Assembly Urges Stronger Voice For Allied Organizations

Allied psychiatric organizations will have a more visible role in APA’s committee structure, and thus its policymaking process, following a vote at the May meeting of the APA Assembly in New Orleans.

Through a pilot project, the APA president-elect, who makes appointments to APA committees, councils, commissions, and task forces, has already begun including allied-organization members on many components, but the Assembly vote last month takes that goal a step further. The Assembly has long acknowledged that APA needs to incorporate subspecialty and other psychiatric groups in the Association’s deliberations as a way to tap the expertise of these psychiatrists and to convince subspecialists that they have a valued place within APA.

The Assembly voted that in the fall of each year, the chair of the Assembly’s Committee of Allied Organization (AAOL) representatives will submit to the APA president-elect recommendations for appointments from its member organizations for open seats on APA components. The cost of these psychiatrists’ attendance at meetings will be shared equally by APA and the allied organization they are representing. The AAOL recommendations are to be of psychiatrists who also belong to APA. They are to be full voting members of the component to which they are appointed and are to serve as liaisons between APA and the allied organization. Each allied organization would be allowed to make a single recommendation each year for appointment of a representative to a component that deals with issues in its area of expertise. The proposal will have to be approved by the Board of Trustees before it can be implemented.

Managed Care Issues

The Assembly representatives also tackled issues relating to carveouts and managed care practices.

One action paper called on the Board to direct the Joint Commission on Government Relations to examine ways in which managed behavioral health care organizations could be compelled to disclose publicly “the strategies they employ to contain medical costs, so that the public can make more informed decisions about them.”

Among the factors the Assembly wants revealed are that these organizations may limit payments and referrals to psychiatrists, may pay bonuses for certain practices, may offer rebates to pharmacies, and may restrict hospital or ER care. This APA strategy might also include the development of a model state statute addressing this topic.

The Assembly also responded to continuing concerns about the practices of mental health carveouts, asking the Board to establish a new task force “to develop a global strategy to oppose carveouts.” The members also want the Committee on APA/Business Relationships “to make a priority of advocating against carveouts to business leaders, who are the purchasers of health care.”

The Assembly also affirmed APA’s commitment to working with other organizations to win passage of Congressional legislation to end Medicare’s discrimination against mental health care as evidenced in the program’s higher copayment requirements for this type of care than for other types of medical treatment.

Education Issues

Two education-related actions were taken by the Assembly. The goal of the first is to ensure that faculty who teach psychiatry residents are competent in the five psychotherapeutic modalities in which the Residency Review Committee in Psychiatry wants all graduating residents to demonstrate mastery. The proposal calls on APA to “develop a position regarding the establishment and maintenance of core competencies” for these faculty members.

In addition, the Assembly voted to have the Council on Medical Education and Career Development and the Council on Children, Adolescents, and Their Families explore ways in which APA could offer a fellowship or award in child and adolescent psychiatry. Members maintained that this would stimulate interest in this underserved subspecialty and would be an inducement for child and adolescent psychiatry residents to join APA.

Other Actions

Also at the May meeting the Assembly voted to

• have APA clarify federal rules on medical privacy protections by adopting “a specific model that clarifies and refines the protections for psychotherapy and mental health information” in any subsequent regulations.

• ask the Board of Trustees to adopt a policy that backs the AMA’s efforts “to seek out legal remedies to stop the sharing of information on physicians’ prescribing practices in violation of doctor-patient privacy.” This is in response to the sharing of diagnoses and prescribing information with drug companies and marketers, which then contact patients regarding their medication.

• have APA “affirm the principle that privacy is the foundation of the physician-patient relationship” and educate members and the public about the importance of confidentiality in that relationship. The Assembly would also like to see each district branch and state society appoint a “privacy ombudsman for members and their patients who need assistance in achieving or preserving privacy.”

• endorse the new practice guideline on borderline personality disorder. The guideline will next go the Board for its approval.

• promote representation in APA “that reflects the demographics of practicing psychiatrists, members in training, and the general public.” One step in such a process would have the Assembly speaker appoint a task force that will address the need to increase the representation of women and of minority/underrepresented psychiatrists in the Assembly and APA as a whole. The speaker will begin producing an annual report on the representation of women and minorities on APA components.

• ask relevant APA components to “explore the issue of whether the term borderline personality disorder should be replaced with another term.” The proposal the Assembly endorsed says that this term is often “misleading” and can trivialize a serious psychiatric disorder.

• include early career psychiatrists on district branch councils in its model district branch constitution and bylaws document and to ask district branches to incorporate such a provision in their own constitutions.

• fund a $1,000 pilot program that would provide child care services for Assembly members attending Assembly meetings.

• have APA consider developing recommendations on how the treatment of chronic mental illnesses could be financed in both the public and private sectors. This funding has long been inadequate or nonexistent, and insurance coverage continues to shrink while governments are also cutting public support of this type of care. ▪