District Branch Research Articles

Canadian Psychiatrists Transition Smoothly Into Emergency Mode for COVID-19

Canadian Psychiatrists Transition Smoothly Into Emergency Mode for COVID-19

COVID-19 Pandemic Presents Timely Opportunity to Become Involved in Advocacy

COVID-19 Pandemic Presents Timely Opportunity to Become Involved in Advocacy

Getting Paid by Patients During the Pandemic

Getting Paid by Patients During the Pandemic

Pender Chosen APA’s Next President-Elect

Back to table of contents Previous article Next article APA & MeetingsFull AccessPender Chosen APA’s Next President-ElectSearch for more papers by this authorPublished Online:27 Feb 2020https://doi.org/10.1176/appi.pn.2020.3a33AbstractAPA members have selected a leader who has long been active in APA and global issues in psychiatry, including human trafficking.Vivian B. Pender, M.D., will become president-elect of APA at the end of APA’s Annual Meeting in April, when Jeffrey Geller, M.D., M.P.H., becomes president.APA’s voting members have elected Vivian B. Pender, M.D., of New York City to become APA’s next president-elect. She ran against David C. Henderson, M.D., of Boston.Pender is a clinical professor of psychiatry at the Weill Cornell Medical College and training psychoanalyst at Columbia University. A Distinguished Life Fellow, she has served APA in leadership roles at the United Nations and in her district branch, APA components, the Assembly, and the Board of Trustees. She is the founder of Healthcare Against Trafficking Inc. She advocates for diversity, inclusion, and equality. Her recent book is titled The Status of Women.Pender told Psychiatric News that she plans to focus her presidency on the social determinants of mental health. She intends to concentrate on prevention of some forms of mental illness by eliminating contributing factors. This will be coupled with early intervention tools and equal access to high-quality psychiatric care. Additional use of psychodynamic theory will provide insightful and durable treatments.“One avenue to accomplish this is through education,” she said. “A more informed society will be able to employ early intervention and create an environment conducive to mental health and devoid of stigma for those who need treatment. Another avenue is prevention. As psychiatrists, we all know there is a relationship between a strong early foundation in life and mental health, and so we must work toward the prevention of childhood trauma and violence. Such experiences include the long-held practice of corporal punishment and the sexual abuse of children. Also, education and prevention can help to decrease the number of incarcerated people who have mental illness, including substance use, and reduce other disparities that exist among women, people of color, indigenous people, the LGBTQ community, people living in poverty, and many other disenfranchised groups.“We are all global citizens who care about the pollution of our environment, refugees, human rights, poverty, and human decency,” she continued. “As president, I will invite APA members and nonmember psychiatrists to contribute to this endeavor of education and prevention to improve the lives of people worldwide.”Other Race ResultsThe race for treasurer, which has a two-year term, was up for election this cycle. Richard F. Summers, M.D., of Bryn Mawr, Pa., defeated Ann Marie T. Sullivan, M.D., of New York City.In the race for trustee-at-large, Michele Reid, M.D., of Novi, Mich., emerged the winner. Her opponents were Frank A. Clark, M.D., of Simpsonville, S.C., and Mark S. Komrad, M.D., of Towson, Md. This position has a three-year term.Two of APA’s seven geographic Areas voted for a trustee in this election cycle. Only members within each Area could vote for their respective Area trustee. Area trustees hold three-year terms.Winning the Area 2 trustee race was Glenn A. Martin, M.D., of Forest Hills, N.Y. His opponent was James P. Kelleher, M.D., M.B.A., of Harrison, N.Y.Jenny Boyer, M.D., Ph.D., J.D., of Norman, Okla., was elected Area 5 trustee. Her opponent was Philip L. Scurria, M.D., of Vicksburg, Miss.The winner of the race for resident-fellow member trustee was Sanya Virani, M.D., M.P.H., a PGY-4 resident at Maimonides Medical Center in New York. Her opponents were Mariam Aboukar, D.O., a PGY-3 resident at Advocate Health Lutheran General Hospital in Park Ridge, Ill., and Aatif Mansoor, M.D., a PGY-3 resident at the Charleston Area Medical Center in West Virginia.“I congratulate Dr. Pender and all of the successful candidates on their election,” said Bruce Schwartz, M.D. “I look forward to collaborating with them as APA works to improve access to and quality of mental health care for all.”“APA members and the profession of psychiatry will be well served by the leadership of Dr. Pender,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “I have known her for years, and her dedication and passion for psychiatry will greatly benefit APA during her tenure.”Election results were approved by the Tellers Committee in February, but the results will not be official until after the Board of Trustees reviews them at its meeting this month. All of the winning candidates will assume their positions on the Board at the close of APA’s Annual Meeting in May. ■ ISSUES NewArchived

Pender Chosen APA’s Next President-Elect

Back to table of contents Next article From The PresidentFull AccessGot Stories About Patient Struggles? Let Me KnowAltha StewartM.D.Altha StewartSearch for more papers by this authorM.D.Published Online:28 Feb 2019https://doi.org/10.1176/appi.pn.2019.3a33As psychiatrists, we know that different pathways in the brain are activated in someone listening to a set of facts versus a compelling story. But it’s one thing to understand that difference intellectually and quite another to prepare to use a story as a prominent tool in your advocacy.During the first week in February, I had the privilege of advocating on Capitol Hill with physician leaders representing our coalition partners in the Group of Six. The coalition, which began at the end of 2016 as an effort to protect access to health care, provides a powerful voice for the 560,000 physicians nationwide whom our six organizations represent. In addition to APA, they are the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American College of Obstetricians and Gynecologists, and American Osteopathic Association.During our meetings, we focused on access to affordable, effective prescription drugs for our patients, the costly administrative burden that takes precious time away from physician- patient interactions, and the need to ensure our patients have ready access to the care they need, including mental health parity, through private and public sector health plans. You and I can cite myriad facts and figures to support public policy fixes in all these areas. In fact, just about everyone visiting with legislators, on any issue, can bombard them with facts and figures. But if you really want to get their attention, don’t just recite the facts. Tell a story that makes your point. One of my physician colleagues explained how a patient decided to skimp on her insulin because she couldn’t afford all the prescribed treatments for her type 2 diabetes. The result? She ended up with multiple, avoidable amputations costing tens of thousands of dollars and trauma that will add to her medical needs for the rest of her life. Another colleague spoke of patients who had been stable on their medications for years but were then subjected to changing formularies and requirements to undergo step therapy by private plans and Medicaid. Virtually anyone can provide facts and figures to lobby their representatives on an issue like insurance market stabilization or access to prescription drugs. But not everyone can tell the stories that drive home the reality those facts represent. You can. We, as psychiatrists, can. And we must.It’s easy to underestimate the power that our individual experiences bring to advocacy. Things that may seem obvious to us and struggles we may assume to be common knowledge are often a revelation to others. They can also provide emotional ammunition for legislative allies promoting mental health or a reason for otherwise skeptical legislators to open their ears.So, I have two simple requests. First, as you prepare to advocate before your state or federal representatives on issues like parity, safe prescribing, prior authorization, step therapy, and access to care, find your story. Don’t name any names. Frame your story in a way that protects the privacy of your patients. But think about a one-minute story or two that demonstrate the challenges your patients face or that you experience in trying to help them navigate the complex world of health care as they struggle with mental illness or addiction. Show the human and emotional face of these issues. After all, that’s what this is all about.Second, let APA’s able staff know about your stories and experiences. APA has a strong advocacy team that is always looking for real-world anecdotes to help us reach and teach legislators. Help us collect meaningful stories that go beyond the stoic use of numbers and logic and move legislators from knowing there’s reason to act to feeling compelled to act! All you have to do is email me or email [email protected] with your stories or questions. APA’s advocacy staff can help you frame your story and connect it to important advocacy goals. And then, put your personal experience to use as part of APA’s Congressional Advocacy Network (sign up on the website if you haven’t already) and at the state house with your district branch. Let’s put a human face on our advocacy. ■Learn more about APA’s Congressional Advocacy Network and other ways you can become involved in APA’s advocacy efforts at https://www.psychiatry.org/psychiatrists/advocacy. ISSUES NewArchived

Groundbreaking Court Ruling Against Insurer Offers Hope in 2020

Groundbreaking Court Ruling Against Insurer Offers Hope in 2020

What Is It Like to Take Our Message to Capitol Hill?

Back to table of contents Previous article Next article From the PresidentFull AccessWhat Is It Like to Take Our Message to Capitol Hill?Bruce Schwartz, M.D.Bruce SchwartzSearch for more papers by this author, M.D.Published Online:23 Oct 2019https://doi.org/10.1176/appi.pn.2019.11a26One of the responsibilities of the APA president and president-elect is to participate in lobbying on Capitol Hill, often with the coalition we call the Group of Six. You may have seen coverage of these visits on APA’s social media and in Psychiatric News. The Group of Six includes APA, the American Academy of Pediatrics, American College of Obstetrics and Gynecology, American College of Physicians, American Academy of Family Physicians, and American Osteopathic Association. Together we represent more than 590,000 physicians and medical students and care for more than 200 million people. Most members of Congress want us to meet with them or their chief aides. They know that the issues we address are important to their constituents.These visits are highly coordinated by our collective government relations and policy staffs, and much groundwork goes into preparing our lobbying agenda. In each meeting, depending on the issue in which the member of Congress we are visiting is interested, the representative of the medical organization relevant to that issue takes the lead. For my recent visit to Capitol Hill, the top three lobbying issues I addressed were funding for maternal health, prescription drug pricing, and mental health parity enforcement.I’d like to share a few of my observations from my Hill visits with you. Our organizations have much in common and very few differences. Their presidents are very clinically grounded. We all essentially provide “primary care” to our patients, many of whom have complex needs. What has impressed me again and again is how important mental and substance use disorder issues are to our colleagues. They know that the failure of so many of their patients to access psychiatric care impacts their well-being. I believe that our arguments about the potential harm caused by the sequestration of substance use treatment records was effective in enlisting much support for the proposal to repeal 42 CFR Part 2 regulations (Psychiatric News).The key to being an effective lobbyist is not about citing statistics or communicating position or policy statements. It’s about telling a story about your patients that illustrates why you are there. Legislators and their aides remember (and use) these stories. On my last Hill visit, I was impressed that my medical brethren had better and more stories than I. A family practitioner from upstate New York who proclaimed himself a gun owner and hunter talked about an elderly male patient with depression who had killed himself with his shotgun. An OB-GYN physician talked about a new mother with opiate addiction and a postpartum patient with severe depression. Dramatic stuff.Moreover, while I was there to represent APA and psychiatry, I was nonetheless pleased that my colleagues kept “beating me to the punch.” They were making my arguments for me as well as or even better than I might have done. Certainly the congressional staffers were more openly receptive to a pediatrician or family practitioner arguing for enforcement of mental health parity than to someone who might have been perceived as having a self-interest in the issue.The Group of Six typically meets with members of Congress to thank them for their support or to encourage them to take positions to which we think they will be receptive. My one suggestion to the group on my last visit was to meet with members of Congress who do not support our agenda. We need to try to change their minds by presenting strong arguments for why they should side with us regarding insurance issues, drug pricing, research on firearms violence, suicide, and more. It’s great to thank legislators who are already our friends, but we need to make new ones who will also vote in support of our issues.I cannot end this column without encouraging you to contribute to APAPAC, APA’s political action committee, and your state political action committees. Like it or not, our political system is fueled by contributions, which get us more direct and informal access to members of Congress and their staffs. Also, I urge you to become involved in lobbying your senators or representative. Not only is it crucial for our patients and the medical profession, but it is also a powerful and eye-opening experience. Advocacy training is readily available through your district branch and at APA meetings. More information on how to get involved is posted on APA’s Advocacy Center. ■ ISSUES NewArchived

Birdlife Castlemaine District Branch – Twelve months On

Birdlife Castlemaine District Branch – Twelve months On

Psychiatrist Patrice Harris, M.D., M.A., Inaugurated 174th AMA President

Psychiatrist Patrice Harris, M.D., M.A., Inaugurated 174th AMA President

Analysis of Giving Credit to Liquidity of the South Sulawesi Regional Development Bank Bantaeng District Branch

This study examines the relationship between granting with a liquid level in a bank that aims: (1) To determine the extent to which credit is given to the liquidity position of the South Sulawesi Regional Development Bank. (2) To get a clear picture of the relationship between the amount of funds available and the credit activities of the South Sulawesi Regional Development bank. (3) To find out the policies stipulated by the Regional Development Bank of South Sulawesi, especially the credit sector. The data collection method used in this study, is through Library Research, and Field Research. Based on the analysis of the results of the research and discussion, in this section it can be concluded: (1) the South Sulawesi Regional Development Bank which is the Regional Government of South Sulawesi Province in addition to functioning as a public bank as well as regional government holders whose source of funds comes from local governments and service office located in the province of South Sulawesi. (2) The development of credit funds channeled by the Regional Development Banks of South Sulawesi tends to increase from year to year, (3) From the supply of funds and credit channeled by the Regional Development Bank of South Sulawesi, it is known that the supply of these funds is not channeled as credit, either short-term credit and long-term credit.

AMA’s Incoming President to Deliver Distinguished Psychiatrist Lecture

AMA’s Incoming President to Deliver Distinguished Psychiatrist Lecture

PENERAPAN IPTEKS UNDANG-UNDANG NOMOR 20 TAHUN 2001 TENTANG PEMBERANTASAN TINDAK PIDANA KORUPSI

Devotion this was done in the title of the application of IPTEKS the act number 20 year 2001 on corruption eradication that was done on tuesday on 11 july 2017 in the vicinity of the candidates and the member of a Party City Hanura Jayapura and on wednesday, on 12 july 2017 who held at the candidates and the member of a Party District Keerom Hanura. Activity is done due to lack of understanding about the importance of conducting corruption eradication for candidates and party members in the neighborhood hanura party because of the ignorance the council of representatives and prospective members of representatives particularly dilingkungan hanura party leadership council branches and the city of jayapura leadership council district branch keerom have understanding for better and can take the lesson from from cases of corruption that has happened and can do prevention at a later date so that corruption not continue to grow and become culture particularly in papua province. Output from devotion this is steps and for better understanding is good about the law no.20 in 2011 on corruption eradication for the and members of representatives especially in hanura party leader council Jayapura the city and the board head branch of Keerom District. Keywords : Crimes, Corruption, Eradication

Preparedness Helps MH Professionals Cope With Hurricane Florence

No one waited for the slow-moving storm and its heavy rainfall to arrive before taking action to help patients with mental illness.

Psychiatry and Politics: Can They Mix?

Psychiatry and Politics: Can They Mix?

An interview with Marlin Mattson, MD

In this continuation of JGLMH’s Oral History series, Dr. Jack Drescher, Emeritus Editor, interviews Dr. Marlin Mattson. Dr. Mattson is Professor Emeritus of Clinical Psychiatry at Weill Cornell Medical College and prior to retirement, a longstanding attending psychiatrist at New York Presbyterian Hospital. He has been a highly regarded teacher and mentor throughout his career, and has served on many boards, including the New York County Medical Society and the New York County District Branch of the American Psychiatric Association of which he is a past President. In this article, Dr. Mattson speaks to Dr. Drescher about his early career and his lived experience as a gay psychiatrist.

Calling all ECPs—and Other Members as Well!

Back to table of contents Previous article Next article From the PresidentFull AccessCalling all ECPs—and Other Members as Well!Altha Stewart,M.D.Altha Stewart,Search for more papers by this authorM.D.Published Online:13 Sep 2018https://doi.org/10.1176/appi.pn.2018.9b9Engagement of early career psychiatrists (ECPs) is one of my presidential goals. I described my thoughts on this goal in my Opening Session speech at APA’s 2018 Annual Meeting last May, and it continues to be high on my list of priorities. I always get some time with residents, fellows, ECPs, and junior faculty when I travel to speak at grand rounds or district branch/state association meetings and am continually impressed with the level of interest they have in making substantial contributions to the field. And I am more convinced than before of how much this goal aligns with my other goals—expanding our global mental health footprint and addressing those social issues that contribute to mental illness, that is, the social determinants of mental health.ECPs are the workforce of the future, so we must spend some time focused on making sure they get the training and mentoring needed to be professionally successful and satisfied. That includes meeting and working with senior officials for mentoring and sponsorship. To my great surprise, however, many still don’t seem to know how to connect with individuals by whom they would like to be mentored and don’t understand the difference between mentoring and sponsorship. I find myself regularly reminding them that it is a well-established fact that no one in leadership got there by themselves and that learning from someone that you would like to model yourself after is important to achieving professional success. Most of us remember the great experiences we had after we showed our enthusiastic, energetic, and open young minds to psychiatrists we looked up to when we were early in our careers. Exposure to those seasoned and established individuals in academic, clinical, and research areas is what has kept most of us involved in APA as well as the profession. Who doesn’t remember that favorite teacher that inspired and encouraged us? I know I still smile when I remember some of these folks, some gone but many still around. Well, the same holds true for psychiatrists entering the field today. We have to remember that this professional period is called “early career” because it is the beginning—it is the time when there is much to learn whether we realize it or not and where we learn sometimes without realizing that we have had a lesson. It is essential that for APA and the profession of psychiatry, we do everything possible to actively engage our ECPs. We need their voices at the table, making decisions about the future of APA and the profession. They need the skills required to weigh in on our efforts to advocate for full implementation of parity, push back at discriminatory and oppressive regulations that negatively affect us and the patients we serve, and be prepared for the paradigm shift in the field likely to come with future health and mental health reforms. Speaking of involvement in APA, you came out in droves asking for component appointments, and while there were not enough slots for everyone to receive an appointment, you can still get involved in many other ways. Make sure you learn more about APA’s component structure. Appointments are made annually on a rotating basis, and all component leaders are looking for members who are knowledgeable, committed, and ready to do the work. Also, think about sharing your knowledge and expertise by offering to contribute to one of Psychiatric News’ columns or APA’s blog. If you use social media, you may want to use these vehicles to share your perspective about the impact of new technology and innovation through an understanding of the use of social media to educate and inform patients, families, and communities.Finally, take advantage of opportunities to join the leadership teams at APA. You can become active in your district branch or state association or consider running for office. We have just entered the next election cycle, and the deadlines for nominations is October 1. And as always, continue to communicate your ideas and concerns to us. We need to hear from you—all of you—if we are going to have the future we all want. ■ ISSUES NewArchived

Iowa Mental Health Law Fills Residential Treatment Gap

Iowa’s new law provides a range of residential and assertive community treatment options for patients with mental illness.

What Is Fee Splitting and Why Is It Unethical?

Back to table of contents Previous article Next article Ethics CornerFull AccessWhat Is Fee Splitting and Why Is It Unethical?Claire Zilber, M.D.Claire ZilberSearch for more papers by this author, M.D.Published Online:26 Jan 2018https://doi.org/10.1176/appi.pn.2018.2a17Claire Zilber, MD, is a psychiatrist in private practice in Denver, Colo., a faculty member of the PROBE (Professional Problem Based Ethics) Program, chair of the Ethics Committee for the Colorado Psychiatric Society, and a corresponding member of APA’s Ethics Committee. She is the co-author of Living in Limbo: Creating Structure and Peace When Someone You Love Is Ill.A recent graduate of a psychiatry residency training program is invited to join a senior psychiatrist’s practice. The senior psychiatrist offers to refer patients to the new colleague as she builds her practice in exchange for 30 percent of the revenue from those patients. The senior psychiatrist will provide the junior colleague with a furnished office and receptionist support. This seems like a good deal to both psychiatrists, but just to be sure it’s acceptable, they ask their district branch ethics chair to approve it. The Merriam Webster Dictionary defines fee splitting as “payment by a specialist (such as a doctor or a lawyer) of a part of his or her fee to the person who made the referral.” Although referral incentives are a common business practice in other industries, in medicine they erode the fiduciary relationship, potentially elevating a physician’s financial interests above the needs of the patient. Rules about avoiding fee-splitting arrangements grew out of laws and government regulations concerning kickbacks. While blatant kickbacks are rarely seen in psychiatric referral patterns, the profession wants to guard against any arrangement in which a psychiatrist will receive compensation for making a referral, because such an incentive may compromise objectivity in deciding on the most appropriate treatment plan for a patient. “Referrals by the psychiatrist should be based upon the training, competence, specific skills, and ethical qualifications offered by the professional to whom a patient is to be referred” (letter to the editor in the January 3, 2003, Psychiatric News by Richard Milone, M.D., and Wade Myers, M.D.).Section 2 of APA’s Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry concerns our duty to uphold the standards of professionalism. Article 7 states, “An arrangement in which a psychiatrist provides supervision or administration to other physicians or nonmedical persons for a percentage of their fees or gross income is not acceptable; this would constitute fee splitting. In a team of practitioners, or a multidisciplinary team, it is ethical for the psychiatrist to receive income for administration, research, education, or consultation. This should be based on a mutually agreed-upon and set fee or salary, open to renegotiation when a change in the time demand occurs.” The APA’s Ethics Committee expressed this from a different perspective in an opinion issued in 1976 and updated in 1978 and 1990: “A physician is licensed by the people of a state to provide medical care. He is not licensed to establish an entrepreneurial business when the care of patients is subordinated to profit” (Opinions of the Ethics Committee on the Principles of Medical Ethics, K.2.b., 2017). Although it is acceptable to receive compensation for providing office space and administrative support to other health care providers, the compensation should be negotiated as a fixed fee, not tied to referral volume. Alternatively, the health care colleague could be paid a salary if the psychiatrist wants to receive all the revenue from services billed by the colleague. The district branch ethics committee chair instructs the psychiatrists that they have two options that are ethical. The senior psychiatrist could hire the junior colleague as an employee. The senior psychiatrist would keep all the revenue generated by the junior psychiatrist, who would be paid a salary and perhaps an incentive bonus based on volume of billing. This is similar to how many clinical psychiatrists are paid in academic medical centers. Alternatively, the junior associate could pay the senior psychiatrist a fixed fee in return for the office space and administrative support, but not tied to referrals or billing revenue. In addition to avoiding fee splitting, the latter arrangement preserves the most autonomy for the junior colleague. Because the rent and administrative fee will be the same every month, the senior psychiatrist won’t have a reason to monitor how many patients are being seen or how many days off are taken. As is often the case, the ethical path works well for both patients and providers. ■APA’s ethics documents can be accessed here. ISSUES NewArchived

APA, Foundation Assist Puerto Rico District Branch

APA, Foundation Assist Puerto Rico District Branch

Trauma of Las Vegas Shooting Likely to Show Up Weeks, Months Later

Trauma of Las Vegas Shooting Likely to Show Up Weeks, Months Later