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APA Fall Assembly Recap Report

Monday, December 23, 2019  
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November 2019
This digest of events during the November Assembly meetings held in Washington, DC summarizes oral presentations and action items of the Assembly. Many other reports presented in written form can be found in the Assembly Packet. It is best to download or read these notes online, but may also be printed and distributed in hardcopy (without access to the web links). You may use it as is, or edit and modify the content to suit your particular needs. Any errors or omissions are to be considered unconscious. Corrections and suggestions may be sent to Adam Nelson, M.D., Northern California Psychiatric Society.
 Download PDF version.

Speaker’s Welcome and Introduction of New Members — Paul O’Leary, MD

Dr. O’Leary welcomed all to the November Assembly. He discussed a change to the procedures for one of the Reference Committees that would involve creating what would amount to a second-chance consent calendar of all items addressed during the deliberations of Reference Committee 4. This would amount to a pilot project of a change in procedures on which the Assembly would then vote later in the session. If approved, the procedures would go into effect for all Reference Committees for the upcoming spring session in Philadelphia. Subsequently, Dr. O’Leary, along with Speaker-Elect Dr. Joseph Napoli and Recorder Dr. Mary Jo Fitz-Gerald, welcomed all new members to the Assembly.

Report of the Assembly Nominating Committee — James R. Batterson, MD

The Nominating Committee presented its slate of candidates for Assembly Officers. In addition, nominations were accepted from the floor. Congratulations and good luck to all the candidates!

Speaker-Elect: Mary Jo Fitz-Gerald, MD (Area 5)

Recorder: Vasilis Pozios, MD (Area 4)

Adam Nelson, MD (Area 6)

Steven Brown (Area 7)

APA President — Bruce Schwartz, MD

Dr. Schwartz has been in Washington lobbying on issues including lack of psychiatric beds, homelessness, ligature use, and poor access to mental health services. He has had meetings with members of the “group of 6”, at the White House with the Deputy Director of Domestic Policy and is currently planning a meeting with Secretary of HHS Alex Azar. Everyone is in agreement that there are universal problems of multiple crises with MH issues. Recent APA accomplishments include the start of appointments to the APA Committee on Women's Mental Health (which grew out of an Assembly Action Paper); the BOT approved a long term plan of change in investments in fossil fuels (another Assembly Action Paper). IPS meeting was a huge success with over 1500 attendees. A workgroup is developing continuing recommendations for the IPS to make it cash-flow neutral. The IPS track on Treatment of Early Psychosis drew a lot of non-psychiatrist attendees. In an effort to improve access to care, Dr. Schwartz has created a task force to explore collaboration, chaired by APA Secretary Sandra DeJong. The task force has engaged a number of non-psychiatric clinical groups and organizations to participate in the discussion. One of the missions is to break through the resistance to the recently passed parity legislation. Another APA task force will examine finances once purchase has concluded of the APA HQ. Finally, there is a workgroup to develop clinically-based criteria for acute and continuing levels care of SMI patients, rather than leaving it to insurers and other 3rd parties.

APA President-elect — Jeffrey Geller, MD, MPH

Dr. Geller began with a history lesson: The first meeting of APA Assembly of District Branches was held in 1953. The agenda topics included psychologists encroaching on psychiatric practice, state and national legislative matters, and the role of APA in inspecting mental hospitals. The budget for the Assembly was $500. (A new color TV cost 3x as much at that time.) From 1953 to 1983, all DBs sent one representative and one deputy representative. There were an estimated 559,000 psychiatric beds, or 340 beds per 100,000 persons in the US.

Today, we have an estimated 11 beds per 100,000 – a huge drop in the past 66 years. Persons with SMI are more likely to encounter police and go to jail than get psychiatric help, or to wind up homeless. 10% of suicides are caused by persons with untreated SMI. Looking forward to 2021, no one knows how many psych hospital beds we need. Dr. Geller includes in his goals as APA president an initiative to figure this out.

Treasurer Report — Gregory W. Dalack, MD

Dr. Dalack presented highlights of the 2019 fiscal year thus far. A full report is in packet. Net income for 2019 has gone up compared to 2018. The annual budget is expected to be net $8.8 positive compared to 2018, including cash reserves as allocated by BOT for the building purchase of the APA headquarters. Expectation by end of year is to break even. Regarding revenues, our investments in market have done significantly better than expected. Dues income is lower due to the “rule of 95”. Publishing and DSM revenue is higher; annual meeting income is lower. Regarding expenses, program and services expenses are lower than expected; advocacy expenses are also lower. Investments in fossil fuels are being divested. Cash is accruing for the eventual purchase of the APA building.

Dr. Dalack then presented a report as chair of the Workgroup on Safe Prescribing. They are working to harmonize the Position Statement from the Assembly Action Paper with previous APA Position Statement. They met once, with one more meeting scheduled to produce a statement to present to BOT in February.

APA Political Action Committee — R. Scott Benson, MD, Chair

In 2019 so far, 1233 contributors gave $234600 – or an average of $190 per contribution. Contributions have come from 66% of Assembly members, 96% of AEC members.

APAPAC donates to key legislators who support issues of importance to APA. Since it was discovered that insurers are not following the Parity law and not reporting on equitable expenditures, PAC contributions have gone to legislators who are now trying to pass a law to follow the parity law. PAC is also contributing to support proposed legislation for effective suicide screening. The APA-CAN (Congressional Advocacy Network) encourages APA members to meet with their federal legislators.

CEO/Medical Director of the APA — Saul Levin, MD, MPA

Dr. Levin began with the sad announcement of the passing last week of Paul Burke, former director of APAF. He was adored by all and “a man for all seasons”. APA has completed the TCPI-SAN 4 year grant, having trained 3566 psychiatrists, 357 primary care physicians, and 920 support staff. Going forward, APA continues to provide CME on all training modules. In a joint project with SAMHSA, APA has produced the SMI Adviser mobile app ( and, in 2017, APA produced an online App Evaluation Model. Illinois has become the 1st state to pass APA's Model Collaborative Care legislation. In addition, APA is sponsoring Mental Health Parity legislation in Congress: S1737 (folded into S1895 - Lowering Healthcare Costs Act) and HR3165 introduced this year. USUHS residency slots are in danger of ending due to proposed cutting of "4th Estate" programs. The 2020 CMS reimbursement schedule currently calls for planned increases in E/M reimbursements. In a note to Assembly members, Dr. Levin observes that Action Papers are much improved and staff have taken notice.

In comments from the Assembly floor, Dr. Levin is congratulated for receiving an honorary fellowship by the Royal College of Psychiatrists.

Presentation of Assembly Awards Committee — Theresa Miskimen, MD, Chair

Presentation of the Assembly Profile of Courage Award: Pamela McPherson, MD

Patricia Westmoreland, MD, President of Colorado Psychiatric Association presented this award to Pamela McPherson, MD for her work with immigrant families in border issues. Dr. McPherson is a mental health expert for the Office of Civil Rights and Civil Liberties at the Department of Homeland Security. She wrote to the Senate Whistleblower Caucus and to Congress about the long-term psychiatric consequences of separation of children from immigrant families. She has published articles in the news media. She also received The Ridenhour Prize for Truth-Telling and the Physicians For Human Rights Award and was interviewed on "60 Minutes". Dr. McPherson describes herself as a whistleblower and recognizes the value of APA in protecting her rights to speak out in protecting the rights of children where they may be infringed.

Assembly Committee on Procedures — Edward Herman, MD (Area 2), Chair

The following items were approved by the Assembly:

A new proposed Action Paper (AP) Pathway & Reference Committee’s Role and Functions (vote Y: 141-N: 46)

This change in the Procedures of the Assembly develops new responsibilities for the Rules Committee, which will now present a Consent Calendar and a Reaffirmation Consent Calendar for the Assembly to approve. The latter will consist of Action Papers and proposals that, in the opinion of the Rules Committee, reflect or reiterate currently existing positions or policies within APA. As with the existing Consent Calendar, any item can be pulled by any member of the Assembly at the time of the meeting of the Assembly. In addition, changes in the Procedures of the Assembly specify the mechanism of an author’s withdrawal of an Action Paper from consideration at each stage of the deliberation process of the Action Paper and address the possibility of Conflict of Interest when an Action Paper’s author serves on the Reference Committee in which the Paper is assigned for consideration.

Eliminate author responsibility of preparing a cost analysis in writing an Action Paper (vote Y: 168-N: 9)

American Psychiatric Association Foundation — Saul Levin, MD, MPA, Chairperson/Chief

Executive Officer and Medical Director & Daniel Gillison, Jr., Executive Director

Dr. Levin reports APA Foundation is looking for new public sector member to join the Board who either has significant fund raising experience or access to funds to support the APAF. There is also opportunity to "give an hour" through the APAF partnership. Mr. Gillison reports the APAF Benefit during the upcoming APA Annual Meeting will be on Saturday, April 25 at the Union League in Philadelphia. For the upcoming holidays, the Foundation presents an opportunity to Adopt-A-Book in the APA Library. Other ways to support APAF include making an annual donation, pledging a planned gift, connect APAF with your network of supporters, or launch a peer-to-peer fundraising campaign. This year, APAF Fellows have come from many states, with the largest number (24) from California. There has been a 30% increase in APAF Fellowships. This year, there are two Jeanne Spurlock Congressional Fellowships ($100K+) available. A new fellowship is the Edwin Vladiserri Correctional Public Psychiatry Fellowship. The Center for Workplace MH ( has had growing media engagement, with significantly expanding number of website and resources hits in the past year. The Typical or Troubled? Program 2019 pilot is being directed at several different school settings. And APAF continues to sponsor the Awards for Advancing Minority Mental Health, which recognize psychiatrists who have undertaken innovative approaches to improve access for minority populations to mental health services

APA Position Statements

The following Position Statements were approved by the Assembly:

**Proposed Position Statement: Disaster Preparedness and Response for Older Americans

**Proposed Position Statement: Mental Health of Foreign Nationals on Temporary Protected Status

**Proposed Position Statement: Addressing Racial and Ethnic Health Disparities in Substance Use Disorder Treatment in the Justice System

**Proposed Position Statement: Diversity and Inclusion in the Physician Workforce

Proposed Position Statement: Transitional Aged Youth

*Retired Position Statement: Consensus Statement on Improving the Quality of Mental Health Care in U.S. Nursing Homes

*Retired Position Statement: Core Principles for End-of-Life Care

*Retained Position Statement: Peer Review of Expert Testimony

Revised Position Statement: Relationship Between Treatment and Mutual Support

*Proposed Position Statement: Prescription Drug Monitoring Programs

*Retained Position Statement: Discrimination Against Persons with Previous Psychiatric Treatment

*Retained Position Statement: Insanity Defense

*Retained Position Statement: The Need to Monitor and Assess the Public Health and Safety Consequences of Legalizing Marijuana

Revised Position Statement: Discriminatory Disability Insurance Coverage

*Revised Position Statement: Assuring the Appropriate Care of Pregnant and Newly- Delivered Women with Substance Use Disorders

Revised Position Statement: Leadership of State Behavioral Health Services

*Retired Position Statement: Ethical Use of Telemedicine

*Retained Position Statement: Joint Resolution Against Torture

*Retained Position Statement: Psychiatric Participation in Interrogation of Detainees

Proposed Position Statement on the Care of Medically Vulnerable Migrants in the United States

Proposed Position Statement on Controlling Drug Prices

Action Papers/Items

Among the Actions taken during this session, the Assembly voted:

To Develop an APA Position Statement Addressing Harmful Consequences of the Rise of White Supremacy

**To Propose an APA Position Statement Regarding Mental Health Screening and Access to Mental Healthcare for Civil Immigrant Detainees of U.S. Homeland Security

To Address Workplace Intimidation and Bullying at the VA

To Have the APA Develop a Toolkit Supporting the Recruitment and Hiring of Psychiatrists

To Oppose Social Security Disability Mental Evaluations by Chiropractors and other Non-Qualified Examiners

To Support Public Education Efforts by APA to Increase Responsible Disposal of Prescription Medication

To Address Variability in State Law Concerning Emergency Holds for Psychiatric Evaluation

To Improve Access to and Ease of Searching of the APA Position Statement Database

To Oppose APA’s Development of an Affiliate Membership Category for Non-Psychiatrists

To Change the Procedural Code of the Assembly to Oppose Action Paper Author and Sponsor Bias in Reference Committee Discussions

To Urge Greater APA Accountability for Climate Change Using Carbon Offsets and Becoming Carbon Neutral

For APA to Join as a Signatory to the US Call to Action on Climate, Health and Equity

(Items with a * were approved by consent. Items with a ** were approved by consent of the recommendations from Ref Committee 4.)
A draft summary of actions taken by the Assembly can be found here.
Final version of all Action Papers can be found here.
You can view all current and previous Action Papers and track their current status on AITS here.

Reports and Next Steps from the Assembly Committees/Work Groups

Committee on MOC - Russell Pet, MD

There were 3 pending lawsuits against ABMS, ABIM, and ABPN on anti-trust concerns. ABIM case was dismissed by the judge. There was discussion on the recent new pilot MOC program and individuals' experiences. Also there was discussion on the Action Paper for APA to explore its own pathway to MOC. APA is actively exploring this as a "benefit of membership".

Committee on Psychiatric Diagnosis and the DSM – Heather Hauck, MD

Members came to speak on the 4 DSM revision action items on which Assembly voted previously. There was discussion between the Assembly Workgroup and the DSM Steering Committee.

Committee on Public and Community Psychiatry – Isabel Norian, MD

Focus of discussion was on further work on a position statement on involuntary hospitalization of SMI adults. Plans include coordinating with the Council on Psychiatry and the Law on crafting the statement. There was discussion on mental healthcare delivery issues in Canada with Dr. Judy Glass. The workgroup will address the crisis in the workforce and peer support services in Public Psychiatry.

Committee on Access to Care - Eliot Sorel, MD

Access to care is one of top 3 issues in this election year. There was discussion on implications of recent successful litigation against UnitedHealthcare in California and the recent fine of $1M against UHC, as well as further discussion of egregious practices by insurance companies in preventing access to adequate MH Care.

Assembly RFM Merit Award Work Group

No chair: first meeting. There was initial effort to establish who is in the workgroup. Awardees may include ECPs as incentive to retain ECP membership in APA. Inclusion and exclusion criteria are still being established.

Assembly Psychiatry Workforce Work Group – William Greenberg, MD

The workgroup is looking to extend forecasting information beyond available data, which currently extends only about 15 years. This is not helpful for current RFMs and ECPs who would be seeking workforce participation for considerably longer.

The (Dis)Assembled Nine

A taste of Assembly talents

New Business

Basker Dave commends Speaker O'Leary for his pilot project on Reference Committee procedures

Bob Batterson recognizes Charles Price, former Dep AEC rep from Area 7 and Assembly member for many years, who has had to resign for personal reasons

Future Meetings

April 2020 Assembly

April 24-26, 2020

Philadelphia, Pennsylvania

[APA Annual Meeting April 25-29, 2020]


November 2020 Assembly

November 6-9, 2020
Capital Hilton, Washington, DC (please note new venue)