Access to care and advocating to ensure that patients get quality care were
among the issues high on the agenda for APA Assembly members at their fall
meeting last month in Washington, D.C.
Among the actions taken by the Assembly was endorsing a proposal to have
APA support federal and state initiatives to continue health insurance
coverage to young adults who lose eligibility to stay on their parents' plan
even though they are still dependents. For example, college students who drop
out of school because of illness often lose eligibility, while their peers who
don't attend college lose coverage when they graduate from high school.
"The issue is of special interest to psychiatry," the proposal
noted, since "late adolescence is the most common age for onset of
mental illness, and these illnesses severely impact function, especially
cognitive function." Loss of coverage could seriously disrupt crucial
treatment relationships in these individuals.
Anna Holmgren, M.D., received the Assembly's Profile of Courage Award at
its meeting last month in Washington, D.C. With her is Laurence Dopkin, M.D.,
who nominated her. He is the Area 2 deputy representative to the Assembly
Committee of ECPs. See story below.
©Sylvia Johnson Photography
One of the highlights of the meeting was the presentation of the Assembly's
Profile of Courage Award to Anna Holmgren, M.D. She was recognized for her
extensive volunteer work in Baton Rouge and New Orleans immediately after
Hurricane Katrina struck in 2005. She closed her New York practice after the
storm to spend weeks helping police, other first responders, and victims cope
with a life-and-death crisis for which none had planned. During much of this
time the conditions under which she lived were brutal, including days sleeping
on a cot in a room where the bodies of people who died while sheltered in the
Superdome were stored. She noted that her experiences were still extremely
difficult to talk about, and she dedicated the award to the police, 911
operators, and others who kept working without sleep or changes of clothes,
even after they lost homes, their possessions, and the lives they once
On other fronts, the Assembly urged APA to partner with the American
Association for Emergency Psychiatry and American College of Emergency
Physicians in an effort to solve the problem of overcrowding that plagues many
emergency departments, with a particular focus on how psychiatric patients are
The group also voted to urge APA to adopt the position that "patients
with acute behavioral problems receive appropriate emergency psychiatric and
medical assessment prior to disposition, using procedures that have been
recognized as sound by medical professional organizations." This action
was an attempt to prevent patients with serious psychiatric problems from
being diverted from emergency departments, or even before they are seen in
emergency departments, to facilities that lack "appropriate psychiatric
and medical assessment."
Use of the term "suicidality" also received attention from the
Assembly, which endorsed a resolution that APA advocate that the Food and Drug
Administration (FDA) limit use of the term "suicidal behavior" to
medications "that have been demonstrated to be associated with suicide
The concern about inaccurate use of the term arose in large part because of
the FDA's practice of using it in relation to risks that may be associated
with antidepressants, particularly in young people. The studies on which the
FDA based its decision to mandate additional warnings on antidepressant
labels, however, did not find an increase in suicides. The background to the
Assembly proposal points out that in some patients, the willingness to discuss
suicide may represent an improvement in their condition, that self-injurious
behavior should not be automatically equated with suicide attempts, and that"
some actions that are pleas for help" end up being labeled"
The Assembly also turned its attention to peripartum depression, calling on
APA to continue supporting a congressional bill to increase research funding
in this area. The delegates also want APA to send information about peripartum
depression to district branches and urge them to work with nurse, midwife, and
physician groups to educate new mothers on warning signs, and to distribute an
APA review of the topic to psychiatry residency directors.
Telepsychiatry has for many years been viewed as a method of expanding
access to psychiatric care, and the Assembly voted to establish a new grant
program for district branches who want to undertake projects to expand access
to and education about telepsychiatry in their areas. The proposal calls for
APA to earmark $50,000 to cover the cost of 10 grants of up to $5,000
In an effort to enhance access to care in underserved areas and share
experiences and knowledge about this issue, Assembly delegates backed a
proposal to survey residency training directors to gather information on"
expertise and activity in academic departments" regarding
psychiatry practice in rural and underserved areas and to disseminate the
survey findings to organizations and federal agencies that focus on this
In other actions the Assembly voted to
The Assembly also wants APA to urge the federal government "to
implement well-designed clinical research into the medical utility of
marijuana," again backing an AMA statement on the issue.