APA Board Discusses ‘Roadmap for the Future,’ M/UR Nomenclature

Five areas of investment and focus—DSM, treatment guidelines, PsychPRO (APA’s mental health registry), development of quality measures and standards of care, and education—are critical to supporting APA’s policy and advocacy goals and to positioning psychiatrists as leaders in health care.

That’s the message Robert Trestman, M.D., chair of the Presidential Workgroup on the Future of Psychiatry, delivered to APA trustees at their December meeting in Washington, D.C. The 13-member workgroup was appointed by APA President Rebecca Brendel, M.D., J.D., and charged with creating a “roadmap for the future” to lead APA’s strategic direction for psychiatric practice and research over the next decade.

“How will we write our future?” Brendel asked at the meeting. “How are we going to ensure our place, and how are we going to lead to make sure people with mental illness and substance use disorders get high-quality, safe, affordable, and accessible care?”

Trestman said the roadmap presented at the Board is a work in progress. “These are broad strokes—we are talking strategy, not tactics—about where we are going to invest our intellectual and financial capital to position psychiatrists and psychiatry for the future.”

The five areas of investment will support the following policy and advocacy goals:

• Positioning psychiatrists to be leaders in a changing health care environment and ensuring patient safety.

• Addressing physician wellness and administrative burden.

• Leveraging psychiatric expertise as physicians who care for complex and severe illness and addressing social determinants of mental health.

• Expanding access and advancing equity.

• Ensuring full implementation of the Mental Health Parity and Addictions Equity Act.

• Leveraging technology, including telehealth.

• Adopting integrated care models.

• Ending the criminalization of mental and substance use disorders.

• Financing models of full systems of care.

M/UR Workgroup Report

Board members also heard a report from Maria A. Oquendo, M.D., Ph.D., past APA president and chair of the Presidential Workgroup Exploring Minority and Underrepresented (M/UR) Group Nomenclature. The workgroup is charged with reviewing and rethinking current nomenclature regarding the term M/UR and developing recommendations for new language.

Oquendo noted that under APA's current nomenclature, minorities include American Indian/Alaska Native/Native Hawaiian, Asian American, Black/African American, and Hispanic members. Underrepresented groups include international medical graduates (IMGs), LGBTQIA+, and women. Each group has its own caucus under the APA Assembly, and all seven are collectively referred to as the M/UR caucuses.

However, Oquendo noted that a review of the literature has shown that words like “minor” (minority/underrepresented) can reflect that a group is viewed as inferior or less favorably and that racial/ethnic groups, including African Americans/Blacks, Hispanics/Latino(a), American Indian, and Alaska Natives, do not self-identify as underrepresented minorities.

Oquendo said, “The current APA nomenclature—M/UR—unnecessarily aggregates and confounds the experiences of diverse groups—racial/ethnic, gender, gender identity, international education, and training—and has the potential to perpetuate a negative and/or inferior stereotype of the groups included in this category.”

The workgroup acknowledged that addressing the M/UR nomenclature should occur as a multiphase process, that captures and represents a diverse and inclusive organization that encourages, supports, and engages all its members.

The first phase focuses on developing nomenclature and collecting data and metrics on groups within psychiatry who have low representation relative to their representation in the population. These include the following:

• American Indian/Alaska Natives, who represent 1.3% of the general population, yet only 0.3% of psychiatrists.

• Black/African Americans, who represent 13.6% of the general population, yet only 4.7% of psychiatrists.

• Hispanics, who represent 18.9% of the general population, yet only 5.7% of psychiatrists.

• Native Hawaiian/Pacific Islanders, who represent 0.3% of general population, yet only 0.06% of psychiatrists.

The workgroup proposed two terms to address the first phase of this process—Population Share in Psychiatry or Percent Representation in Psychiatry. These two terms were not suggested as a substitute for the M/UR nomenclature, but rather a way to identify and collect data on those racial and ethnic populations that are underrepresented in the psychiatric profession relative to their numbers in the general population. This data would provide the most current statistics available about active psychiatrists and psychiatrists in training who are members of APA, which can then be used to develop and evaluate policies and programs to create a physician workforce that is demographically representative of the U.S. population.

The second phase would involve receiving input on a name that is inclusive and supports members of groups who may not have low percent representation in psychiatry relative to their representation in the general population, but who have not achieved full voice and equity and/or face discrimination and inequity within the profession.

“This nomenclature would remove the subordinate, negative connotations of ‘minority’ and provide a term that accommodates including and removing racial/ethnic groups on the basis of changing demographics in society and in the psychiatric profession,” Oquendo said.

The third phase is to constitute a workgroup with expertise in APA governance to address the needs of all seven groups.

Immediate next steps include scheduling listening sessions with all seven groups to obtain their input and feedback on the term “M/UR” and in the phase one definitions.

Other Actions

In other business, the Board approved the following:

• Sen. Christopher Murphy (D-Conn.) as the recipient of the Jacob K. Javits Public Service Award, the highest award that APA gives a public servant.

• An Assembly action paper calling on APA to reinstate funding for two in-person Assembly meetings a year beginning 2023.

• Four new or revised position statements: Need to Train Psychiatrists in Provision of Care and Support to Individuals With Differences in Sex Development and Their Families; Use of Jails to Hold Persons Without Criminal Charges Who Are Awaiting Civil Psychiatric Hospital Beds; Health Care; and Misuse of Psychiatric Examinations and Disclosure of Psychiatric Records in Sexual Harassment Litigation. ■