APA Board Approves New Codes for Suicidal Behavior and Nonsuicidal Self-Injury, Discusses Major New Initiatives
Abstract
APA Trustees engaged in lively discussion on a broad range of issues at last month’s virtual meeting and approved more than 20 new or revised position statements.
APA’s Board of Trustees approved the addition of definitions and descriptive texts and associated International Classification of Diseases 10th Edition-Clinical Modification (ICD-10-CM) codes for suicidal behavior and nonsuicidal self-injury. The changes will be made to the chapter “Other Conditions That May Be a Focus of Clinical Attention” in Section II of DSM-5-TR.
The Board’s virtual meeting in July encompassed a wide range of issues including early reports from the APA Task Force on Structural Racism Throughout Psychiatry and the Work Group on the Assessment of Psychiatric Bed Needs—both high priorities of APA President Jeffrey Geller, M.D., M.P.H.
The approval of the addition of the associated ICD-10-CM codes and descriptive texts on suicidal behavior and nonsuicidal self-injury came at the request of APA’s DSM Steering Committee. Committee Chair Paul Appelbaum, M.D., told Psychiatric News after the Assembly approved the codes in May that Assembly and Board approvals are usually reserved only for changes to mental disorders listed in their respective chapters in Section II. However, explicit approval was sought in the case of the ICD-10-CM codes and descriptive text on suicidal behavior and nonsuicidal self-injury “because of the clinical and public health significance of these categories.”
The committee’s report to the Assembly stated: “Even when clinicians are primed to identify and record a history of suicidal behavior or ideation, its documentation is unreliable. The risk of not recording suicidal behavior would be reduced if it were a codable entity in DSM-5-TR, as such conditions are typically conserved during hand-offs and in discharge summaries.”
The committee’s report also stressed that “having a freestanding ICD-10-CM code for suicidal behavior helps to recognize that suicidal behavior occurs across conditions from schizophrenia to autism, not only as a depressive symptom.”
DSM-5-TR is scheduled for release next spring, in conjunction with APA’s 2021 Annual Meeting in Los Angeles.
At last month’s meeting, Trustees also discussed structural racism within APA and the profession of psychiatry and the formation of the Task Force on Structural Racism Throughout Psychiatry. Task Force Chair Cheryl Wills, M.D., said the composition of the task force—including subject matter experts and current and past Board members—was designed to help produce “actionable items” the Board could approve that would address structural racism.
Danielle Hairston, M.D., president of the APA Caucus of Black Psychiatrists, called structural racism “a system of policies and practices that perpetuate racial inequality” and drew attention to a powerful article by Resident-Fellow Member Trustee Michael Mensah, M.D., M.P.H., in the New England Journal of Medicine titled “Majority Taxes—Toward Antiracist Allyship in Medicine.”
“The holy grail of system design is understanding how many psychiatric beds in a given community would be necessary to serve the needs of that community.” —Anita Everett, M.D.
Mensah is a PGY-4 chief resident at the Semel Institute for Neuroscience and Human Behavior at the University of California, Los Angeles.
The Board meeting was also the occasion for the formal introduction of the APA President’s Ad Hoc Work Group on the Assessment of Psychiatric Bed Needs. Past APA President Anita Everett, M.D., chair of the work group, told Trustees, “The holy grail of system design is understanding how many psychiatric beds in a given community would be necessary to serve the needs of that community.”
(For further coverage of the work group, see the August 21 issue of Psychiatric News.)
Everett said the work group is charged with researching, assessing, and developing recommendations regarding the current capacity of inpatient psychiatric care in the United States. It will accomplish this through a series of subgroups that are charged to work on the following:
Review the historical and current context of access to psychiatric care.
Assess the current funding model and identify financial barriers.
Identify community resources that might mitigate the need for inpatient care for the treatment of mental illness.
Review disparities and equity in accessing treatment.
Address the critical shortage of inpatient treatment and services for children.
Geller noted that the lack of availability of inpatient beds drives problems throughout the mental health system. In his address at APA’s Spring Highlights Meeting (a virtual two-day meeting that was planned after APA was unable to hold its 2020 Annual Meeting), Geller said, “Fundamental to extricating ourselves from the current quagmire of services for persons with mental illness is getting to the right number of psychiatric beds.”
Trustees also approved more than 20 new or revised position statements. Among them are the following:
Issues pertaining to capital sentencing and the death penalty. There should be a moratorium on capital punishment in the United States until jurisdictions seeking to reform the death penalty implement policies and procedures to assure that capital punishment, if used at all, is administered fairly and impartially in accord with the basic requirements of due process.
Leadership of academic departments of psychiatry. APA strongly believes that training programs in Departments of Psychiatry must be chaired by a psychiatrist. No other mental health professionals have similar training or the same priorities as psychiatrists, and psychiatry residents need strong physician role models in leadership positions. The Accreditation Council on Graduate Medical Education should ensure that psychiatry accreditation standards reflect this position.
Consent to mental health treatment by guardians, health care agents, or other legally designated surrogate decision-makers for adults with mental illness. When a person has been reliably determined to lack decisional capacity according to applicable law, guardians, health care agents, or other surrogate decision-makers should be legally empowered to make any mental health treatment decisions, including for psychiatric hospitalization, medication, and electroconvulsive therapy to which the person would otherwise be entitled to make for him- or herself. In the case of a health care proxy, if the person has specifically limited the authority of the agent regarding any treatment decisions, those limitations must be respected. ■
