Trustees Approve Council on Women’s Mental Health, Discuss AI and Venture Capital

APA’s Board of Trustees approved the creation of the Council on Women’s Mental Health during its July meeting in Washington, D.C. The council, which will become an official component of APA in May 2024, will replace the Committee on Women’s Mental Health, which has been active since 2020.

Establishment of the council was one of a number of actions taken by the Board, including approval of proposed and revised position statements.

“Our female patients have distinct needs that are deserving of a council that can provide consultation directly to the Board in ways that will benefit women with mental illness and/or substance use disorders and their families and loved ones,” said APA President Petros Levounis, M.D., M.A. “Women may respond differently to medications, and they are subject to social and environmental influences and stressors unique to them. In addition to holding jobs, women are often caretakers of children and of aging parents, sometimes at the same time and sometimes without help.

“Additionally, women have in the past been underrepresented in clinical research, and although that is changing, there continues to be a need for research that is focused on the particular needs of women. Our new Council on Women’s Mental Health will have the funding and staffing to advise the Board on these matters and many others. This is an important step forward for APA in its efforts to serve all of our patients.”

Ludmila De Faria, M.D., chair of the Committee on Women’s Mental Health, said a council will facilitate centralization of APA’s work related to women’s mental health across the lifespan and serve as a source of information, guidance, and support for other APA components. “By creating the council, the Board of Trustees recognizes the need for more resources and visibility for the work that the Committee on Women’s Mental Health has already been doing for the last three years,” she said.

The council’s charge will remain similar to the committee’s charge. De Faria said the council will be responsible for “prioritizing and advancing clinical knowledge and research related to the diagnosis and treatment of psychiatric illnesses unique to women, the treatment of disorders during the reproductive years, the special risk factors and pharmacologic considerations unique to women patients, and health care access and outcome disparities associated with gender, including intersectional issues.”

Difficult Challenges Discussed

The Board heard reports on two subjects of gathering concern and some controversy: care and treatment of individuals seeking gender transition and the emergence of artificial intelligence and its possible uses in psychiatry.

“The push to limit gender-affirming care for youth is part of a larger, politically motivated agenda to enact legislation to limit the human rights of LGBTQ+ people and women’s health/reproductive rights,” said Area 2 Trustee Kenneth Ashley, M.D., who delivered the report. He is the director of outpatient consultation-liaison psychiatry at Mt. Sinai Beth Israel Hospital. “The strategy often involves use of medical mis- and dis-information. This movement is not limited to the U.S.”

He presented the guidelines of the World Professional Association of Transgender Health (WPATH) Standards of Care, which are mirrored in the Endocrine Society guidelines for transgender care.

Ashley noted that the quality of evidence supporting gender-affirming care is not high but added, “The majority of treatments/interventions in medicine do not have high-quality evidence, yet there is rarely any recommendation for their discontinuation, but instead a demand for more research.”

He also presented the findings of a 2019 study in the Nordic Journal of Psychiatry, which found that the need for psychiatric treatment after gender reassignment was lower and that symptoms of depression, anxiety, suicidality, self-harm, conduct disorder, and attention-deficit/hyperactivity disorder were diminished, in some instances markedly so: The prevalence of depression and anxiety following reassignment was 15% for each compared with 54% and 48%, respectively, prior to reassignment.

“Withholding treatment is not a neutral act, but often causes psychiatric morbidity and mortality,” Ashley told Psychiatric News. He added that reports of regret by patients who have undergone gender reassignment are rare, with some studies reporting cases of regret under 1%.

German Velez, M.D., the resident-fellow member trustee, provided a broad overview of challenges confronting psychiatry by the rapid emergence of artificial (or augmented) intelligence (AI) and by the acquisition by private equity firms and venture capitalists of psychiatric practices and hospitals. Velez noted that venture capital has already invested heavily in mental health apps, though with some disappointing returns on investment.

He stressed that these emerging trends should be tempered by the professional ethics and regard for patient autonomy and integrity that psychiatrists can bring to bear.

“AI has been explored for some time, resulting in the development of chatbot therapists and AI-based therapy session analysis to enhance efficiency and accessibility,” he told Psychiatric News. “However, concerns linger regarding privacy, transparency, therapeutic strategies, and legal liability, as many apps lack robust evidence of their effectiveness. Ensuring patient safety and efficacy in the digital mental health industry requires standardized regulations and oversight. While AI can expand access to mental health tools, ethical considerations and limitations must be carefully taken into account.”

The subject sparked a vigorous discussion by the Board, reflecting the speed with which AI may transform every facet of society. “We need to be humble and acknowledge that this is a massive juggernaut coming at everyone,” said APA Treasurer Richard Summers, M.D. “We should stick to what we are good at—thinking about what quality psychiatric treatment is, what a good outcome looks like, what is equitable and appropriate for diverse populations, and what is ethical. The Roadmap for the Future of Psychiatry [developed under the presidency of immediate past president Rebecca Brendel, M.D., J.D.] was our attempt to answer these questions pre-AI. Now I think we are looking at how to take that roadmap and adapt it to this new element.” ■