Board Approves ‘A Roadmap for the Future of Psychiatry’
Abstract
Trustees also approved some minor changes in the current conflict-of-interest guidelines that would allow for wider participation of experts on the DSM review committees.
At its meeting in March, APA’s Board of Trustees approved a strategic plan that outlines recommendations on how APA can position itself a decade from now to remain the practice leader in mental illness diagnosis, treatment, and recovery and inform APA’s advocacy efforts.
APA President Rebecca Brendel, M.D., J.D. (right), honors Robert Trestman, Ph.D., M.D., for his work as chair of the Presidential Workgroup on a Roadmap for the Future of Psychiatry. He presented the workgroup’s final report at the Board of Trustees’ March meeting. At left are Agathe Farrage, senior manager of APA’s Policy, Programs, Partnerships Division; and Kristin Kroeger, the division’s chief. They provided staff support to the workgroup.
The plan was proposed by a presidential workgroup chaired by Robert Trestman, Ph.D., M.D., chair of the APA Council on Healthcare Systems and Financing, and APA President Rebecca Brendel, M.D., J.D.
Brendel’s presidential theme has been about charting a “roadmap for the future of psychiatry,” and the approval of the roadmap along with its recommendations is a signature achievement of her presidential year—a remarkable exercise in which the workgroup and the Board looked out to the horizon to chart a long-term direction for APA and the profession of psychiatry.
(The Board also approved a number of new or revised position statements and addressed other issues; see box.)
Trustees Approve Position Statements, Other Actions
At its March meeting, the Board of Trustees approved revised or proposed position statements and action items and acted on several other issues important to APA and members. Trustees did the following:
Approved the revised Position Statement on Human Rights.
Approved the revised Position Statement on Mental Health and Climate Change.
Approved the revised Position Statement on Abortion and Women’s Reproductive Healthcare Rights, with editorial changes, and referred the position statement to the Dobbs Work Group.
Approved the Position Statement on Engaging Law Enforcement Personnel and Correctional Staff to Address Mental Health and Racial Inequities in Jails and Prisons.
Approved an action item calling for the National Board of Physicians and Surgeons (NBPAS) to join APA’s Council on Medical Education and Lifelong Learning as a corresponding member organization.
Voted to approve the manuscript “Post-Roe Psychiatry: Part I—A Systematic Review and Multilevel Meta-Analysis Investigating the Impact of Unwanted Pregnancy and Denied Abortion on Mental Health” for submission for publication after the Council on Research reviews its data and gender language.
“Our job has been to think through what we need to do so that we can really be the leaders a decade from now and not be marginalized or minimized because psychiatry is a small percentage of the mental health workforce,” Trestman told the Board.
Broadly, the roadmap approved by the Board focuses on five components, each with specific recommendations for how to maintain APA as the leader in mental illness diagnosis, treatment, and recovery. These are the five core components:
DSM and psychiatric diagnosis
Clinical practice guidelines
PsychPRO (Psychiatric Patient Registry Online), APA’s certified mental health registry
Development of quality measures and standards of care
Education
Each of these components will support APA’s policy development and advocacy, which will focus on positioning psychiatrists to be leaders in a changing health care environment, addressing the root causes of social determinants of mental health, achieving payment reform to sustain psychiatric practice, and expanding access to care.
Trestman said the roadmap will require an investment of resources, but one that promises an immense return for psychiatrists and patients. “Remember that in 1999, Apple was almost out of business,” Trestman said. “But a transformation occurred at the company that led to its being among the most capitalized businesses in the world. APA is doing well right now, but I believe if we can succeed in implementing this roadmap, we can grow by an order of magnitude in terms of our impact on global mental health.”
Conflict of Interest Guidelines Updated
The Board also approved a revision to APA’s existing conflict-of-interest (COI) guidelines for Tier 1, the highest level of scrutiny, which applies to the DSM Steering and Review committees, Practice Guideline Executive and Steering committees, and chairs and vice chairs of workgroups. This tier includes specific monetary cutoffs that can preclude an individual from participating (a limit of $5,000 annually in direct compensation from pharmaceutical and other industry sources, and a limit of $50,000 in stock shares or $10,000 annually in dividends).
APA Secretary Sandra De Jong, M.D., chair of the APA Conflict of Interest Committee, reported that Tier 1 as currently defined has made it difficult for the Division of Research to recruit expert participants for the DSM review committees. She said because more than a quarter of nominees had withdrawn from consideration due to the restrictions in the last recruitment cycle, the Division of Research had requested greater flexibility in the policy to enable a broader selection of experts.
The revision proposed by the committee, after a review of other medical organizations’ COI policies, divides Tier 1 into two categories—Tier 1A, which retains the same language and monetary constraints; and Tier 1B, which creates some flexibility for participation. De Jong said that the Tier 1A constraints would continue to apply to the DSM Steering Committee and committee chairs; new Tier 1B flexibilities would be applied only to review committee members.
The Tier 1B flexibilities for participation on review committees are related to these three parameters:
Applicability (Is the potential conflict of interest directly related to the APA decision-making role?)
Directness (Is the monetary payment directly to the participant or to a related other?)
Activeness of the monetary interest (Is it an active or inactive one—not current but within the past three years?)
The Board approved the following for Tier 1B: “If these factors [applicability, directness, active vs. inactive] suggest the interest is attenuated, then exception to the letter of Tier 1A may be made in circumstances where there are not readily available qualified participants who have no conflicts. Participants who fall under Tier 1B may be permitted to participate in discussions, but the chairperson should consider their interests in relation to the subject matter discussed and err in favor of excluding them from voting if the interests are applicable, direct, and/or active.”
Trustees also approved other recommendations from the COI committee requiring summaries of conflict-of-interest disclosures of participants to accompany the agenda at all APA meetings and requiring COI disclosures from DSM consultants and workgroup members who will share them with participants.
In addition, the Board approved making the DSM participant disclosures available electronically and in print.
M/UR Nomenclature
In other business, Regina James, M.D., chief of APA’s Division of Diversity and Health Equity, reported on the results of “listening sessions” that were held with each of APA’s seven minority and underrepresented group caucuses (American Indian/Alaska Native/Native Hawaiian; Asian American; Black; Hispanic; International Medical Graduates; LGBTQ; Women) regarding the work of the Presidential Workgroup Exploring Minority and Underrepresented (M/UR) Group Nomenclature.
That workgroup, chaired by APA past President Maria A. Oquendo, M.D., Ph.D., is charged with reviewing and rethinking current nomenclature regarding the term M/UR and developing recommendations for new language. 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 of its members.
The workgroup adopted a three-phase process for reevaluating the M/UR nomenclature. The first phase focused on the need for data collection and data-driven implementation and assessment of programs to enhance diversity in the psychiatric workforce of racial/ethnic groups with low representation in psychiatry relative to their numbers in the general population. The second phase involved the one-hour listening sessions, led by Brendel, on the utility of M/UR as a designation in APA, potential alternatives to the current M/UR nomenclature, and priority issues of all M/UR groups—including those who have population share but lack equity in leadership and other priority issues. The next phase is to constitute a workgroup with expertise in APA governance to address the needs of all seven groups.
James said a common concern raised in the sessions was the need for mentorship toward leadership at every level of training. Trustees accepted the report of the committee and referred it to the Structural Racism Accountability Committee for further work. ■
