiatrically hospitalized, college and university mental health, and the public health and safety consequences of legalizing cannabis, and child civil commitment laws. Additionally, the Council frequently cross-collaborates with other APA components, including the Councils on Addiction Psychiatry, Mental Health and Health Disparities, Quality Care, Children, Adolescents and Their Families, and Research. The Isaac Ray Award Committee and Manfred S. Guttmacher Award Committee each report to the Council. The Isaac Ray Award recognizes a person who has made outstanding contributions to forensic psychiatry or the psychiatric aspects of jurisprudence; it was awarded to Dr. Roy O'Shaughnessy in 2021. The Manfred S. Guttmacher Award recognizes an outstanding contribution to the literature of forensic psychiatry; it was awarded to Drs. Debra Pinals and Lisa Callahan for their articles Challenges to Reforming the Competence to Stand Trial and Competence Restoration System and Evaluation and Restoration of Competence to Stand Trial: Intercepting the Forensic System Using the Sequential Intercept Model, both published in Psychiatric Services. Both committees are in the process of selecting 2022 award recipients. Additionally, the Council on Psychiatry and Law and Committee on Judicial Action will hold a joint session in September focused on transgender issues in civil and criminal settings.

The Council on Quality Care

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

The Council on Quality Care’s overarching goal is to ensure the highest standards of care remain an integral part of APA’s mission. To achieve this goal, the Council on Quality Care (hereafter referred to as “Council”) monitors advances, carries out activities, and disseminates information related to, but not limited to, the following areas: clinical practice guidelines; quality measures and performance indicators; implementation of patient registries; standards and survey procedures; clinical informatics that leverage health information technologies to improve care; and patient safety. The Council collaborates with other groups within APA’s governance structure to respond to topics of mutual concern, such as quality measures, accreditation standards, and the effects of quality improvement efforts on clinical practice, individual patient outcomes and general population health. The Council continues to give greater attention to counteracting structural racism and inequity by strengthening its collaboration with the Presidential Task Force to Address Structural Racism Throughout Psychiatry, the Council on Minority Mental Health and Health Disparities and other relevant Councils, as well as the APA Division of Diversity and Health Equity. In addition, the Council has tasked each reporting component to identify key tasks they can undertake to address this issue.

Committee on Mental Health Information Technology (CMHIT)

The Committee on Mental Health Information Technology, chaired by Dr. John Torous, continues to provide feedback to APA staff on letters to the Administration on federal regulations pertaining to digital health. Over the past year, they have responded to proposed rules and requests for information on electronic prescribing; interoperability and the Physician Fee Schedule; and other technology-focused proposed rules. Most recently, the CMHIT responded to a call to submit supplementary information to the Agency for Healthcare Research and Quality’s (AHRQ’s) Evidence-based Practice Centers’ (EPC) Program’s review of the evidence for its current work on technical brief, “Evaluation of Mental Health Applications.” APA submitted a letter highlighting our App Evaluation Model for inclusion into AHRQ's work on creating a framework for evaluating mental health mobile applications.

The CMHIT continues to work on gathering information on how third parties–especially payers–collect and use patient data. They have reviewed past APA policy, past and current AMA policy, as well as the relevant literature in order to develop the Position Statement as well as a Resource Document on the topic. Before moving forward, CMHIT will discuss how any Position Statement would intersect with future changes to Part 2.

The Committee on Mental Health IT has recently started meeting 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 currently writing a “Best Practices in Mental mHealth” guidance/resource document, which will be reviewed by the full CMHIT as a resource document 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.

Finally, the CMHIT continues to monitor the degree to which the Office of the National Coordinator for Health Information Technology (ONC)'s Final Rule on Interoperability and Information Blocking affects psychiatric practices. Members of this Committee joined with members from other Components to create an Intra-Component Working Group on the ONC Final Rule. Together, they developed key advocacy priorities for APA highlighting the concerns of psychiatry regarding provisions of Information Blocking and its 8 Exceptions. APA staff continue to use these talking points in advocacy meetings with the ONC and its new National Coordinator, and its Chief Medical Officer. The ONC has offered to work with APA in developing resources and other guidance on helping psychiatrists comply with the Rule.

Committee on Practice Guidelines

The Committee continues to focus on developing evidence-based practice guidelines to assist psychiatrists and others with clinical decision-making and the care of patients. There are currently three Guideline Writing Groups.

The first writing group, chaired by Dr. Victor Reus, is developing an updated guideline for the treatment of bipolar disorder based on an Agency for Healthcare Research and Quality (AHRQ) systematic review, along with supplemental reviews and an expert survey.

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

A third writing group, chaired by Dr. George Keepers, will begin work shortly 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 Committee is considering treatment resistant depression as an upcoming topic, but learned that the VA is currently undertaking a review of major depressive disorder and when completed, the Committee will assess for use as the basis of an APA guideline. Considering this, the committee chose to wait for this systematic review, and instead will move ahead with a systematic review on generalized anxiety disorder.

In 2020, the Committee, working with Guideline Central, produced its first pocket guides for schizophrenia and will be producing guides for future topics. In 2021 the Committee is exploring making guidelines computable and allowing for topics and recommendations to be searchable, embedding the guidelines into EHRs, and eventually developing electronic clinical decision support tools.

The Committee began reviewing other guidelines and materials for inclusion on the web page and has two VA guidelines and one ASAM guideline as well as several resource documents posted. We will continue to review materials that may be appropriate for inclusion. 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 (CQPM)

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

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

The CQPM has also been providing input and guidance on APA’s measure development efforts, which are being conducted under a cooperative agreement with the Centers for Medicare & Medicaid Services. Under the oversight and guidance of the Council on Quality, 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 updated their charge and has been working on issues related to suicide risk reduction (i.e., ligature risk, observation, suicide risk screening/assessment), medication safety, and development of member education materials (i.e., patient safety tips). The workgroup will also be subsuming the work of the former workgroup on Standards and Survey Procedures within their charge. Members of the Standards and Survey Procedures Workgroup are those member experts that represent psychiatry’s interest with various accrediting and standard-setting bodies. The Patient Safety Workgroup is currently working on a Resource Document providing guidance on selection of seclusion versus restraints in inpatient settings.

Workgroup to Discuss Clinical Care provided via Telephone/Audio.

The workgroup was developed to refine APA’s recommendations regarding telepsychiatry including consideration of what should be considered when providing care via audio-only means. This effort has been helpful in our advocacy efforts as legislation is interested in Congress and in individual states.

Technical Advisors

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

The Council on Research

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

The Council on Research continues to help ensure that research on mental health remains integral to the American Psychiatric Association’s (APA) mission and in the forefront of the national health agenda. The Council embodies APA’s commitment to advance psychiatric knowledge through the conduct of research by physician scientists across a broad range of research fields and issues: basic science, clinical diagnosis and assessment, treatment research, epidemiology, health services, computational psychiatry, and research training. These areas are represented by the committees, caucuses, and task forces under the Council’s Jurisdiction. The following is a brief report of the May 2021 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, including the review of PsychPRO’s Research Guidelines that govern the use of PsychPRO data by researchers and other external entities. Recent Registry activity includes an evaluation of registry processes to meet Phase II objectives and goals. PsychPRO has proved a valuable tool for APA membership who require quality data reporting services to comply with CMS’ Merit-based Incentive Payment System (or MIPS) Program. This was a Phase I proof of concept, which resulted in participation, from across the country, of about 200 practices and 1000 clinicians, including data for 300k unique patients and 4+million encounters. PsychPRO’s technical infrastructure also proved successful in supporting several federal grants, which helped to develop quality data acquisition processes and framing common data elements for a robust data repository.

PsychPRO, as a registry of the future, 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 healthcare through data science. As such, for Phase II, the PsychPRO registry aims to migrate to a next-generation registry solution that allows for flexibility and scalability, and will enhance clinician and patient engagement, to create a high quality data enclave for the purposes of quality measurement-based care as well as clinical research and development of learning healthcare systems and networks. PsychPRO is currently undergoing this transition with a new software vendor, which is planned through to the end of 2021. Onboarding of new users has already begun and transition of current users will begin 2022.

For more information about the Registry, please go to www.psychiatry.org/psychiatrists/registry

Component Updates

Work Group on Research Training.

The Council’s Work Group on Research Training, chaired by Charles Nemeroff, M.D., Ph.D. and Steven Siegel, M.D., Ph.D. met to discuss the 2021 Research Colloquium for Junior Psychiatrist Investigators (Colloquium). The 2021 Research Colloquium was held virtually on May 1 − 2 before the APA Annual Meeting. This year, 31 applicants were selected to attend the Colloquium including five international awardees from Brazil (2), France (1), Mexico (1), and Peru (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 five groups based on their research areas of interest and discussed topics such as managing a research team, working with special populations, and other hot topics in psychiatric research. Mentees and mentors then returned to the main session for a presentation on research methodology and big data in psychiatry, and presentations from representatives of the Brain and Behavior Research Foundation (BBRF), National Institute on Drug Abuse (NIDA), and American Foundation for Suicide Prevention (AFSP). Finally, participants broke into small groups of 3–5 mentees where they presented their research and received feedback from their Senior Research and Statistical Methodological mentors in their group.

The Work Group is planning the Colloquium Booster Session which will be held on Saturday, December 4, 2021, before the ACNP Annual Meeting in San Juan, Puerto Rico. Both the Booster Session and the ACNP Annual Meeting will be a hybrid format. Mentees from 2020 and 2021 will be invited to participate in the Booster Session.

The Colloquium continues to be jointly funded by the APA Foundation (APAF), and through our partnership with the American College of Neuropsychopharmacology (ACNP) and the Society of Biological Psychiatry (SOBP). The Colloquium is also funded by a National Institute on Drug Abuse (NIDA) R-13 grant that was awarded for three years.

Senior psychiatric research mentors including Drs. Jonathan Alpert, Nina Kraguljac, Carolyn Rodriguez, and James Potash from the Council on Research and its components took part in this year’s event. Additionally, biostatisticians/methodologists participated to provide a valuable perspective often unavailable to young researchers. The Work Group hopes to continue its efforts to include a panel of statistical and methodological mentors to help senior psychiatric researchers in the mentorship of Colloquium awardees.

APA Past President (2016–2017) Maria Oquendo, M.D., Ph.D. and Bernardo Ng, M.D., chair of the APA’s Council on International Psychiatry, continue to lead the effort to expand the Research Colloquium to include more international ERC psychiatrists. Five international awardees from Brazil (2), France (1), Mexico (1), and Peru (1) were invited to attend this year’s Colloquium. International mentees are selected and sponsored by their institution, country’s psychiatric association or branch of SOBP, or are self-funded.

Research Awards and Fellowships.

The Award for Research in Psychiatry, the highest award for research given by the APA, was presented to Dr. Myrna Weissman. In addition, the Judd Marmar Award, established in 1999 to honor an individual who has made a substantial contribution to advancing the biopsychosocial model of psychiatry, was awarded to Dr. Lawrence Kirmayer. Several other prominent researchers were recognized this year for their outstanding contributions to psychiatry and psychiatry research: Dr. Scott Woods received the Alexander Gralnick Award for Research in Schizophrenia; Dr. Bruce Pollock received the Mrazek Award in Psychiatric Pharmacogenomics; Dr. Sophia Vinogradov received the APAF/American Association of Chairs of Departments of Psychiatry Research Mentorship Award; Dr. Joan Luby received the Blanche F. Ittleson Award for Research in Child and Adolescent Psychiatry; Dr. Charles Nemeroff received the Nasrallah Family Award for Advances in Psychiatric Neuroscience; and the mentor/mentee team of Dr. Dilip Jeste and his trainee, Dr. Ellen Lee received the Kempf Fund Award for Research Development in Psychobiological Psychiatry. Dr. Carlos Blanco received the 2020 APA Health Services Research Senior Scholar Award, and Dr. John Torous received the 2020 APA Health Services Research Early Career Award.

Last year, the APAF awarded a nonrenewable Research Grant on the Impact of COVID-19 in Psychiatry. The small grant is funded by the APAF to provide its fellows with the opportunity to design and conduct a research study related to the impact of COVID-19 on a) patients with mental and substance use disorders, b) the psychiatric workforce (including early career psychiatrists), and/or c) the practice of psychiatry. The grant was awarded to 7 APA/APAF Fellows including Drs. Anees Bahji, Sebastian Cisneros, Devin Cromartie, Juliet Edgcomb, Youngjung Kim, Michael Mensah, and Tina Thomas.

This year, the APAF Special Topics Small Research Grant Program will focus on Structural Racism and Discrimination. The program will provide small grants up to $25,000 per year for 1–2 years for five of APA/APAF’s incoming and current fellows who are interested in research, to design and conduct a research study related to the impact of structural racism/racial discrimination with respect to a) patients with mental and substance use disorders, b) the psychiatric workforce (including early career psychiatrists), and/or c) the practice of psychiatry. The Fellow's research activities will be carried out under the supervision and guidance of a mentor at his/her primary institution in collaboration with his/her mentor(s) at the APA Division of Research. This initiative will enable the APA and APA Foundation to actively participate in 1) enhancing the field's understanding of the impact of structural racism/racial discrimination in individuals with mental and substance use disorder; and 2) diversifying, sustaining and strengthening the clinical investigator workforce in psychiatry. Applicants for the small research grant are under review.

The 2021 Psychiatric Research Fellowship was awarded to Dr. Uzoamaka (Stephanie) Asonye. Dr. Asonye is interested in the management of agitation in hospital-based settings. Her research will examine differences in management practices based on race. Dr. Asonye’s fellowship begins in July 2021 and will end in June 2023.

Committee on Psychiatric Dimensions of Disaster

Chair: Joshua Morganstein, M.D.: The Committee on Psychiatric Dimensions of Disaster coordinated with the APA Communications Department to reach out to the district branches and state associations affected by recent tragic events, including extreme heat in the northwestern US, multiple mass shootings, and the large condo collapse in Miami, Florida. Committee members have led special webinars on disaster psychiatry topics and participated in interviews through major media outlets. The Committee has been engaged in supporting APA’s response to the COVID-19 pandemic and written numerous guidance documents, including recent and timely guidance on cultivating preparedness for future public health emergencies, effective communication with the public during public health emergencies, and the role of psychiatrists in distributing the COVID-19 vaccines.

Diagnostic and Novel Treatments Work Group

Chair: Charles Nemeroff, M.D., Ph.D.; This Workgroup, chaired by Charles B. Nemeroff, M.D., Ph.D., completed two manuscripts on biomarkers to guide interventions in autism spectrum disorder, and cannabinoids and THC in psychiatry. In addition, the Work Group has three manuscripts nearing completion on ecological momentary assessment in clinical research, neuroimaging biomarkers in psychiatry, and technology in mental health. The Work Group is developing papers on several topics including the treatment of posttraumatic stress disorder (PTSD), ketamine, and the use of pharmacogenomics in prescribing antidepressants.

Health Services and Health Disparities Work Group

Chair: Jonathan Alpert, M.D., Ph.D. The Work Group completed a commentary on climate change and psychiatric workforce needs and a manuscript on gaps in research on climate change and mental health. The Work Group plans to develop further papers related to mental health impacts of climate change as well as on topics including suicidality and suicide safety planning, integrated care for individuals with serious mental illness, and gun violence. Additionally, the Work Group put on a 2-part symposium on Climate Change and Mental Health during the virtual APA Annual Meeting.

DSM Steering Committee

Chair: Paul S. Appelbaum, M.D.; Vice‐Chairs: Kenneth Kendler, M.D. and Ellen Leibenluft, M.D. The DSM Steering Committee, its Subcommittee on Minor Changes, and its five Review Committees have been working on several dimensions of the DSM since the last report in October 2020. This year's major focus has been the development of DSM‐5‐TR, involving a thorough revision of the text and inclusion of the changes made to DSM‐5 since its publication in 2013. The addition of prolonged grief disorder under the trauma- and stressor-related disorders, which was approved by the APA Assembly and Board of Trustees, has been one of the most prominent changes to the DSM. Other notable changes include the addition of olfactory reference disorder (olfactory reference syndrome) under other specified obsessive-compulsive and related disorder, elimination of extraneous specifiers in persistent depressive disorder, modifications of the specifiers for bipolar and depressive disorders, and reconciliation of discordant versions of criterion A in substance/medication-induced bipolar and related disorder and bipolar and related disorder due to another medical condition, all also approved by the APA Assembly and Board. An Ethnoracial Equity and Inclusion Work Group was created, including experts with a diversity of backgrounds and expertise, to review the DSM-5-TR text to identify and address issues related to race, ethnicity, and geographic origin. The Work Group’s goals included ensuring that notations of differences in prevalence rates or presentations by race, ethnicity, or geographic origin do not suggest essentializing differences between groups, and that adequate emphasis is given to the impact of environmental factors such as racism and discrimination. The Work Group also updated language that may have reflected outdated or noninclusive terminology. A number of proposals for the addition, deletion, or modification of diagnostic criteria were received and reviewed by the Steering Committee, with requests made for modification or submission of additional data by the proposers. The Steering Committee expects to receive revised versions of these proposals in the coming year.