Psychiatr News December 7, 2007
Volume 42, Number 23, page 1
© 2007 American Psychiatric Association
Access, Patient-Care Issues Get Assembly Attention
Ken Hausman
Advocating for patients is one of APA's key strategic goals, and
Assembly delegates give their support to a number of proposals to further that
goal at their meeting last month.
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.
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Anna Holmgren, M.D., received the Assembly's Profile of Courage Award at
its meeting last month in Washington, D.C. With her is Laurence Dopkin, M.D.,
who nominated her. He is the Area 2 deputy representative to the Assembly
Committee of ECPs. See story below.
©Sylvia Johnson Photography
2007
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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
- support a proposed APA position statement on ECT, emphasizing that
the treatment is a "safe and effective evidence-based medical treatment
[that is] endorsed by APA when administered by properly qualified
psychiatrists for appropriately selected patients." (Position statements
must be approved by the Board of Trustees before they become APA policy.)
- adopt a draft position statement on release of patients' records to
state medical boards. The statement stresses that patients should have the
right to determine whether to release their records to a medical board
investigating a complaint against a physician. If the patient refuses to
consent, an independent panel should be convened to determine "whether
the medical board's interest in obtaining the records outweighs the patient's
interest in privacy."
- agree with the Board of Trustees that APA's secretary-treasurer position
should be split into two offices in light of an unexpectedly large
workload for the person serving in this combined position. The positions were
separate until 2005.
- support an AMA position statement on medical use of marijuana that
states, "The AMA believes that effective patient care requires the free
and unfettered exchange of information on treatment alternatives and that
discussion of these alternatives between physicians and patients should not
subject either party to criminal sanction," as has been threatened by
the federal government in the case of physicians who prescribe marijuana for
medical use in the 12 states that permit it.
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.
- ask the APA Committee on Psychiatric Diagnosis and Assessment for its
evaluation of a proposal to change the term "mental
retardation" to "intellectual disability" in the 2009
printing of DSM-IV-TR and to urge the federal government to approve
adding this term to codes used in ICD-9-CM beginning in 2009.
Related Articles:
-
Candidates Announced
Psychiatr News 2007 42: 28.
[Full Text]
-
Congressman Tells Psychiatrists: Get Involved
Psychiatr News 2007 42: 28.
[Full Text]
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