Board Takes Action on Wide Range of Issues

APA’s Board of Trustees met last month in Washington, D.C., and addressed a number of major issues—among them, ethics, potential formation of a patient registry, APA’s operating budget, and approval of several new position statements. Board members also heard an update on mental health reform legislation by staff of APA’s Division of Government Relations.

David Hathcox

Trustees approved a business “case” for the development of a multi-illness national mental health quality registry. They directed the APA administration to continue to work with the appropriate consultants and APA components, including using focus groups, to develop and design a detailed business plan for the Board along with options and alternatives of types of registries that will work for APA and psychiatry.

A registry is a system of data collection for tracking and evaluating outcomes among populations of patients and comorbid conditions. Registries are increasingly viewed as vital to the goals of the so-called “triple aim”: improving the patient experience of care (including quality and satisfaction), improving the health of populations, and reducing the per capita cost of health care.

They are being developed by integrated and collaborative care networks to help them improve outcomes for the populations they treat. Today some medical specialty groups are developing registries around the populations with the disorders treated by them.

“Our Board of Trustees is moving thoughtfully in its deliberations about development of a registry,” said APA President Renée Binder, M.D. “The next step in this process is to ask the APA administration and related councils and leadership to develop a more detailed business plan, and we look forward to the input of our members.”

In other actions, the Trustees approved publication of an educational document, “APA Commentary on Ethics in Practice,” designed to help psychiatrists better understand how the profession’s code of ethics can be applied in everyday clinical practice.

David Hathcox

The commentary, developed by the Ad Hoc Work Group on Revising the Ethics Annotations chaired by Rebecca Brendel, M.D., J.D., is based on the existing Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry and is meant to provide practical guidance for managing ethical dilemmas that come up in day-to-day practice. The commentary is cross-referenced to the Annotations so that there is an explicit link between each subject and the existing ethics code.

The “APA Commentary on Ethics in Practice” can be accessed here.

The document was first conceived under then APA President Paul Appelbaum, M.D. An early draft of an ethics resource document was developed by a work group chaired by Laura Roberts, M.D., and Edward Hundert, M.D. Binder and immediate past President Paul Summergrad, M.D., both wanted to revive the document and update it. Binder made it a priority and appointed the ad hoc work group.

Applebaum said the commentary will fill a gap. “APA’s Annotations, which are the basis on which the ethics committees of APA and its district branches adjudicate ethics complaints, were never intended to provide a comprehensive overview of ethics in psychiatry, and hence they are of limited value as an instructional tool,” he said. “Until now APA has lacked a document that offers a clear overview of the area. This new resource, which reflects the thinking of an experienced group of psychiatrists and experts in ethics about the state of the art of psychiatric ethics, should be an excellent resource in residency training and for continuing education of practicing psychiatrists.”

The Board also approved the use of the unrestricted (investment) reserve fund for the APA operating budget as follows: for Fiscal 2017, $3 million will be available to supplement operations; beginning in Fiscal 2018, 50 percent of the unrestricted reserve investment income, calculated over the prior three-year rolling average of completed fiscal years, will be available to supplement operations. (For example: for Fiscal 2018, the average of Fiscal 2014, 2015, and 2016 will be used for the calculation.)

Trustees approved the APA Practice Guideline on the Use of Antipsychotics to Treat Agitation or Psychosis in Patients With Dementia and also approved these position statements: Opioid Overdose Education and Naloxone Distribution-A Joint Position Statement of the APA/AAAP; Substance Abuse Disorders in Older Adults; Tobacco Use Disorder; and Involuntary Outpatient Commitment and Related Programs of Assisted Outpatient Treatment.

The Board also voted to approve the following:

• A recommendation of the Membership Committee to partner with Credible, an affinity program that serves as an independent marketplace for student loans and can help resident and other members consolidate loans.

• The appointment of the chair of APAPAC, ex-officio, as a corresponding member to the Council on Advocacy and Government Relations. This will occur with the understanding that APAPAC will include the chair of the Council on Advocacy and Government Relations as an ex-officio corresponding member to the APAPAC Board of Directors.

• The nomination of David Satcher, M.D., for the 2016 Human Rights Award. ■