Access, Patient-Care Issues Get Assembly Attention

Access to care and advocating to ensure that patients get quality care were among the issues high on the agenda for APA Assembly members at their fall meeting last month in Washington, D.C.

Among the actions taken by the Assembly was endorsing a proposal to have APA support federal and state initiatives to continue health insurance coverage to young adults who lose eligibility to stay on their parents' plan even though they are still dependents. For example, college students who drop out of school because of illness often lose eligibility, while their peers who don't attend college lose coverage when they graduate from high school.

“The issue is of special interest to psychiatry,” the proposal noted, since “late adolescence is the most common age for onset of mental illness, and these illnesses severely impact function, especially cognitive function.” Loss of coverage could seriously disrupt crucial treatment relationships in these individuals.

One of the highlights of the meeting was the presentation of the Assembly's Profile of Courage Award to Anna Holmgren, M.D. She was recognized for her extensive volunteer work in Baton Rouge and New Orleans immediately after Hurricane Katrina struck in 2005. She closed her New York practice after the storm to spend weeks helping police, other first responders, and victims cope with a life-and-death crisis for which none had planned. During much of this time the conditions under which she lived were brutal, including days sleeping on a cot in a room where the bodies of people who died while sheltered in the Superdome were stored. She noted that her experiences were still extremely difficult to talk about, and she dedicated the award to the police, 911 operators, and others who kept working without sleep or changes of clothes, even after they lost homes, their possessions, and the lives they once led.

On other fronts, the Assembly urged APA to partner with the American Association for Emergency Psychiatry and American College of Emergency Physicians in an effort to solve the problem of overcrowding that plagues many emergency departments, with a particular focus on how psychiatric patients are handled.

The group also voted to urge APA to adopt the position that “patients with acute behavioral problems receive appropriate emergency psychiatric and medical assessment prior to disposition, using procedures that have been recognized as sound by medical professional organizations.” This action was an attempt to prevent patients with serious psychiatric problems from being diverted from emergency departments, or even before they are seen in emergency departments, to facilities that lack “appropriate psychiatric and medical assessment.”

Use of the term “suicidality” also received attention from the Assembly, which endorsed a resolution that APA advocate that the Food and Drug Administration (FDA) limit use of the term “suicidal behavior” to medications “that have been demonstrated to be associated with suicide per se.”

The concern about inaccurate use of the term arose in large part because of the FDA's practice of using it in relation to risks that may be associated with antidepressants, particularly in young people. The studies on which the FDA based its decision to mandate additional warnings on antidepressant labels, however, did not find an increase in suicides. The background to the Assembly proposal points out that in some patients, the willingness to discuss suicide may represent an improvement in their condition, that self-injurious behavior should not be automatically equated with suicide attempts, and that“ some actions that are pleas for help” end up being labeled“ suicidal.”

The Assembly also turned its attention to peripartum depression, calling on APA to continue supporting a congressional bill to increase research funding in this area. The delegates also want APA to send information about peripartum depression to district branches and urge them to work with nurse, midwife, and physician groups to educate new mothers on warning signs, and to distribute an APA review of the topic to psychiatry residency directors.

Telepsychiatry has for many years been viewed as a method of expanding access to psychiatric care, and the Assembly voted to establish a new grant program for district branches who want to undertake projects to expand access to and education about telepsychiatry in their areas. The proposal calls for APA to earmark $50,000 to cover the cost of 10 grants of up to $5,000 each.

In an effort to enhance access to care in underserved areas and share experiences and knowledge about this issue, Assembly delegates backed a proposal to survey residency training directors to gather information on“ expertise and activity in academic departments” regarding psychiatry practice in rural and underserved areas and to disseminate the survey findings to organizations and federal agencies that focus on this topic.

In other actions the Assembly voted to

The Assembly also wants APA to urge the federal government “to implement well-designed clinical research into the medical utility of marijuana,” again backing an AMA statement on the issue.