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Assembly Backs Gay Marriage, Asks Board to Share Power

Two proposals generated considerable debate in the APA Assembly last month. One seeks to put APA on record in support of same-sex civil marriage, and the other asks the Board to give the Assembly more power.

A large majority of the APA Assembly voted last month to have APA adopt a position statement supporting the legal recognition of same-sex civil marriage.

The vote came on a resolution and supporting position statement proposed by the Council on Minority Mental Health and Health Disparities and developed by its Committee on Gay, Lesbian, and Bisexual Issues. It came to the Assembly as a referral from the Joint Reference Committee, and council Chair Francis Lu, M.D., explained the statement's background and intent to the Assembly.

In October 2004 the Board of Trustees had asked four APA components—the Committee on Gay, Lesbian, and Bisexual Issues; Council on Psychiatry and Law; Committee on Judicial Action; and Council on Children, Adolescents, and Their Families—to work with the Joint Reference Committee to develop a statement on same-sex marriage.

Before the statement can become official APA policy, it must be approved by the Board of Trustees. The Board is scheduled to review the statement at its July meeting.

The position statement emphasizes the positive impact on mental health of a "stable, adult partnership" and points out that "sustained and committed marital and family relationships are cornerstones of our social-support network as we face life's challenges, including illness and loss. There is ample evidence that long-term spousal and family support enhance physical and mental health at all stages of development."

The statement also says that same-sex couples lack the protections of law to which heterosexual spouses are entitled, including protections for adopted children, ability to make health care decisions for a disabled partner, or even visit a hospitalized partner.

Coverage of APA's 2005 annual meeting, which was held in Atlanta May 21 to 26, begins in this issue and will continue in next month's issues.

"Same-sex couples therefore experience several kinds of state-sanctioned discrimination that can adversely affect the stability of their relationships and their mental health," reads the statement.

The statement further emphasizes that it refers to civil and not religious marriage and expands an earlier statement supporting civil unions for same-sex couples.

Opponents of the statement appeared to back the position articulated by Daniel Cowell, M.D., West Virginia's deputy representative, who said that the issues involved were social or political rather than in the realm of mental health concerns, and APA should thus avoid taking a position despite adoption of similar statements by other mental health organizations.

Lu countered, however, that the statement "builds on 30 years of APA support for equal rights for sexual minorities."

Michael Gales, M.D., a representative from the Southern California Psychiatric Society, said that while several of his Area 6 colleagues maintained that "this was not the right time" for APA to take such a position, the majority agreed that "it falls to [psychiatrists] to be leaders in this area and to take the principled position."

Stephen McLeod-Bryant, M.D., of the Assembly's Committee on Minority/Underrepresented Groups urges Assembly representatives to support a proposed APA position statement emphasizing the mental health benefits that would accrue from granting same-sex couples the right to marry. The statement was passed by a substantial margin and will be voted on next month by APA's Board of Trustees. David Hathcox

Stephen McLeod-Bryant, M.D., who represents black psychiatrists on the Assembly's Committee of Minority/Underrepresented Groups, urged support for the statement, likening the legal situation of same-sex couples to that of African Americans, who for centuries were subject to a "lower level of rights" than the majority of Americans.

"It doesn't bode well for anyone's mental health to be denied what otherwise would be their legal due, if not for their color, gender, or sexual orientation," he stated.

Lois Flaherty, M.D., chair of the Council on Children, Adolescents, and Their Families, stressed that "children should have the same rights no matter who raises them."

A voice vote indicated that the statement had overwhelming support.

Reflecting many Assembly members' desire to have more say in APA's decision- and policymaking process, the representatives endorsed a proposal to increase the Assembly's power.

Some Assembly members believe that the Assembly is more representative than the Board of Trustees and more closely mirrors members' thinking, since it has representation from every district branch and APA-recognized minority group and from several allied organizations.

This proposal, which called for a revision of the APA Bylaws, would give the Assembly the power to reverse a Board action in some instances. It would allow the Assembly to override a Board action that overrules, ignores, or fails to implement an action passed by the Assembly. For this override to occur, 75 percent of Assembly members would have to vote in favor of it. The proposal excludes actions that the Board of Trustees deems would be illegal or would threaten APA's tax status.

It also would apply to actions by the Joint Reference Committee on papers passed by the Assembly.

Jerome Rogoff, M.D., who introduced the proposal, said it was "an attempt to give the Assembly the final word and create the real impression that it's not just a debating society."

Area 5 Rep. Gary Weinstein, M.D., called the proposal "a tiny step toward power sharing."

Former Assembly Speaker and incoming APA Vice President Nada Stotland, M.D., disagreed that this was an important step for APA to take, suggesting that the time spent on internal governance issues seems to many members to be "merely navel gazing." Members, she said, want their Assembly representatives to "focus on bigger issues."

The measure passed with 61 percent of the votes and will go to the Board with a request that the Board either amend the bylaws or include the proposed amendment on the next APA election ballot.

In other actions the Assembly

• ratified an amendment to the APA Bylaws that redefines the roles and responsibilities of the APA president and medical director and shifts the CEO position from the president to the medical director. The change reflects the idea that while a new president takes office every year, the medical director has a multiyear tenure and is thus in a better position to act as the chief executive. The Board has already approved this amendment.
  
• asked the Council on Healthcare Systems and Financing to address the issue of third-party reimbursement, including by the federal government, for off-label uses and doses of prescription drugs. Proponents of the measure noted that psychiatrists treating children and adolescents often prescribe psychotropics for off-label uses and in off-label doses, but pharmacy benefit managers and insurers sometimes deny reimbursement for such uses even when a physician determines that a medication or dosage is best for a particular patient.
  
• voted to have APA discuss with the Federal Aviation Administration and other licensing agencies the evidence base showing the benefits of psychiatric care. The goal of the proposal is to have these agencies evaluate pilots and other licensed individuals based on their "ability to function" rather on a specific diagnosis or treatment.
  
• approved a proposal to have APA develop "resource documents about psychiatric conditions and their medical treatments" that would be targeted to patients and the general public. The goal is to provide "an objective source of accurate information" on these topics. The paper notes that the APA Web site gives only limited information and directs visitors to other Web links for detailed information on somatic treatments for psychiatric disorders. Thus, the proposal also calls on APA to enhance the somatic treatment information on its Web site as well.
  
• agreed to urge APA to develop a position statement emphasizing that chairs of departments of psychiatry or behavioral medicine should be physicians who have completed an accredited psychiatry residency.
  
• voted to urge the Scientific Program Committee to ask each annual meeting course instructor to add five extra seats for members-in-training (MITs), who would pay only the cost of course materials. Each MIT would be allowed to attend one course on this basis at each annual meeting. MITs now pay the same course fee as all other registrants, though they can register on the day of a course, if space is available, for half of the standard fee. The Assembly also called for the appointment to the Scientific Program Committee of an MIT from the Area Committee of MIT Representatives.
  
• called on APA to "advocate for legislation or other types of remedies that address the need for the consideration of the privacy of patient records when there has been a complaint to a [government] agency about the treatment when the patient is not the complainer." The paper says that in such cases the patient should be advised of the potential privacy breach and have the right to object and be informed of a process to challenge the request for records.
  
• voted to explore having fetal-alcohol-related disorders included in DSM-IV-TR and in DSM-V, which is in the early stages of development. The disorders would include fetal alcohol syndrome, fetal alcohol spectrum disorders, and alcohol-related neurodevelopmental disorder.
  

Nada Stotland, M.D., former Assembly speaker and incoming APA vice president, presents the District Branch Best Practices Award to Harry Brandt, M.D. (center), of the Maryland Psychiatric Society. Also shown is Area 3 Deputy Rep. Bruce Hershfield, M.D. The district branch won for its comprehensive membership programs, which include a sophisticated database that allows for referrals, billings, and other functions; publication of three newsletters; outreach to the academic community; and establishing committees to address private-practice and public-sector psychiatry issues. David Hathcox

The draft summary of the Assembly's actions is posted in the "Members Corner" section of APA's Web site at <www.psych.org/members/index.cfm> under "Assembly." The document "APA Actions on Legal Recognition of Same-Sex Civil Marriage" is posted in the Members Corner section of APA's Web site at <www.psych.org/members/download.cfm?file=667>.

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