APA District Branch Report
Psychiatric Society of Virginia District Branch Report to the Area V Council Meeting
American Psychiatric Association
May 19-21, 2017
John P. D. Shemo, MD, DLFAPA
PSV Representative to the
Varun Choudhary, Adam Kaul and I attended the 86th meeting of the APA Assembly held in San Diego on May 19-21, 2017. I also attended the meeting of the APA Practice Guidelines Steering Committee on May 22 where I served as Chair of the Assembly Liaisons.
As is our usual practice, we did have reports from persons in APA leadership positions. Saul Levin, MD, our CEO and Medical Director, discussed issues related to the APA being very “alert” to maintenance of certification issues, including their expense and time demands. He also discussed the position of the APA that mental health must be an essential health benefit under any version of the American Health Care Act (AHCA). He pointed out that with approximately 37,000 members, the APA is at a historical high in membership. Psychiatry is now the third largest specialty in the American Medical Association.
Anita Everett, MD, our rising President, also addressed the Assembly. I have known Anita since her years of medical education and am so impressed with her development as an eloquent and thoughtful advocate for our patients and our profession.
As is the central role of the Assembly, we reviewed numerous position statements and action papers which I will try to briefly summarize:
- An action paper was passed directing the APA to develop a comprehensive position statement on the use of involuntary commitment for the treatment of substance abuse disorders. This entire area is very complex in terms of the interplay of need versus funding.
- A paper was passed relating to the adoption of Neuroscience-based Nomenclature (NbN) for medications. That is, a medication would not be described by its first FDA approved use (i.e., an antipsychotic), but by its understood mechanism of action (i.e., a dopamine receptor blocker). This area is very complex as often a particular pharmaceutical effect does not explain a medication’s effectiveness, but rather is a marker of a medication that may be effective in treating a certain condition. For example, all serotonin reuptake inhibitors are not effective antidepressants. This paper is focused not on a particular position on this complex problem, but rather on the APA’s engagement in the process, with the goal of helping move nomenclature in this direction.
- A paper related to having an APA member survey done regarding “Medical Aid in Dying as an Option for End of Life Care” failed. It was felt that the current position of the hospice system adequately covers this and that psychiatric illness should not be considered as a routinely “terminal condition.”
- A paper was passed supportive of our use of caution in the use of Pharmaco genomics in clinical practice in psychiatry. While there are proprietary entities “selling” genomic profiles that they maintain will establish the diagnosis of various conditions or supporting differential responsiveness to certain modalities in treatment, the state of the art does not, in fact, yet support this use of Pharmaco genomics in many of the ways for which it is being advertised/sold.
- A paper was passed supporting the position that the medical school clerkship in psychiatry should be at least six weeks.
- An action paper was passed asking that the APA advocate that healthcare is a “human right.” The issue of what is a “right” versus a “goal” was central in this debate. The argument being, reasonably, that a “right” is something that is yours until taken away while a “goal” is something you want to achieve because it is of the greatest good to the greatest number of people. Since the paper passed, this argument obviously was not adequately persuasive.
- An interesting paper was passed taking the position that, during an election for APA officers, a member logging onto the APA website would be confronted with a voting page that they would need to default to not vote. This would occur during election cycles whenever the voting member accessed the APA site for any reason until they, in fact, voted. Obviously, the goal of this would be to increase voter turnout.
- A paper was passed lowering the APA dues paid by members of the Puerto Rico District Branch to the level paid by members of the Canadian District Branches since, like the Canadian members, members from Puerto Rico are not eligible for a number of APA member benefits such as access to the APA-endorsed insurance or advocacy support. Of interest, the latter is related to the fact that citizens of Puerto Rico, while American citizens, are not subject to the American legal system but rather to the Spanish legal system.
- A paper was passed trying to streamline the application process for former APA members since much of their historical data is still on record with the APA.
- Finally, an action paper I presented for the fifth time was, for the fifth time, passed. The paper is focused on reinstating a viable member-driven referendum action process. Currently, referenda are attached to the APA officer election ballots. Officers are elected by majority vote of whatever percentage of members elect to vote. A referendum must attain a majority of votes of at least 40 percent of voting eligible members. In the past, this system worked because large numbers of APA members, in fact, voted. For many years now the percentage of eligible voters who in fact vote in the officer elections, is very low, sometimes as low as 15-20 percent. The majority of members have not voted in many years. This process of having the referendums attached to the election ballot is therefore no longer viable. In 2011, in the last referendum that was attempted, 80 percent of voters voted for the referendum. Because 40 percent of eligible voters had not voted, the Board of Trustees took no action on the referendum despite the fact that had 40 percent voted and all of the extra votes to get to the 40 percent had voted against the referendum, the referendum still would have passed.
The first “therefore” in this paper presented a plan to deal with this situation if it were to recur and to open the door for the reestablishment of a viable member driven referendum process. I will note that this plan retained the requirement that a vote of 40 percent of the eligible voters would still be required to pass a referendum. I am certainly not looking for the development of a process to allow “minority mandates” to occur. Ironically, this very phenomena may now occur in our officer elections due to, as noted above, at times, there is less than a 20 percent voter turnout. A second “therefore” in the paper requested that if the Board of Trustees for a fifth time does not act on this Assembly-passed paper, that they prepare an alternative option for reinstituting a viable referendum process to be presented to the Assembly at our next meeting. An amendment was added to this second “therefore” requiring that Assembly liaisons be appointed to sit with the Board to address this issue. It will be interesting to see if, despite the (again) overwhelmingly positive vote of the Assembly in favor of this paper, the appointed Assembly members turn out to be those who, in fact, oppose the paper. This concern is based on the stipulation that the Assembly members who are to sit with the Board of Trustees will be selected by members of the Board of Trustees. It was my observation that those limited number of Assembly members who have opposed this paper tend to be those positioning themselves for eventual roles on the Board of Trustees.
A number of APA Position Statements were retained, revised, or retired. Some of interest include:
- Retained – Use of stigma as a political tactic.
- Retained – Role of the psychiatrist In long-term care settings. The Council on Geriatric Psychiatry asked that this paper be revised and this is in process.
- Retired – US Military policy Of “Don’t Ask, Don’t Tell.” This act has been repealed by the federal government and the “Defense of Marriage Act” was overturned in 2013 by the US Supreme Court. Thus, this paper was retired as now being irrelevant.
- Retained – Resolution against racism and racial discrimination and their negative impact on mental health.
- Retained – Position statement regarding discrimination against international medical graduates and regarding APA’s position on both diversity and on the promotion of psychiatrists from under-represented groups into leadership roles.
- Revised – Position statement on abortion, with updated references.
- Retained – Misuse of psychiatric examinations and disclosure of psychiatric records in sexual harassment litigation.
- Retained – No “dangerous patients” exceptions to federal psychotherapist - patient testimonial privilege.
- Proposed – Risk of adolescent online behavior.
- Proposed – Role of psychiatrists in addressing the care of people affected by forced displacement.
- Proposed – Legislative attempts permitting pharmacists to alter prescriptions.
- Revised – Use of the concept of recovery.
Obviously, I could have written an essay on the intricacies of each of these actions of the Assembly, but I hope this outline supports the recognition that the APA Assembly is committed to providing support for the work of our members and the well being of our patients.
As always, Adam,Varun and I are committed to bringing your concerns to the attention of the APA Assembly and the Board of Trustees. If you have observations or concerns which you feel need to be addressed, please contact us.
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