Assembly Considers Array of Issues
Abstract
Tracking the number of mental health practitioners, neuromodulation, substance use disorders among the elderly, and telepsychiatry requirements were among the issues addressed by the Assembly in April.
APA’s Assembly approved action papers and position statements addressing a variety of issues—tracking the psychiatric workforce, the use of neuromodulation for treating psychiatric disorders, text changes to DSM, and telepsychiatry, among them—during its virtual meeting in April.
At the meeting, the Assembly also voted to elect the following candidates as officers of the Assembly from April 2021 to May 2022: for speaker-elect, Adam Nelson, M.D., of Area 6, and for recorder, Vasilis K. Pozios, M.D., of Area 4.
Assembly Approves Statements on Racial Bias, Services in Correctional Facilities, Alternative Payment Models
The APA Assembly approved more than a dozen position statements and action papers during its virtual meeting in April. Statements and action papers do not become APA policy until they are approved by the Board of Trustees. Among the items approved in April are the following:
Position Statement on Recognizing Childhood Trauma in the Setting of the COVID-19 Pandemic and Race-Related Challenges to Human Rights
Position Statement on Medical Supervision of Psychiatry Residents and Fellows
Position Statement on Racism and Racial Discrimination in the Psychiatric Workplace
Position Statement on Orchiectomy or Treatment With Anti-Androgen Medications as a Condition of Release From Incarceration
Position Statement on Psychiatric Services in Adult Correctional Facilities
Revised Position Statement on Core Principles for Alternative Payment Models for Behavioral Health
Action Paper on Addressing Bias in Law Enforcement Personnel and Correctional Staff
Action Paper on Addressing Bias and Capacity for Law Enforcement Personnel
Action Paper on Addressing Structural Racism in APA Through Public Outreach. This action paper calls on the APA Foundation to aspire to allocate at least 50% of its annual budget to fund programs in work, school, justice, community, and/or research initiatives that focus exclusively on minority and underrepresented mental health issues, including health disparities, social determinants of mental health, and cultural literacy.
(Position statements and action papers approved by the Assembly are not APA policy until they are approved by the Board of Trustees.)
Assembly members approved an action item calling on the Council on Healthcare Systems and Financing, Council on Quality Care, and the Council on Research to track the number of active mental health practitioners in the United States using accessible databases, such as the APA Health Workforce Mapper. The tally will include psychiatrists, nurse practitioners, physician assistants, prescribing pharmacists, and psychologists for the purpose of understanding and predicting future workforce needs. The Assembly also voted that the data should be analyzed statistically and graphically, projecting out beyond 2032, and be available on the APA website for members’ review.
Among the approximately 15 position statements approved, two were passed in a vote by strength, in which Assembly members’ votes are weighted according to the number of APA members they represent.
A revision of the Position Statement on Substance Use Disorders Among Older Adults was approved by strength; the statement says that psychiatrists and other health care professionals should promote screening for substance use disorders and co-occurring psychiatric disorders in older adults. The statement also asserts five points with regard to treatment:
Older adults should have full access to an affordable and comprehensive range of mental health services, including home-based care and community-based care, as well as care provided in long-term-care facilities.
Initiation or continuation of evidence-based pharmacotherapy for the treatment of substance use disorder is an essential component of comprehensive care.
Appropriate treatment of older adults may include a combination of pharmacotherapy, psychotherapy, case management, and social support services.
Engagement of social supports in treatment is particularly important for older adults, who may be more isolated or face functional barriers to accessing care independently.
Treatment can include reducing the doses of prescribed controlled drugs taken by patients to eliminating prescribed drugs, using evidence-based guidelines.
“Substance abuse in older adults is a growing problem,” said Ilse Wiechers, M.D., a representative from the American Association for Geriatric Psychiatry. “It is imperative that clinicians are aware of this.”
Also approved in a vote by strength was the position statement on Interstate Licensure for Telepsychiatry.
The approved position points out that “state medical licensure requirements requiring a psychiatrist to hold a medical license where a patient is physically located when conducting telepsychiatry represent a significant barrier for patient access, quality, and continuity of mental health care. These challenges have been increased as well as highlighted by the current COVID pandemic.”
APA supports the reduction of barriers to interstate telepsychiatry services. Among the proposed solutions are the following:
Full license reciprocity across all states.
Extension of the current federal licensing exemption for psychiatrists who treat patients whose care is supported through federal funding.
A national telehealth medical license.
Extending the Federation of State Medical Board’s interstate compact for all 50 states for full interstate licensure, with one application and a single fee.
Federal legislation that changes the location of a virtual medical evaluation from the current standard of the patient’s location to the psychiatrist’s location.
Additionally, the Assembly approved an action paper calling on APA’s Joint Reference Committee (JRC) to appoint a task force or work group to consider the development of a component on neuromodulation.
The component might help advance the standards for a range of neuromodulation services (electroconvulsive therapy, transcranial magnetic stimulation, deep brain stimulation, vagus nerve stimulation, among others) and promote research in neuromodulation.
Finally, the Assembly approved several text changes to DSM-5 that had been previously approved by the Board (Psychiatric News). Those changes were approved by the Board first so they could be included in DSM-5-TR, now under development.
The majority of the action papers were referred to the JRC for consideration, and, if approved, they will then be referred to the appropriate APA component. The Assembly-approved position statements that have already been reviewed and approved by the JRC will be submitted for consideration by the Board at its meeting this month. ■
