Summer 2002

xxAACP Newsletter, Volume 16, Number 3, Spring 2002

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APA Assembly Focuses on SPMI

In November 2001, APA Speaker Nada Stotland formed a task force to refocus the APA on Serious and Persistent Mental Illness (SPMI). Her charge was to answer the following question: "What would you say the APA should accomplish in three to four years that would be valuable for persons with serious mental illnesses and their families, and for members of the APA caring for such individuals?" Over the last several years, while emphasizing a number of other issues of interest to APA members such as managed care, parity, privacy, insurance billing, finances and membership, and psychologist prescribing, the APA has not clearly prioritized persons suffering with SPMI and the professionals who work with them. Many have had the sense that this represents a drift away from the actual roots of APA, which began over 150 years ago as an organization of state mental hospital superintendents. In contemporary vernacular we might say that the APA started as a group through which physicians exchanged best practice strategies for the institutional management of persons with serious mental illness.

From the outset, Dr. Stotland’s intent with this task force was to create a set of recommendations, produced in the style of AACP, that would help to redirect the priorities of APA so that professional issues related to major mental illnesses and public psychiatry would be more prominent. It is not coincidental that the task force membership includes several AACP members: Drs. Roger Peele, Al Gaw, Debra Cross, Jon Gudeman, Robert Ronis and myself, task force co-chair. The other task force co-chair is Dr. Larry Miller, APA representative from Arkansas. Dr. Miller also represents the National Association of State Mental Health Program Directors (NASHPD) as the Medical Director from Arkansas. Other members of the task force are: Drs. Prakash Desai, Basker Dave, Susan Boust, Jeffrey Geller, Elizabeth Galton and Gloria Pitts.

The work of the group has been well supported by the Assembly Speakers. As I am learning, this is extremely helpful in making a difference within the APA. We are very fortunate to have a series of Speakers who are dedicated public and community psychiatrists. Dr. Stotland started the charge which has been strongly supported by the current speaker Dr. Gaw. The speaker elect, Dr. Desai, is also an active member of the task force and is committed to supporting the initiative through his term as Speaker. The State Hospital Caucus within the APA has also supported the work.

So much for the background, what is the group actually doing? Initially the APA Assembly asked the group to create a Bill of Rights for persons with SPMI. From this original charge and from the consensus of the group came ten action items that are working their way through the APA. At the last Assembly meeting in May 2002, five of the ten items were unanimously passed by the Assembly and the remaining five are to be worked on for the November Assembly for a formal vote.

The items that passed the Assembly and that are currently being actively addressed by the APA are:

Action Item 1. Adoption of a Bill of Rights that includes two basic areas: Right to Treatment, and Right to Quality of Life.

Right to Treatment.

Full access to treatment, rehabilitation and support services in a coordinated and comprehensive system of care that is culturally competent.

Continuity of care.

Treatment that meets standards of care that are supported by best practice research.

Pharmacological intervention based primarily on efficacy and total cost rather than short term costs.

Treatment in the least restrictive setting that is consistent with both safety and reasonable expectations of benefit.

Right to Quality of Life.

Financial support adequate to meet basic human needs.

Safe, supportive housing with the ultimate goal being housing as independent as possible.

Daily activity that is meaningful, productive and life enhancing.

Social opportunities and collegiality within a community.

Support services that assist attaining this quality of life.

Action Item 2. Create a Committee for Practice Guidelines, to include rehabilitative services for individuals with SPMI in the APA Practice Guidelines for Schizophrenia.

Action Item 3. Encourage more APA members to participate in local and national advocacy groups through endorsement of this on Assembly and M2M List Serves.

Action Item 4. Have APA continue current work to advocate for parity and nondiscrimination in state and federal programs but particularly for persons with SPMI in addition to those with other mental illnesses.

Action Item 5. Work with the editor of Psychiatric News to develop a regular column highlighting issues of persons with SPMI and the APA professionals who serve them. (Note to AACP members: This has been discussed and the Psychiatric News staff is very willing to do this. They need contact persons in public mental health. If you are an AACP member and have something to contribute to help promote and highlight careers and issues in public psychiatry, please send information to Psychiatric News.)

The following items are being developed:

Action Item 6. Have APA become more prominent in the public eye in promoting reduction of stigma associated with SPMI as an APA initiative as well as in prominent partnership with other national organizations. Have APA work to develop an "issues kit" for advocacy at the state level to implore state and county jurisdictions to fund quality mental health services.

Action Item 7. Have APA as a national organization offer more coordinated support to state district branches to educate and influence state legislators regarding the role and responsibility of state government in funding services for citizens with SPMI.

Action Item 8. Have the APA: 1) support the Residency Review Committee’s decision to advocate with residency training directors to make modules of training in the care of the SPMI, both didactic and experiential , mandatory and 2) make training and mentoring opportunities available to those who seek special emphasis in administration of clinical programs and 3) advocate before foundations and national institutes involved in research funding to make care of the SPMI a priority area of investigation.

Action Item 9. Establish an office within the APA to provide ongoing consultation regarding standards of care in the public sector.

Action Item 10. Ask the APA 1) to formally review Medicare/Medicaid policies that allow for discrimination against the psychiatrically ill, and 2) to investigate the national shortage of psychiatric beds in the public and private sectors.

This is an ambitious set of actions designed to enhance considerably our interests as professionals in AACP. In the Assembly itself there is already excitement about these initiatives. If you as an AACP member have experiences or particular interest in the further development of any of these ideas, particularly the last five action items which are under development, please contact myself or Dr. Ronis. Also, if you have any interest in contributing a story to Psychiatric News about community psychiatry, please let us know. We want your input! AACP has a reputation within APA as having a very strong, productive, compassionate and passionate membership. AACP has been invited to participate so prominently in this initiative because of our organization’s dedication to the persons we care about and provide professional services to--persons with Serious and Persistent Mental Illness.

Anita Everett, M.D.

AACP, Representative at Large

SPMI Task force Co-Chair

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