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Assembly Executive Committee Meeting

The Grand Hotel Minneapolis, Minneapolis, MN

July 22-24, 2016

Materials Included in this Packet

**PLEASE CLICK ON THE ITEM TO VIEW**

Draft Report of the Assembly Executive Committee Meetings, May 2016 Summary of Actions, Board of Trustees, May 2016 Draft Summary of Actions, Board of Trustees, July 2016 Action Paper 12.CC: Increasing the Opportunity for Involvement of Resident Fellow Members (RFMS) and Early Career Psychiatrists (ECPs) in the APA Assembly Action Paper 12.DD: Allow Deputies to Vote Draft Summary of Actions, Joint Reference Committee, June 2016 Action Paper 12.A: Access to Care Provided by the Department of Veterans Affairs

Report from the Council on Advocacy and Government Relations

Draft Summary of Actions, Assembly, May 2016 Assembly Draft Schedule, November 2016 Special Rules of the Assembly Procedural Code of the Assembly

1 Assembly Executive Committee Meeting May 13 & 16, 2016

Assembly Executive Committee

Draft Report

Friday, May 13, & Monday, May 16, 2016

Georgia World Congress Center & Omni at CNN Center

Atlanta, Georgia

Glenn Martin, M.D., Speaker

Daniel Anzia, M.D., Speaker-Elect

Theresa Miskimen, M.D., Recorder

John Wenert, III, M.D., Parliamentarian

A. Evan Eyler, M.D., Area 1 Rep

Manuel Pacheco, M.D., Area 1 Dep Rep

Seeth Vivek, M.D., Area 2 Rep

Jeffrey Borenstein, M.D., Area 2 Dep Rep

Joseph Napoli, M.D., Area 3 Rep

William Greenberg, M.D., Area 3 Dep Rep

James R. Batterson, M.D., Area 4 Rep

Bhasker Dave, M.D., Area 4 Dep Rep

Laurence Miller, M.D., Area 5 Rep

Philip Scurria, M.D., Area 5 Dep Rep

Joseph Mawhinney, M.D., Area 6 Rep

Barbara Weissman, M.D., Area 6 Dep Rep

Craig Zarling, M.D., Area 7 Rep

Charles Price, M.D., Area 7 Dep Rep

Linda Nahulu, M.D.,M/UR Rep [A]

Sarit Hovav, M.D., RFM Rep

Mark Haygood, D.O., ECP Rep (Friday)

David Scasta, M.D., ACROSS Rep

Jenny L. Boyer, M.D., J.D., P.h.D., Immediate Past Speaker (Monday)

Melinda Young, M.D., Past Speaker

Saul Levin, M.D., MPA, CEO and Medical Director (Friday)

Guests (Friday): A. David Axelrad, M.D., Chair, Assembly Committee on Procedures Daniel Gillison, Incoming Director, American Psychiatric Association Foundation Guests (Monday) Kenneth Busch, M.D., Incoming Area 4 Dep Rep Matthew Kruse, M.D., Incoming RFM Rep James Nininger, M.D., Incoming Parliamentarian Lawrence Malak, M.D., for Mark Haygood, D.O., ECP Rep Administration:Margaret C. Dewar, Director of Association Governance Allison Moraske, Senior Governance Specialist, Assembly Colleen Coyle, JD, APA General Counsel (Friday) Yoshie Davison, Chief of Staff (Friday) Jon Fanning, Chief Membership & RFM/ECP Officer (Friday) Tristan Gorrindo, M.D., Director, Division of Education (Friday) David Keen, Chief Financial Officer (Friday) Kristin Kroeger, Chief of Policy, Programs & Partnerships (Friday)

Judson Wood, JD, Special Assistant to the CEO & Medical Director (Friday) Ranna Parekh, M.D., MPH, Director, Division of Diversity and Health Equity (Friday) Jeffrey Regan, Interim Chief of Government Affairs (Friday) Shaun Snyder, JD, Chief Operating Officer Philip Wang, M.D., Director, Division of Research (Friday)


Friday, May 13, 2016 (Georgia World Congress Center) 1. Call to Order and Opening Remarks — Dr. Martin

Dr. Martin welcomed the AEC to Atlanta and had everyone introduce themselves and disclose any potential conflicts of interest.

2. Approval of Report of the AEC meeting January 2016 MOTION APPROVED: The AEC voted to approve the report of the Assembly Executive Committee Meeting from January 2016. 3. Remarks from Speaker-Elect — Dr. Anzia

Dr. Anzia requested that the AEC members review the Consent Calendar during the Area Council meetings.

4. Remarks from the Recorder — Dr. Miskimen Dr. Miskimen noted that the action paper status (May & November 2015) document is available it in the online reports packet. She encouraged the AEC to remind the Assembly to use the Action Item Tracking System (AITS), which is available online at http://ait.psychiatry.org/, to track Assembly actions. She also stressed the importance of Assembly Representatives writing articles for their District Branch newsletters.

5. Remarks from the CEO and Medical Director — Dr. Levin Dr. Levin gave a brief update to the AEC. He began by reminding the AEC that Shaky Knees, a music festival, would take place in Centennial Olympic Park throughout the weekend and that this may have some impact on the Annual Meeting, including transportation delays, and sound issues in the convention center and at nearby hotels. Dr. Levin announced that the Centers for Medicare and Medicaid Services released the first proposed rule to implement the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which changes Medicare quality reporting requirements and incentives for health professionals. The APA’s Department of Reimbursement Policy reviewed the rule and developed a summary which was shared on the Assembly listserv earlier in the day. He mentioned that H.R.2646 -Helping Families in Mental Health Crisis Act of 2015, has come up for a vote by the House Energy & Commerce Committee and that he was encouraged by the level of interest that the Assembly has shown. Dr. Levin concluded his remarks by formally introducing David Keen, CPA, APA’s Chief Financial Officer, Judson Wood, JD, Special Assistant to the CEO & Medical Director, and Daniel Gillison, Incoming Executive Director for the American Psychiatric Association Foundation.

6. Review of Assembly Agenda — Dr. Martin The Assembly Executive Committee reviewed the Assembly agenda. Dr. Martin noted that the agenda is quite full, with thirty-two action papers, nineteen JRC items, and a bylaws amendment which requires a vote by strength. Reference Committees will continue to draft brief reports on their recommendations, which will be distributed Saturday morning prior to the Area Council meetings. In addition, two items have been submitted for consideration and approved by the Rules Committee as new business items: 14.A: APA Endorsement of the Position Statement of AGLP on Discrimination against LGBT Citizens Based on Arguments of Religious Liberty and 14.B: Task Force on Fighting Mental Health-Injurious Discrimination. Dr. Martin requested that the Area Councils/Assembly Groups add both new business items to their agendas. At its meeting in March, the Board of Trustees approved moving forward with the creation of APA medical registries. There will also be presentation on APA registries by Dr. Gregory W. Dalack, Chair, Registries Work Group on Saturday afternoon.

http://ait.psychiatry.org/


7. Reports of Assembly Component Chairs

A. Rules Committee The Rules Committee reviewed the action items submitted for the May Assembly and assigned a number of the action items to the Consent Calendar. This vote will occur during the first plenary session.

B. Awards Committee — Dr. Young Dr. Young announced that there will be three awards given at this meeting: The DB Best Practice Award, the Awards to the DB and Area with the Greatest Percentage of Voting Members, and the Assembly Award for Excellence in Service and Advocacy.

C. Committee on Procedures — Dr. Axelrad Dr. Axelrad informed the Assembly that due to a previous commitment, he will be unable to attend the Assembly meeting and that the report of the Assembly Committee on Procedures will be given by Dr. Batterson. The Assembly Committee on Procedures will request the approval of four proposed amendments to the Procedural Code of the Assembly and these will be voted on during the fourth plenary Sunday morning.

D. Assembly Nominating Committee The AEC reviewed the candidates for the upcoming Assembly election: Candidates for Recorder: James R. Batterson, M.D. [Elected Recorder 2016-2017] David Scasta, M.D. Candidate for Speaker-Elect: John de Figueiredo, M.D. Theresa Miskimen, M.D. [Elected Speaker-Elect 2016-2017]

Monday, May 16, 2016 (Omni at CNN Center) 8. Introduction of New Assembly Executive Committee Members James Nininger, M.D., Parliamentarian Matthew Kruse, M.D., RFM Chair Eric Plakun, M.D., ACROSS Chair (not present) Kenneth Busch, M.D., Area 4 Deputy Representative 9. Follow-up on Passed Assembly Actions — Dr. Martin The AEC reviewed the passed Assembly actions. The AEC reviewed the approved action papers and confirmed that the following paper will go directly to the Board of Trustees in July 2016: 12.O: Direct to Consumer Advertising. The AEC then prioritized the top seven action papers of those referred to the Joint Reference Committee. 12.I: Pharmacists Substituting Medications with Similar Mechanisms of Action 12.J: Eliminate Out of Pocket Cost Barriers to Care for Patients with Serious and Recurrent Disabling Mental Disorders 12.T: Protecting Senior Psychiatrists from Mandatory Competency Testing 12.U: Psychiatrist Involvement in Medical Euthanasia and Physician-assisted Suicide of the non-Terminally Ill 12.Y: Develop an APA Resource Document Regarding the Ethical Tensions Faced by Psychiatrists Serving as Third Party Utilization Management Reviewers under the Parity Law 12.FF: APA Referendum Voting Procedure


14.A: APA Endorsement of the Position Statement of AGLP on Discrimination against LGBT Citizens Based on Arguments of Religious Liberty The AEC discussed item 14.A and decided that, if the action paper is approved by the JRC, they would request that it be referred directly to the July 2016 Board of Trustees meeting. MOTION APPROVED: The Assembly Executive Committee voted to have the Speaker-Elect bring action item 14.A: APA Endorsement of the Position Statement of AGLP on Discrimination against LGBT Citizens Based on Arguments of Religious Liberty to the July 2016 Board of Trustees meeting. The AEC also discussed action paper 12.F: Making Access to Treatment for Erectile Disorder Available Under Medicare. The action paper had previously been approved at the November 2015 Assembly meeting and the JRC did not refer it, noting that the action paper does not fit within the APA’s strategic goals and initiatives and the necessary prioritization of the current work to implement these goals. It was requested that if the JRC decides to once again not refer the paper to a component, it needs to explain its rationale in more detail. The role of the Assembly members on APA components was also discussed as these members need to be more active in pushing Assembly actions forward as well as updating the Assembly on the components’ activities. This was suggested as a topic for further discussion at the July 2016 AEC meeting in Minneapolis. 10. Assembly Role in the APA Budget Process Dr. Anzia explained that the Assembly budget was significantly increased in 2016 and that this included increases in housing, travel, and food/beverage costs. He noted that the APA budget process is formula based and that it was these formulas that resulted in the majority of the increase. Dr. Anzia wants the AEC to review the budget at its meeting in July and see where, if any, the Assembly can move funds to cover additional items, such as increases to the Area Council block grants. He also announced that ECP, M/UR, and RFM Representatives/Deputy Representatives are now funded to attend the Area Council meetings out of the general Assembly account, not the Area block grants. APA Administration requested that Areas 2 and 6 direct these groups to submit their expenses for these meetings to the APA for reimbursement. Dr. Anzia will be activating the Assembly Committee on APA Budget Planning so that the Assembly has a voice in the APA budget process. This committee will be members of the AEC and its composition will be discussed and determined at the AEC meeting in July. 11. Planning for AEC Summer Meeting — Dr. Anzia

The AEC will be meeting July 22-24 at The Grand Hotel Minneapolis in Minneapolis, MN. In addition to the budget, it was requested that the AEC discuss the following:

Area Council block grants

The Assembly schedule

APA medical registries

Review of the Assembly Committees and work groups

Assembly processes such as the election of Assembly Officers

Assembly elections (personal travel/hotel costs incurred by the candidates)

The use of clickers to survey the Assembly on certain issues

Seating arrangements

Assembly agenda (order of the meeting)

The role of Assembly members on APA components


12. New/Unfinished Business Dr. Martin stressed the importance of having Assembly Committees report to the Assembly and that the agenda should be revised to ensure that these groups are given adequate time to report. The AEC discussed the recently approved changes to the Procedural Code of the Assembly, specifically disallowing dual representative roles of APA members serving on both the Board of Trustees and the Assembly and when the changes take effect. The AEC determined that this change is effective immediately. 13. Closing Remarks — Drs. Anzia and Martin Dr. Martin thanked the AEC for its hard work both on the AEC and at the local level. He also thanked Association Governance for their work through the year. 14. Adjournment UPCOMING AEC MEETINGS • July 22-24, 2016, Minneapolis, MN • Friday, November 4, 2016, Washington, D.C. • Sunday, November 6, 2016, Washington, D.C.

February 10-12, 2017, Location TBD

AMERICAN PSYCHIATRIC ASSOCIATION BOARD OF TRUSTEES

SUMMARY OF ACTIONS

May 15, 2016

Agenda Item #

Title/Action

Consent Calendar Items Notated by [cc]

Responsible

Office/Component

2.A Requests to Remove Items from the Consent Calendar No items were removed.

Chief Operating Officer

Association Governance

2.B Approval of Items on the Consent Calendar The Board of Trustees voted to approve the Consent Calendar.



3.A Sunsetting of Completed Ad Hoc Work Groups The Board of Trustee voted to sunset, with appreciation, the following Board Ad Hoc Work Groups which have completed their charge:

Board Ad Hoc Work Group on Revise the Ethics Annotations

Board Ad Hoc Work Group on Health Care Reform

Board Ad Hoc Committee on Real Estate

Board Ad Hoc Work Group on Involvement with ‘Social’ Issues

Board Ad Hoc Work Group on Telepsychiatry [cc]



cc = Approval by Consent Calendar Page 2 of 2

Agenda Item #

Title/Action


Responsible

Office/Component

3.B Ad Hoc Work Groups to be Continued The Board of Trustee voted to continue the following Board Ad Hoc Work Groups until they have completed their charge:

Board Ad Hoc Work Group on Outside Funding for APA Registry (report by July 2016 BOT Meeting)

Board Ad Hoc Work Group on Communications to Members during APA Elections (report by July 2016 BOT Meeting) [cc]



5.A Minutes of the March 19-20, 2016 Board of Trustees Meeting The Board of Trustees voted to approve the minutes of its March 19-20, 2016 Meeting. [cc]



6.B Status of the Board Contingency Fund The Board of Trustees voted to accept the report of the status of the Board Contingency Fund. [cc]

Chief Financial Officer

Finance & Business Operations



6.C Presidential New Initiative Fund The Board of Trustees voted to accept the report of the status of the President’s New Initiative Funds for Dr. Summergrad, Dr. Binder, and Dr. Oquendo. [cc]





6.D Assembly New Initiative Fund The Board of Trustees voted to accept the status report of the Assembly’s New Initiative Fund. [cc]





AMERICAN PSYCHIATRIC ASSOCIATION BOARD OF TRUSTEES

DRAFT SUMMARY OF ACTIONS

July 9, 2016

Agenda Item #

Title/Action


Responsible

Office/Component

2.A Requests to Remove Items from the Consent Calendar Items 9.A.3, 9.A.14, and 9.A.19 were removed.



2.B Approval of Items on the Consent Calendar The Board of Trustees voted to approve the Consent Calendar.



4.A CEO’s Report The Board of Trustees voted to approve the Council on Research’s and Council on Quality’s recommendations to pursue the inclusion of these measures in the APA registry [cc].

Chief Operating Officer Chief of Policy, Programs and Partnerships

Research

5.A Minutes of the May 15, 2016 Board of Trustees Meeting The Board of Trustees voted to approve the minutes of its May 15, 2016 Meeting. [cc]



6.B Status of the Board Contingency Fund The Board of Trustees voted to accept the report of the status of the Board Contingency Fund. [cc]





6.C Presidential New Initiative Fund The Board of Trustees voted to accept the report of the status of the President’s New Initiative Funds for Dr. Binder, Dr. Oquendo, and Dr. Everett. [cc]






Agenda Item #

Title/Action


Responsible

Office/Component

6.D Assembly New Initiative Fund The Board of Trustees voted to accept the status report of the Assembly’s New Initiative Fund. [cc]





7.A.1 Joint Reference Committee Report The Board of Trustees reaffirmed the JRC decision that approval and implementation of action paper APA Referendum Voting Procedure (ASMMAY1612.FF) is not feasible.



7.A.2 Joint Reference Committee Report The Board of Trustees voted to approve the following statement: The APA reaffirms its opposition to discrimination against LGBTQ citizens including discrimination based on arguments of religious liberty.



7.A.3 Joint Reference Committee Report The Board of Trustees voted to approve a representative of the APA Committee on Performance Measurement be assigned to each APA Practice Guideline writing group. [cc]



Chief of Policy, Programs and Partnerships

Research

7.A.4 Joint Reference Committee Report The Board of Trustees voted to approve granting permission to the authors to submit for publication to a high profile general medical journal (e.g., NEJM) the resource document entitled Clinical Guidance on the Use of Ketamine in the Treatment of Mood Disorders: A Review of Related Literature to Date. [cc]


Publishing


Agenda Item #

Title/Action


Responsible

Office/Component

7.A.5 Joint Reference Committee Report The Board of Trustees voted to approve the submission of the Council on Research’s review article S-Adenosylmethionine (SAMe) for Neuropsychiatric Disorders: A Clinician-Oriented Review of Research to the American Journal of Psychiatry, or another APA journal, for publication. [cc]


Publishing

Chief of Policy, Programs and Partnerships

Research

7.A.6 Joint Reference Committee Report The Board of Trustees approved the APA including “T” for “Transgender” and “Q” for “Questioning/Queer” to LGB so that the acronym reads LGBTQ in all future APA communications.



8.A.1 Audit Committee Report The Board of Trustees approved the 2015 audit reports for American Psychiatric Association – Consolidated.


8.A.2 Audit Committee Report The Board of Trustees approved the 2015 audit reports for American Psychiatric Association Foundation.


8.A.3 Audit Committee Report The Board of Trustees approved the 2015 audit reports for American Psychiatric Association Pension Plan.


8.C.1 Membership Committee Report Rep

The Board of Trustees approved a recommendation from the Membership Committee to award $3,571 to each district branch or state association listed in Attachment D as part of the DB/SA Grant process. [cc]

Chief Membership & RFM-ECP Officer

Membership


Agenda Item #

Title/Action


Responsible

Office/Component

8.C.2 Membership Committee Report The Board of Trustees voted to approve the recommendation of the Membership Committee to expand the definition of Medical Student Members in the Operations Manual to allow international students to be eligible for membership by adding the following statement after the first sentence in Chapter 5, D1. Medical Student Members.

“Individuals in medical schools outside the U.S. or Canada are also eligible for Medical Student Membership if the school is listed in the World Directory of Medical Schools and the applicant provides proof of enrollment.”


Membership

8.C.3 Membership Committee Report The Board of Trustees authorized dropping from APA membership the Member listed in Attachment G for failure to meet the requirements of membership. [cc]


Membership

8.C.4 Membership Committee Report The Board of Trustees voted to approve the applicants listed in Attachment H for International Membership. [cc]


Membership

8.C.5 Membership Committee Report The Board of Trustees voted to approve the Membership Committee's recommendations on the dues relief requests as listed in Attachment I. [cc]


Membership

9.A.1 Speaker’s Report The Board of Trustees voted to approve the Proposed Position Statement: Integrating Opioid Use Disorders Treatment with Buprenorphine and Naltrexone with that of Co-Occurring Mental Illnesses. [cc]




Agenda Item #

Title/Action


Responsible

Office/Component

9.A.2 Speaker’s Report The Board of Trustees voted to approve the Revised Position Statement: The Role of Psychiatrists in Assessing Driving Ability. [cc]



9.A.3 Speaker’s Report The Board of Trustees voted to approve the Proposed Position Statement: Patient Access to Electronic Mental Health Records.



9.A.4 Speaker’s Report The Board of Trustees voted to approve the Proposed Position Statement: Trial and Sentencing of Juveniles in the Criminal Justice System. [cc]



9.A.5 Speaker’s Report The Board of Trustees voted to approve the retirement of the 2005 Position Statement: Adjudication of Youths as Adults in the Criminal Justice System. [cc]



9.A.6 Speaker’s Report The Board of Trustees voted to approve the retirement of the Position Statement: Infectious Disease Epidemics Including H1N1. [cc]



9.A.7 Speaker’s Report The Board of Trustees voted to approve the Revised Position Statement: Sexual Harassment. [cc]



9.A.8 Speaker’s Report The Board of Trustees voted to approve the Proposed Position Statement: Equitable Access to Quality Medical Care for Substance Related Disorders. [cc]




Agenda Item #

Title/Action


Responsible

Office/Component

9.A.9 Speaker’s Report The Board of Trustees voted to approve the retention of the Position Statement: Any Willing Physician. [cc]



9.A.10 Speaker’s Report The Board of Trustees voted to approve the Revised Position Statement: Psychiatric Hospitalization of Children and Adolescents. [cc]



9.A.11 Speaker’s Report The Board of Trustees voted to approve the Proposed Position Statement: Integrated Care. [cc]



9.A.12 Speaker’s Report The Board of Trustees voted to approve the Proposed Position Statement: Off-Label Treatments. [cc]



9.A.13 Speaker’s Report The Board of Trustees voted to approve the retirement of the Position Statement: Patient Access to Treatments Prescribed by Their Physicians. [cc]




Agenda Item #

Title/Action


Responsible

Office/Component

9.A.14 Speaker’s Report The Board of Trustees voted to approve the Proposed Position Statement: The Call to Action: Accountability for Persons with Serious Mental Illness as amended below. Ensuring appropriate treatment, rehabilitation, and opportunities for recovery of persons with serious mental illness is a public health responsibility. Federal, state, and local governments must be accountable for ensuring access to comprehensive assessment, treatment, and evidence-based care and evidence based treatments. Psychiatrists have a unique role and responsibility for developing strategies to address these challenges.



9.A.15 Speaker’s Report The Board of Trustees voted to approve the retirement of the Position Statement: A Call to Action for the Chronic Mental Patient. [cc]



9.A.16 Speaker’s Report The Board of Trustees voted to approve the Proposed Position Statement: College and University Mental Health. [cc]



9.A.17 Speaker’s Report The Board of Trustees voted to approve the retirement of the Position Statement: College and University Mental Health. [cc]



9.A.18 Speaker’s Report The Board of Trustees voted to approve the retention of the Position Statement: Policy on Conflicts of Interest Principles and Guidelines: With Special Interest for Clinical Practice and Research. [cc]




Agenda Item #

Title/Action


Responsible

Office/Component

9.A.19 Speaker’s Report The Board of Trustees voted to approve the position statement only of the Proposed Position Statement: Emergency Department Boarding of Patients with Acute Mental Illness. The Board of Trustees voted to refer the “Issue” section of the document back to the Joint Reference Committee to consider possible subsequent revision.



9.A.20 Speaker’s Report The Board of Trustees voted to approve action paper 2016A1 12.O: Direct to Consumer Advertising. [cc] [The request is to approve the document as an APA position statement.]



11.A.1 AHWG on Outside Funding for APA Registry The Board of Trustees voted to have the Finance and Budget Committee review feasibility of the APA reducing expenditures or increasing revenue, including by dues increases, to cover at least 60% of the registry costs or any other options and report back to the APA Board with its evaluation by its October, 2016 meeting.

Chief Financial Officer Chief Operating Officer


11.A.2 AHWG on Outside Funding for APA Registry The Board of Trustees voted to approve the Memorandum of Understanding between the ABPN and the APA. Follow-up: APA Administration will carry out appropriate review and share any recommendations or concerns with the Board of Trustees.

Chief Financial Officer Chief Operating Officer



Agenda Item #

Title/Action


Responsible

Office/Component

13.A

Unfinished Business The Board of Trustees voted that the APA does not support psychiatry residents be given the option of using their PGY-4 year of training to also fulfill the requirements of ACGME-accredited subspecialty fellowship training, with the exception of Child and Adolescent Psychiatry training.

Chief of Policy, Programs, and Partnerships

Division of Education

EX.2 Amicus Brief - Rosen v. Regents of the UCLA The Board of Trustees voted to approve signing the amicus brief of the California Psychiatric Association in Rosen v. Regents of UCLA.



Chief of Government Affairs

EX.3.1 Scientific Program Committee Awards The Board of Trustees voted to approve the nomination of H. Steven Moffic, M.D., to receive the 2016 Administrative Psychiatry Award.

Chief of Policy, Programs & Partnerships

Education

EX.3.2 Scientific Program Committee Awards The Board of Trustees voted to approve the nomination of Chirlane McCray to receive the 2016 Award for Patient Advocacy.

Chief of Policy, Programs & Partnerships

Education

EX.4.1 Appointments to the Psychiatric News Editorial Advisory Board The Board of Trustees voted to approve the appointment of John Luo, MD, for a three-year term (2016-2019) to the Psychiatric News Editorial Advisory Board.

Chief Communications Officer

Psychiatric New


Agenda Item #

Title/Action


Responsible

Office/Component

EX.4.2 Appointments to the Psychiatric News Editorial Advisory Board The Board of Trustees voted to approve the appointment of Claudia Reardon, MD, for a three-year (2016-2019) term to the Psychiatric News Editorial Advisory Board.

Chief Communications Officer

Psychiatric New

Item 2016A1 12.CC Assembly

May 13-15, 2016 ACTION PAPER

FINAL TITLE: Increasing the Opportunity for Involvement of Resident Fellow Members (RFMs) and Early Career Psychiatrists (ECPs) in the APA Assembly WHEREAS: RFM and ECP involvement in the Assembly ensures that psychiatry and the APA has strong future leadership. A majority of RFMs and ECPs in the country are not aware that they have the opportunity to be a part of the Area Council, that a Council exists, and for many, that the Assembly exists. Currently, it is not feasible to create a listserv for a specific group at the APA, and given the inability to tailor the listserv to individual communications The Assembly Committee of Resident Fellow Members (ACORF) and the Assembly Committee of ECPs cannot have a listserv to communicate with District Branch RFMs/ECPs, Executive Directors of District Branches, and Residency Training Directors. Given the current inability to tailor communications distributed through the APA to a specific Committee's preference, access to the database is tightly controlled. There is also no defined organizational structure for communications that would allow identification of the appropriate person who could filter and approve messages to be sent out to the list or to sub-lists. Attempting to advertise as an Area RFM or Area ECP on open positions in the Area Council and Assembly has been inconsistent due to a breakdown of communication on a variety of levels outside the Council (level of the Executive Directors, District Branch RFMs/ECPs) due to varying degrees of participation. Advertising opportunities for RFMs and ECPs should be made as simple as possible, with as few barriers as possible, so that the APA can be promoted as a fair and welcoming organization that looks to engage its young members. Engagement of younger members can enhance member retention and improve leadership capability, which translates into future financial and organizational benefits for the association. ECPs are specifically a group whose membership declines with time, and engaging this member early in their career can help keep them informed on the issues, develop a sense of responsibility to general member issues, help them with networking opportunities, and stimulate their interest in varying issues. This will ultimately lead to retention of membership though and beyond the ECP membership level. BE IT RESOLVED: That a description of the Area ECP Rep/Dep be posted and clearly articulated on the APA website and

That the Area ECP Rep/and Dep Rep position be advertised in the Member Benefit area of the website (in addition to other areas within the website), so as to promote engagement of the member in the organization as a benefit to the ECP member, which will ultimately boost membership. That the basic application for Area RFM Rep/Dep Rep and Area ECP Rep/and Dep Rep would be available for download on the APA website. That the Assembly Procedures Committee create a uniform application process for all Area RFM and ECP Dep Rep positions. This would not prevent Area Councils from having additional requirements. That the APA use the AADPRT listserv of Program Directors to target new faculty members that are recent graduates, so that information can be further distributed to more ECPs. That the Chief-Resident listserv be used as a way to spread information to about-to-become ECPs on opportunities for Area ECP Rep/Dep Rep positions. AUTHORS: Sarit Hovav, M.D., RFM Representative, Area 4 [email protected] Lara Cox, M.D., APA Member Eileen McGee, M.D., Representative, Ohio Psychiatric Physicians Association Matt McDougall, M.D., APA Member Justin Schoen, M.D., APA Member ESTIMATED COST: Author: $424 APA: $2,156 ESTIMATED SAVINGS: none ESTIMATED REVENUE GENERATED: unable to determine at this time ENDORSED BY: Nebraska Psychiatric Society, Assembly Committee of Resident-Fellow Members KEY WORDS: Fairness and equality in voting, opportunity, RFM, ECP; communication; member benefits; diversity APA STRATEGIC PRIORITIES: Diversity REVIEWED BY RELEVANT APA COMPONENT: none

mailto:[email protected]

Item 2016A1 12.DD Assembly

May 13-15, 2016 ACTION PAPER

REFERRED TO THE COMMITTEE ON PROCEDURES TITLE: Allow Deputies to Vote WHEREAS: 1. There are duly-elected Members of the Assembly who are allowed to speak, but not to vote: Seven Deputy Representatives of the Minorities, seven Deputy Representatives of ECPs, and seven Deputy Representatives of RFMs. 2. The number of APA Members that an Assembly Member represents is quite variable. Some speak for less than a hundred, others speak for over five thousand [AACAP Liaison]. Having the deputies’ vote doesn't alter that variability meaningfully. 3. One of the rationales to having deputies of the ECP psychiatrists and RFM psychiatrists not vote is that they are "overwhelmed" at the complexity of the Assembly process and need a year to get seasoned. They are no more "overwhelmed" than many a representative joining the Assembly for the first time and having a vote immediately. [Actually, the RFM and ECP Deputy's learning curve is probably superior to most coming into the Assembly.] 4. There is no evidence that allowing these leaders of their constituencies to vote would be detrimental to the APA. None. 6. This Action Paper has no costs implications because it only allows Deputies who are otherwise attending the Assembly to vote. 7. It is unseemly for the Assembly not to allow the leaders of their constituencies to vote. The Assembly should have a climate of equality and openness. BE IT RESOLVED: 1. That the Assembly allows its elected Deputies to vote. 2. Refer to the Assembly Procedures Committee to change the procedures to where the Assembly allows its Deputies to vote. AUTHORS: Roger Peele, M.D., DLFAPA, Representative, Washington Psychiatric Society Catherine May, M.D., DFAPA, APA Member Eliot Sorel, M.D., DLFAPA, Representative, Washington Psychiatric Society Hind Benjelloun, M.D., APA Member Natalie Velasquez, M.D., APA Member Arushi Kapoor, M.D., APA Member

ESTIMATED COST: Author: $0 APA: $77 ESTIMATED SAVINGS: $0 ESTIMATED REVENUE GENERATED: $0 ENDORSED BY: Washington Psychiatric Society, January, 2011 KEY WORDS: Deputies, a climate of equality, respect for the members APA STRATEGIC PRIORITIES: Advancing Psychiatry, Diversity REVIEWED BY RELEVANT APA COMPONENT:

Joint Reference Committee – Draft Summary of Actions – page 1

Joint Reference Committee June 18, 2016

DRAFT SUMMARY OF ACTIONS

As of June 22, 2016

N.B: When a LEAD Component is designated in a referral it means that all other entities to which that item is referred will report back to the LEAD component to ensure that the LEAD component can submit its report as requested in the JRC summary of actions. JRC Members Present: Anita Everett, MD: JRC Chairperson: APA President-elect (stipend); receives income from Johns Hopkins School of Medicine Theresa Miskimen, MD: Speaker-elect; Rutgers University Health Care; State of NJ - psychiatrist leading the involuntary medication panel review for three state hospitals Altha Stewart, MD: APA Secretary. Full time faculty from University of Tennessee Health Science Center; Medical Director for the WNBA James Batterson, MD: full time faculty Children’s Mercy Hospital; receives funding from Pfizer and Psyadon Pharmaceuticals through the hospital Lama Bazzi, MD: receives income from Maimonides Medical Center; forensic private practice. Glenn Martin, MD: Immediate Past Speaker– receives income from the Icahn School of Medicine at Mt. Sinai; receives income from private practice; Medical Director of

Information Exchange in Queens. Human Subjects Director for Mt. Sinai; Saul Levin, MD, MPA: CEO/Medical Director – APA salary; Chair of the APAF Board of Directors Nina Vasan, MD: APAF SAMHSA fellow; Resident; Consulting for Mackenzie and Co; book royalties JRC Administration: Margaret Cawley Dewar – Director, Association Governance Laurie McQueen, MSSW – Associate Director, Association Governance APA Administration: Yoshie Davison, MSW – Chief of Staff Ariel González, JD – Chief, Government Affairs – via speakerphone Tristan Gorrindo, MD – Director, Division of Education – via speakerphone Kristin Kroeger – Chief, Policy, Programs, & Partnerships Ranna Parekh, MD, MPH – Director, Division of Diversity and Health Equity – via speakerphone Shaun Snyder, JD – Chief Operating Officer Philip Wang, MD, DrPH – Director, Division of Research Glenn O’Neal – Interim Chief of Communications


Agenda Item #

Action Comments/Recommendation Administration Responsible Referral/Follow-up & Due Date

2

Review and Approval of the Summary of Actions from the January 2016 Joint Reference Committee Meeting Will the Joint Reference Committee approve the draft summary of actions from the January 2016 meeting?

The Joint Reference Committee approved the draft summary of actions from the January 2016 meeting.

Shaun Snyder, JD Margaret Cawley Dewar Laurie McQueen


3 CEO/Medical Director’s Office Report Updates on Referrals

3.1 Referral Update – no action needed Advocating for Medicaid Expansion (ASMNOV1512.N; JRCJAN166.10) As requested by the JRC, Government Affairs has begun discussions to identify opportunities to advocate for the expansion of Medicaid in those states which have not yet done so. The Department is working with like-minded advocacy groups to urge Medicaid expansion specifically targeting the southern states where many have opted against expansion.

The Joint Reference Committee thanked Dr. Levin and the APA Administration for the referral update.

N/A

3.2 Referral Update – no action needed Timely Reimbursement for Psychiatric Treatment (ASMMAY1512.G; JRCJULY156.6) APA has looked into the timely reimbursement for psychiatric treatment and Smart Cards have been developed using an EMV chip to store roughly 32KB of patient data. These cards are popular in parts of Europe and Taiwan, but are not in the USA. The GAO released a report on the potential uses of Smart Cards for Medicare beneficiaries: http://www.gao.gov/assets/670/669228.pdf

The Joint Reference Committee thanked Dr. Levin and the APA Administration for the referral update.

N/A

5 Assignment of Position Statements to Councils for Review

The Joint Reference Committee referred the position statements with a review date of 2016 or earlier to the relevant councils for review.

All Councils Report to JRC – October 2016 Deadline: 10/05/16

6 Report of the Assembly – Theresa Miskimen, MD Please see the Assembly’s Report for information items.


Agenda Item #


6.1 Performance in Practice Certification by the American Psychiatric Association (ASMMAY1612.A) (Please see item 6, attachment 1) The action paper asks the APA Division of Education along with the Council on Medical Education and Lifelong Learning to explore the possibility of the APA creating a program whereby the currently existing products that satisfy MOC requirements such as PIPs, Self-Assessment CME and the safety course be packaged together and if required elements are met, the physician would receive a certificate recognizing participation in the program. The certificate could be used by the member to satisfy Part 4 of MOC if they are participating in MOC or used to prove participation in quality improvement for federal reimbursement if not participating in MOC. Will the Joint Reference Committee refer action paper 12.A: Performance in Practice Certification by the American Psychiatric Association to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Performance in Practice Certification by the American Psychiatric Association (ASMMAY1612.A) to the Council on Medical Education and Lifelong Learning and requested a report back to the JRC in October 2016.

Tristan Gorrindo, MD Kristen Koeller

Council on Medical Education and Lifelong Learning Report to JRC – October 2016 Deadline: 10/05/16

6.2 Standards for Inpatient Psychiatric Care (ASMMAY1612.B) (Please see item 6, attachment 2) The action paper asks that the APA Council on Quality Care explore the APA developing a practice guideline for inpatient psychiatric care. The Council will report back to the Assembly by the May 2017 Assembly meeting. Will the Joint Reference Committee refer action paper 12.B: Standards for Inpatient Psychiatric Care to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Standards for Inpatient Psychiatric Care (ASMMAY1612.B) to the Council on Quality Care and requested a report in October 2016.

Kristin Kroeger Samantha Shugarman

Council on Quality Care Report to JRC – October 2016 Deadline: 10/05/16


Agenda Item #


6.3 Position Statement: Mental Health Hotlines (ASMMAY1612.C) (Please see item 6, attachment 3) The action paper asks the Council on Quality Care to develop a Position Statement presenting minimum uniform standards for mental health hotlines in the United States and Canada and to present such Position Statement to the Assembly during the November 2016 meeting for approval. Will the Joint Reference Committee refer action paper 12.C: APA Position Statement on Mental Health Hotlines to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Position Statement: Mental Health Hotlines to the Council on Quality Care (LEAD) and the Council on Communications and requested a report in October 2016.

Kristin Kroeger Samantha Shugarman Glenn O’Neal

Council on Quality Care Council on Communications Report to JRC – October 2016 Deadline: 10/05/16

6.4 Position Statement: Migrant and Refugee Crisis around the World (ASMMAY1612.D) (Please see item 6, attachment 4) The action paper asks that the appropriate component of the APA develop a position statement on the mental health impact of the migrant and refugee crisis in time for review at the Assembly meeting in the fall of 2016. The APA supports the intent and sentiment as expressed by The World Association of Cultural Psychiatry’s Call for Action on the Position Statement Migrant Crisis Around the World. Will the Joint Reference Committee refer action paper 12.D: Position Statement on Migrant and Refugee Crisis around the World to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Position Statement: Migrant and Refugee Crisis around the World (ASMMAY1612.D) to the Council on Minority Mental Health and Health Disparities (LEAD), the Council on International Psychiatry, the Council on Psychiatry and Law and the Council on Children, Adolescents and Their Families. The Councils are asked to develop a position statement as noted in the action paper and to include legal and human rights perspectives.

Ranna Parekh, MD, MPH Brandon Batiste Ricardo Juarez, MD Tatiana Claridad Ariel González, JD Lori Klinedinst Whitaker

Council on Minority Mental Health and Health Disparities (LEAD) Council on International Psychiatry Council on Children, Adolescents and Their Families Council on Psychiatry and Law Report to JRC – October 2016 Deadline: 10/05/16


Agenda Item #


6.5 Eliminate Federal Parity Opt-Out (ASMMAY1612.E) (please see item 6, attachment 5) The action paper asks that the American Psychiatric Association lobby for elimination of the federal "opt-out" provisions so that self-funded, nonfederal governmental health plans are no longer permitted to opt-out of parity, ensuring that all health insurance plans are subject to the same parity requirements. Will the Joint Reference Committee refer action paper 12.E: Eliminate Federal Parity Opt-Out to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred action paper Eliminate Federal Parity Opt-Out (ASMMAY1612.E) to the Department of Government Affairs and the Department of Parity Implementation and Enforcement Policy. The JRC requested that a report on the APA’s current “opt-out” lobbying activities be provided to the Assembly in November 2016.

Ariel González, JD Kristin Kroeger Sam Muszynski, JD

Department of Government Affairs Department of Parity Implementation and Enforcement Policy Assembly – November 2016 Deadline: 9/19/16


Agenda Item #


6.6 Making Access to Treatment for Erectile Disorder Available under Medicare (ASMMAY1612.F) (please see item 6, attachment 6) The action paper asks that the APA seek to collaborate with other medical societies, including the American Urological Assoc., AMA, etc., as well as organizations devoted to advocacy for those with illness which may result in Erectile Disorder to assure access to a full range of evidence based pharmaceutical, mechanical and surgical treatment options for dealing with Erectile Disorder in a cost effective manner. That the Council on Advocacy and Government Relations and the Council on Healthcare Systems and Financing advocate, along with other professional societies and advocacy groups, for legislation to allow access to the full array of medications, mechanical therapies, and other treatments for Erectile Disorder which are currently excluded from coverage under Medicare. Will the Joint Reference Committee refer action paper 12.F: Making Access to Treatment for Erectile Disorder Available under Medicare to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Making Access to Treatment for Erectile Disorder Available under Medicare (ASMMAY1612.F) to the Council on Government Relations (LEAD) and the Council on Healthcare Systems and Financing. The councils were asked to broaden the scope of the action paper to include all sexual side effects regardless of gender and provide a report by October 2016.

Ariel González, JD Deana McRae Kristin Kroeger Rebecca Yowell

Council on Advocacy and Government Relations (LEAD) Council on Healthcare Systems and Financing Report to JRC – October 2016 Deadline: 10/05/16


Agenda Item #


6.7 Providing Recordings of Individual Presentations from the APA Annual Meeting (ASMMAY1612.G) (please see item 6, attachment 7) The action paper asks that the APA Board of Trustees direct the appropriate component and/or staff department to require that any Annual Meeting recording vendors it engages make available for purchase both individual session recordings as well as recordings of the Meeting as a whole. Will the Joint Reference Committee refer action paper 12.G: Providing Recordings of Individual Presentations from the APA Annual Meeting to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Providing Recordings of Individual Presentations from the APA Annual Meeting (ASMMAY1612.G) to the Division of Education. The Division of Education is asked to develop an analysis of the pros and cons of providing this service and recommendations for potential alternatives and report back to the JRC in October.

Tristan Gorrindo, MD Division of Education Report to JRC – October 2016 Deadline: 10/05/16

6.8 Third Party Coverage of Medication Found to be Beneficial to an Individual Patient (ASMMAY1612.H) (please see item 6, attachment 8) The action paper asks that the APA instruct its delegation to the American Medical Association House of Delegates to promulgate and promote legislation mandating that health insurance companies be required to provide coverage of a particular patient’s ongoing costs for the purchase and use of any medication and its dose and schedule from which that patient has empirically experienced two months or more of continuous benefit with respect to a particular condition, regardless of the FDA’s stated indications for that medication’s use. Will the Joint Reference Committee refer action paper 12.H: Third Party Coverage of Medication Found to Be Beneficial to an Individual Patient to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Third Party Coverage of Medication Found to be Beneficial to an Individual Patient (ASMMAY1612.H) to the Council on Healthcare Systems and Financing. The Council is asked to review the current policies on this issue and provide a report to the JRC in February 2017. The JRC will consider the report from the Council and determine next steps, which may include referral to the APA AMA Delegation.

Kristin Kroeger Rebecca Yowell

Council on Healthcare Systems and Financing Report to JRC – February 2017 Deadline: 1/20/17


Agenda Item #


6.9 Pharmacists Substituting Medications with Similar Mechanisms of Action (ASMMAY1612.I) (please see item 6, attachment 9) The action paper asks that the Joint Reference Committee refer this action to the Council on Quality Care and Council on Advocacy and Government Relations re: scope of practice issues to update the APA’s 2009 "Position Statement on Medication Substitutions,” incorporating such considerations as “therapeutic class” and/or “mechanisms of action,” and to present the draft Position Statement to the Assembly in May, 2017. That among these considerations be included the following concerns: There are vast inter-individual differences in genetics and biology. Medications may be lumped together and described as a “therapeutic class,” but which are not therapeutically equivalent as there are frequently significant differences in metabolic pathways, drug interactions, multiple receptor actions and adverse reactions. Will the Joint Reference Committee refer action paper 12.I: Pharmacists Substituting Medications with Similar Mechanisms of Action to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Pharmacists Substituting Medications with Similar Mechanisms of Action (ASMMAY1612.I) to the Council on Quality Care (LEAD), Council on Healthcare Systems and Financing and the Council on Advocacy and Government Relations. The JRC requests the identified councils (Quality Care, Healthcare Systems and Financing, Advocacy and Government Relations communicate and provide reports back in October 2016. At that time, the JRC will determine what additional action is indicated.

Kristin Kroeger Samantha Shugarman Rebecca Yowell Ariel González, JD Deana McRae

Council on Quality Care (LEAD) Council on Healthcare Systems and Financing Council on Advocacy and Government Relations Report to JRC – October 2016 Deadline: 10/05/16


Agenda Item #


6.10 Eliminate Out Of Pocket Cost Barriers to Care for Patients with Serious and Recurrent Disabling Mental Disorders (ASMMAY1612.J) (please see item 6, attachment 10) The action paper asks: 1. That APA will develop a Position Statement through the Council on Health Care Systems and Financing, asserting that Care Managing Entities, public and private, should waive or minimize co-pays, deductibles and share of costs for patients with serious, recurrent or disabling mental disorders including child, adolescent and adult patient populations, (this is based on development of a Position Statement) and; 2. That the APA will advocate through legislative and regulatory lobbying and state legislative outreach, and; 3. That the APA, through its AMA delegation, advocate for a similar resolution for all patients with serious, recurrent or disabling illness. Will the Joint Reference Committee refer action paper 12.J: Eliminate Out of Pocket Cost Barriers to Care for Patients with Serious and Recurrent Disabling Mental Disorders to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Eliminate Out Of Pocket Cost Barriers to Care for Patients with Serious and Recurrent Disabling Mental Disorders (ASMMAY1612.J) first to the Council on Healthcare Systems and Financing to draft a position statement (item #1). The JRC requests a draft position statement from the Council for review at the JRC February 2017 meeting. The JRC will then determine, based on the outcome of the report from the council, next steps which could include referral to the Council on Advocacy and Government Relations for advocacy efforts and to the APA AMA Delegation.

Kristin Kroeger Rebecca Yowell

Council on Healthcare Systems and Financing Report to JRC – February 2017 Deadline: 1/20/17


Agenda Item #


6.11 Improving Electronic Medical Record (EMR) Psychiatric Documentation (ASMMAY1612.N) (please see item 6, attachment 11) The action paper asks that the APA will take action to facilitate the improvement of efficiency and quality of Electronic Medical Records and psychiatric documentation. The APA will explore developing specific and practical templates to improve clinical utility. The issue should be referred to the Committee on Mental Health Information Technology, Assembly Executive Committee and the Board of Trustees for further consideration. Will the Joint Reference Committee refer action paper 12.N: Improving Electronic Medical Record (EMR) Psychiatric Documentation to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred action paper Improving Electronic Medical Record (EMR) Psychiatric Documentation (ASMMAY1612.N) to the Council on Quality Care and its Committee on Mental Health Information Technology with reports back to JRC in October 2016.

Kristin Kroeger Nathan Tatro

Council on Quality Care Committee on Mental Health Information Technology Report to JRC – October 2016 Deadline: 10/05/16

6.12 Improving the Efficacy of Prescription Drug Monitoring Programs (ASMMAY1612.P) (please see item 6, attachment 12) The action paper asks that the American Psychiatric Association support the inclusion of methadone and buprenorphine dispensed or prescribed from opioid treatment programs in all Prescription Drug Monitoring Programs in an effort to decrease the risk of serious drug interactions, overdose, and death. Will the Joint Reference Committee refer action paper 12.P: Improving the Efficacy of Prescription Drug Monitoring Programs to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Improving the Efficacy of Prescription Drug Monitoring Programs (ASMMAY1612.P) to the Council on Addiction Psychiatry (LEAD) and the Council on Healthcare Systems and Financing, and also to the Council on Psychiatry and Law for a review of the HIPAA and confidentiality issues. A report is requested in October 2016.

Tristan Gorrindo, MD Beatrice Eld Kristin Kroeger Rebecca Yowell Ariel González, JD Lori Klinedinst Whitaker

Council on Addiction Psychiatry (LEAD) Council on Healthcare Systems and Financing Council on Psychiatry and Law Report to JRC – October 2016 Deadline: 10/05/16


Agenda Item #


6.13 Develop an APA Resource Document on the Use of Patient Information Discovered in Targeted Internet or Social Media Searches in Various Practice Settings (ASMMAY1612.Q) (please see item 6, attachment 13) The action paper asks that the APA assist the Ethics Committee or an ad hoc work group appointed with representation from various components of the APA (e.g., Ethics, Psychiatry and Law, Communications, etc.) in developing a detailed resource document on patient targeted internet and social media searches to provide guidance on when (if) and how to use the internet and social media clinically, and disseminate the position statement to its members. Finally, that the work group develop a resource document, and include at least two resident and /or early career psychiatrist consultants to assist in developing this resource document, as there may be generational differences in the thinking and approach to patient targeted internet and social media searches. Will the Joint Reference Committee refer action paper 12.Q: Develop an APA Resource Document on the Use of Patient Information Discovered in Targeted Internet or Social Media Searches in Various Practice Settings to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred action paper Develop an APA Resource Document on the Use of Patient Information Discovered in Targeted Internet or Social Media Searches in Various Practice Settings (ASMMAY1612.Q) to the Ethics Committee, the Council on Psychiatry and Law and the Division of Communication with a report due in October 2016.

Colleen Coyle, JD Ariel González, JD Lori Klinedinst Whitaker Glenn O’Neal

Ethics Committee Council on Psychiatry and Law Division of Communications Report to JRC – October 2016 Deadline: 10/05/16


Agenda Item #


6.14 Encouragement of Senior Psychiatrists to Maintain Active Membership in APA (ASMMAY1612.R) (please see item 6, attachment 14) The action paper 2016A1 12.R asks: The APA Membership Division to look back over their records for the last 5 years and determine: 1. The percentage of psychiatrists over the age of 55 who resign, fail to renew membership, or request Inactive Status 2. The percentage of psychiatrists who reach Life status who do not continue to renew membership until their 11th year of Life status, either by attrition or by death 3. How the loss of these members’ dues revenues currently impacts the functioning of the APA and whether it would be worth changing the structure of the dues formula to charging Life Members in years 1-3 to two-thirds of dues and 4-6 to one third of dues and making the 7th year on as free membership. This would almost certainly be useful in maintaining more senior members as it would mean 4 less years of dues that need to be paid. Continuing their membership would generate more income when they continue to participate in APA meetings as qualified members, rather than not participating. 4. The Membership Committee, following its review, will recommend the appropriate action or ask for further study to the JRC/Board of Trustees or Assembly with a report back to the Assembly by May 2017. Will the Joint Reference Committee refer action paper 12.R: Encouragement of Senior Psychiatrists to Maintain Active Membership in APA to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Encouragement of Senior Psychiatrists to Maintain Active Membership in APA (ASMMAY1612.R) to the Membership Department and requests that the Membership Committee communicate to the Assembly its report on Senior Psychiatrists to the Assembly.

Jon Fanning Susan Kuper

Membership Department Report to JRC – October 2016 Deadline: 10/05/16


Agenda Item #


6.15 Enhancing Ethical Knowledge of APA Members (ASMMAY1612.S) (please see item 6, attachment 15) The action paper 2016A1 12.S asks that: APA supports the importance of ethics by recommending continuing medical education in ethics. APA offers identified ethics content at its Annual Meeting each year. APA offers an educational activity that can be performed online for credit with an ethical focus and that this activity be offered for free to members as one of the monthly free courses offered online and that this course be updated at least every 2 years. Will the Joint Reference Committee refer action paper 12.S: Enhancing Ethical Knowledge of APA Members to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Enhancing Ethical Knowledge of APA Members (ASMMAY1612.S) to the APA Administration and requested that a report on the current ethics education activities underway at the APA be submitted in October 2016.

CEO/Medical Director’s Office Saul Levin, MD, MPA Division of Education

APA Administration Report to JRC – October 2016 Deadline: 10/05/16


Agenda Item #


6.16 Protecting Senior Psychiatrists from Mandatory Competency Testing (ASMMAY1612.T) (please see item 6, attachment 16) The action paper 2016A1 12.T asks that: 1. The Council on Medical Education and Lifelong Learning A. Identify the best interests of psychiatrists who may be subject to mandatory competency testing. B. Consider developing informational and support resources for members who face mandatory competency testing, similar to the information and support the AMA provides its members but more specific to psychiatrists. 2. The Delegation to the American Medical Association collaborate with the AMA to ensure psychiatrists’ best interests are represented in AMA activities that are related to mandatory competency testing. 3. The Council on Advocacy and Government Relations A. Advocate the interests of psychiatrists as proposals for state and federal regulations related to mandatory competency testing of physicians are being considered. B. Collaborate with the American Medical Association to ensure the interests of psychiatrists are represented in current and future guidelines for physicians competency testing. Will the Joint Reference Committee refer action paper 12.T: 16.Protecting Senior Psychiatrists from Mandatory Competency Testing to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred action paper Protecting Senior Psychiatrists from Mandatory Competency Testing (ASMMAY1612.T) to the APA Administration and requested that the AMA’s position on this issue be determined and reported to the JRC when it becomes available. The JRC will then determine the best course of action.

CEO/Medical Director’s Office Saul Levin, MD, MPA

APA Administration Report to JRC – October 2016 Deadline: 10/05/16


Agenda Item #


6.17 Psychiatrist Involvement in Medical Euthanasia and Physician-assisted Suicide of the Non Terminally Ill (ASMMAY1612.U) (please see item 6, attachment 17) The action paper asks that the Board of Trustees of the American Psychiatric Association adopt the following position statement: “The American Psychiatric Association holds that a psychiatrist should not deliberately prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.” Will the Joint Reference Committee refer action paper 12.U: Psychiatrist Involvement in Medical Euthanasia and Physician-assisted Suicide of the Non Terminally Ill to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Psychiatrist Involvement in Medical Euthanasia and Physician-assisted Suicide of the Non Terminally Ill (ASMMAY1612.U) to the Council on Psychiatry and Law.

Ariel González, JD Lori Klinedinst Whitaker

Council on Psychiatry and Law Report to JRC – October 2016 Deadline: 10/05/16

6.18 A Psychiatric Response to Human Trafficking (ASMMAY1612.V) (please see item 6, attachment 18) The action paper 12.V asks that the American Psychiatric Association write a position statement acknowledging human trafficking as a public health issue which impacts the mental health of its victims and advocating for improved research and education surrounding issues of identifying victims and treating their mental health needs. Will the Joint Reference Committee refer action paper 12.V: A Psychiatric Response to Human Trafficking to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper A Psychiatric Response to Human Trafficking (ASMMAY1612.V) to the Division of Diversity and Health Equity (LEAD), the Council on International Psychiatry. Council on Children, Adolescents and Their Families. The Council on Psychiatry and Law is included in the referral as the issue may also pertain to asylum and refugee issues. A report is requested for the October 2016 JRC meeting.

Ranna Parekh, MD, MPH Ricardo Juarez, MS Tatiana Claridad Ariel González, JD Lori Klinedinst Whitaker

Division of Diversity and Health Equity Council on International Psychiatry Council on Children, Adolescents and Their Families Council on Psychiatry and Law Report to JRC – October 2016 Deadline: 10/05/16


Agenda Item #


6.19 Disapproval of the Detention of Central American Asylum Seeking Children and Families in Need of International Protection (ASMMAY1612.X) (please see item 6, attachment 19) The action paper asks that the APA reaffirm its position statements on “Detained Immigrants with Mental Illness” and “Xenophobia, Immigration, and Mental Health”. The APA strongly supports efforts to provide access to mental health services for children and families seeking asylum. Will the Joint Reference Committee refer action paper 12.X: Disapproval of the Detention of Central American Asylum Seeking Children and Families in Need of International Protection to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Disapproval of the Detention of Central American Asylum Seeking Children and Families in Need of International Protection (ASMMAY1612.X) to the Council on International Psychiatry, the Council on Children, Adolescents and Their Families and the Division of Diversity and Health Equity no later than the JRC meeting in October 2016.

Ranna Parekh, MD, MPH Ricardo Juarez, MS Tatiana Claridad Ranna Parekh, MD, MPH

Council on International Psychiatry Council on Children, Adolescents and Their Families Division of Diversity and Health Equity Report to JRC – October 2016 Deadline: 10/05/16


Agenda Item #


6.20 Develop an APA Resource Document Regarding the Ethical Tensions Faced by Psychiatrists Serving as Third Party Utilization Management Reviewers under the Parity Law (ASMMAY1612.Y) (please see item 6, attachment 20) Action paper 2016A1 12.Y asks: 1. That the Board of Trustees shall create an ad hoc committee to develop a resource document to educate and inform psychiatrists about the competing ethical tensions faced by psychiatrists serving as managed care utilization reviewers, or as managed care medical directors developing utilization review management standards. 2. The committee shall include members of the Council on Healthcare Systems and Finance, the Committee on Managed Care, psychiatrist ethicists familiar with the 2015 Commentary on Ethics in Practice, at least one member of the Assembly, and a member of the Ethics Committee or their designee. 3. The resource document shall define and elaborate the ethical tensions, described in the 2015 APA Commentary on Ethics in Practice under Topic 3.4.1, that are encountered by psychiatrist utilization management reviewers and managed care medical directors, with special regard to the implications of the parity law on these tensions. Will the Joint Reference Committee refer action paper 12.Y: Develop an APA Resource Document Regarding the Ethical Tensions Faced by Psychiatrists Serving as Third Party Utilization Management Reviewers under the Parity Law to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Develop an APA Resource Document Regarding the Ethical Tensions Faced by Psychiatrists Serving as Third Party Utilization Management Reviewers under the Parity Law (ASMMAY1612.Y) to the Ethics Committee (LEAD) and the Council on Healthcare Systems and Financing. A report to the JRC is requested for October 2016.

Colleen Coyle, JD Kristin Kroeger Rebecca Yowell

Ethics Committee Council on Healthcare Systems and Financing Report to JRC – October 2016 Deadline: 10/05/16


Agenda Item #


6.21 U.S. Joint Statement on Conversion Therapy (ASMMAY1612.Z) (please see item 6, attachment 21) The action paper asks that the American Psychiatric Association sign on as a signatory to the US Joint Statement on Conversion Therapy which cautions mental health professionals that conversion or change therapies for Lesbian, Gay, Bisexual and Transgendered patients are unethical and embody a risk of harm to those patients. Will the Joint Reference Committee refer action paper 12.Z: US Joint Statement on Conversion Therapy to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred action paper U.S. Joint Statement on Conversion Therapy (ASMMAY1612.Z) to the APA Administration for a review of the implications if the APA were to become a signatory on the Joint Statement. The Council on Minority Mental Health and Health Disparities was referred the action paper for follow-up on these issues. The Joint Reference Committee recommended that the Board of Trustees approve the APA including “T” for “Transgender” and “Q” for “Questioning/Queer” in the acronym LGBT in all APA communications. Lesbian, Gay, Bisexual, Transgender, Queer/Questioning = LBGTQ

Shaun Snyder Margaret Cawley Dewar Ardell Lockerman CEO/Medical Director’s Office

Board of Trustees – July 2016 APA Administration Report to JRC – October 2016 Deadline: 10/05/16

6.22 Utilization of DSM-5 Terminology in APA Publications and Communications (ASMMAY1612.BB) (please see item 6, attachment 22) The action paper asks that the American Psychiatric Association will make every effort to see that every new program, publication, and public communication utilizes up-to-date-language that reflects DSM-5. Will the Joint Reference Committee refer action paper 12.BB: Utilization of DSM-5 Terminology in APA Publications and Communications to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee referred the action paper Utilization of DSM-5 Terminology in APA Publications and Communications (ASMMAY1612.BB) to the Division of Communications for implementation.

Glenn O’Neal Division of Communications Report to JRC – October 2016 Deadline: 10/05/16


Agenda Item #


6.23 APA Referendum Voting Procedure (ASMMAY1612.FF) (please see item 6, attachment 23) The action paper asks that that the American Psychiatric Association distribute the ballot for referendum, the ballot for officers, polls on issues identified by the Assembly and the yearly dues statement concurrently, by both paper and electronic media at the members’ choice. Will the Joint Reference Committee refer action paper 12.FF: APA Referendum Voting Procedure to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee reviewed the history of the requests for changes to the APA Referendum voting procedures. After an extensive discussion of the issues, the JRC determined that implementing this action paper is unfeasible and not in the best interests of the APA. The JRC therefore recommended that the Board of Trustees reaffirm the JRC’s action. Dr. Miskimen, the Speaker-elect of the Assembly will follow-up with the originators of the paper.

Shaun Snyder, JD Margaret Cawley Dewar Chiharu Tobita Ardell Lockerman

Board of Trustees – July 2016


Agenda Item #


6.24 APA Endorsement of the Position Statement of AGLP on Discrimination against LGBT Citizens Based on Arguments of Religious Liberty (ASMMAY1614.A) (please see item 6, attachment 24) The action paper asks that the sudden proliferation of “religious liberty” legislation requires an immediate response by the American Psychiatric Association to prevent psychiatric and psychological harm to LGBT people in the interim between passage and legal challenge; That the Assembly of the American Psychiatric Association emergently endorse the position statement of the Association of Gay and Lesbian Psychiatrists: Discrimination against LGBTQ Citizens under the Guise of Religious Liberty and requests similar endorsement by the Board of Trustees of the American Psychiatric Association Will the Joint Reference Committee refer action paper 14.A: APA Endorsement of the Position Statement of AGLP on Discrimination against LGBT Citizens Based on Arguments of Religious Liberty to the appropriate Component(s) for input or follow-up?

The Joint Reference Committee discussed the action paper APA Endorsement of the Position Statement of AGLP on Discrimination against LGBT Citizens Based on Arguments of Religious Liberty (ASMMAY1614.A). In a substitution action, the Joint Reference Committee forwards to the Board of Trustees the following statement for their consideration. The APA reaffirms its opposition to discrimination against LGBTQ citizens including those with arguments based on claims of religious liberty.

Shaun Snyder, JD Margaret Cawley Dewar Ardell Lockerman


7 Membership Committee – Rahn Bailey, MD


Agenda Item #


7.A Referral Update – no action required Changing ECP Status to 8 years Following Completion of Training (JRCJAN5.1; ASMMAY1512.N; JRCJULY15 6.11) In January 2016, the JRC referred the above item back to the Membership Committee to determine if they could clarify and delineate their position regarding the extension of ECP status to 8 years. The committee discussed this issue again and reviewed the current dues structure and benefits for ECPs. The Membership Committee unanimously voted to “not support” the extension of ECP status to 8 years. The cost and potential loss of revenue were the primary concerns of the committee.

The Joint Reference Committee thanked the Membership Committee for their update on the referral and will forward it to the Board of Trustees for their information.


FYI: Board of Trustees – July 2016

7.B Referral Update – no action required Senior Psychiatrists (JRCJAN 5.2; ASMMAY1512.CC; JRCOCT154.C) In January 2016, the JRC referred the above item back to the Membership Committee and requested that they use a sub work group of the Membership Committee to include a representative from the Board of Trustees and the Assembly and a Senior Psychiatrist. The sub work group was asked to address the issues and needs raised in the action paper.

The Joint Reference Committee thanked the Membership Committee for their update on the referral and will forward it to the Board of Trustees for their information.



8.A Council on Addiction Psychiatry Please see item 8.A for the Council’s report, summary of current activities and information items.


Agenda Item #


8.A.1 Revised Position Statement: Adolescent Substance Use (please see attachment 1) Will the Joint Reference Committee recommend that the Assembly approve the revised Position Statement: Adolescent Substance Use and if approved, forward it to the Board of Trustees for consideration?

The Joint Reference Committee recommended that the Assembly approve the revised Position Statement: Adolescent Substance Use and if approved, forward it to the Board of Trustees for consideration. N.B. If the revised position statement is approved, the 2009 PS on Adolescent Substance Use will be retired.

Shaun Snyder, JD Margaret Cawley Dewar Allison Moraske

Assembly – November 2016 Deadline: 9/19/16

8.A.2 Revised Position Statement: The Care of Pregnant and Newly Delivered Women (please see attachment 2) Will the Joint Reference Committee recommend that the Assembly approve the revised Position Statement: The Care of Pregnant and Newly Delivered Women and if approved, forward it to the Board of Trustees for consideration? N.B. If the revised position statement is approved, the 2007 PS on Care of Pregnant and Newly Delivered Women Addicts will be retired.

The Joint Reference Committee recommended that the Assembly approve the revised Position Statement: The Care of Pregnant and Newly Delivered Women and if approved, forward it to the Board of Trustees for consideration. Caveat: the JRC will determine if the term “newly-delivered” versus “post-partum” has any implications for the position statement and may revise the statement prior to its submission to the Assembly.



8.A.3 Proposed Position Statement: Substance Use Disorders in the Criminal Justice System (please see attachment 3) Will the Joint Reference Committee recommend that the Assembly approve the proposed Position Statement: Substance Use Disorders in the Criminal Justice System and if approved, forward it to the Board of Trustees for consideration?

The Joint Reference Committee recommended that the Assembly approve the proposed Position Statement: Substance Use Disorders in the Criminal Justice System and if approved, forward it to the Board of Trustees for consideration.



8.B Council on Advocacy and Government Relations Please see item 8.B for the Council’s report, a summary of current activities and informational items.


Agenda Item #


8.B.1 Referral Update Access to Care Provided by the Department of Veterans Affairs (ASMNOV1512.A; JRCJAN166.1) Will the Joint Reference Committee accept the Council on Advocacy and Government Relations’ recommendation to return the Action Paper on “Access to Care Provided by the Department of Veterans Affairs” to the Assembly for clarification and expansion, including a definition of the problem that is being addressed? (please see attachment 2) The Council on Advocacy and Government Relations (CAGR) discussed the JRC referral of the Action Paper. “Access to Care Provided by the Department of Veterans Affairs.” As directed through the JRC summary of actions, the Council considered the recommended actions and the political aspects of the Action Paper. Through a majority vote, it was recommended the Action Paper not move forward. The Council proposed the Action Paper be returned to the author for review and to incorporate substantive changes as previously recommended by the Council.

The Joint Reference Committee recommended that a written report on the issues related to the action paper be submitted by the Council to the Assembly Executive Committee for its July 2016 meeting. The AEC will provide additional information to the Council on Advocacy and Government Relations, taking into consideration the new regulations on this issue and APA’s position on scope of practice issues.

Ariel González, JD Deana McRae

Council on Advocacy and Government Relations Report to AEC – July 2016


Agenda Item #


8.B.2 Referral Update Endorsement of Principles for the Provision of Mental and Substance Abuse Treatment Services: A Bill of Rights (JRCOCT148.G.17; JRCJULY158.B.2) The Council discussed the JRC referral of the position statement, “Endorsement of Principles for the Provision of Mental Health and Substance Abuse Treatment Services: A Bill of Rights.” The Council agreed the position statement remains important when advocating on behalf of the mental and substance use treatment services. Through unanimous consent, the Council will form a new workgroup—inclusive of new Council members and Officers—to craft an APA document which would address the rights of patients, revised to reflect developments in law and policy over the past 15 years and best represent the organization in addressing treatment services.

The Joint Reference Committee thanked the Council for the referral update.

N/A

8.B.3 Referral Update: Reaffirm APA Adoption of the AMA’s 2010 Position Statement: Direct to Consumer (DTC) Advertising of Prescription Drugs and Implantable Devices The Council was informed that the Council on Quality Care (LEAD) agreed to accept the language of the recently Assembly (May 2016) supported Action Paper, “Direct-to-Consumer Advertising.” As the secondary component, the Council on Advocacy and Government Relations will adhere to the Council on Quality Care’s decision.

The Joint Reference Committee thanked the Council for the referral update.

N/A

8.C Council on Children, Adolescents and Their Families Please see item 8.C for the Council’s report, a summary of current activities, and information items.

8.D Council on Communications Please see item 8.D for the Council’s report. The council does not have any actions.

8.E Council on Geriatric Psychiatry Please see item 8.E for the Council’s report, summary of current activities and information items.


Agenda Item #


8.E.1 Composition of the Council Will the Joint Reference Committee recommend that the Board of Trustees approve that the President-elect of the AAGP serve as a corresponding member of the Council on Geriatric Psychiatry in an ongoing, ex-officio basis?

The Joint Reference Committee noted that in December 2014, the Board of Trustees approved the following action: The Board of Trustees voted to approve, as a pilot program, that each ABPN subspecialty (Addiction; Child; Forensic; Geriatric and Psychosomatic Medicine, identify one individual [Medical Director or equivalent] to hold an ex-officio, non-voting position on its corresponding APA council. Costs of participation would be shared equally between APA and the participating subspecialty organization.

Ranna Parekh, MD, MPH Sejal Patel Shaun Snyder, JD Margaret Cawley Dewar Laurie McQueen

Council on Geriatric Psychiatry Association Governance

8.F Council on Healthcare Systems and Financing Please see item 8.F for the Council’s report, summary of current activities and information items.

8.F.1 Proposed Position Statement: Out of Network Restriction of Psychiatrists (please see attachment 3) Will the Joint Reference Committee recommend that the Assembly approve the proposed Position Statement: Out of Network Restriction of Psychiatrists and if approved, forward it to the Board of Trustees for consideration? Background: The JRC referred item 3 of Assembly Action paper 12.F (Nov15) to the CHSF. The item asks that the relevant APA component develop a Position Statement similar to that of the AMA, supporting coverage by all payers of prescriptions and tests ordered by nonparticipating psychiatrists.

The Joint Reference Committee recommended that the Assembly approve the proposed Position Statement: Out of Network Restriction of Psychiatrists and if approved, forward it to the Board of Trustees for consideration.



8.G Council on International Psychiatry Please see item 8.G for the Council’s report, summary of current activities and information items.


Agenda Item #


8.G.1 Retain Position Statement: Identification of Abuse and Misuse of Psychiatry (please see attachment 1) Will the Joint Reference Committee recommend that the Assembly vote to retain the Position Statement: Identification of Abuse and Misuse of Psychiatry and if retained, forward it to the Board of Trustees for consideration? Rationale: The reviewing Council work group determined that the content of the position statement was adequate, but that it may be impacted following the outcome of current discussions regarding the topic of physician assisted death/physician aid in dying.

The Joint Reference Committee recommended that the Assembly vote to retain the Position Statement: Identification of Abuse and Misuse of Psychiatry and if retained, forward it to the Board of Trustees for consideration. The Joint Reference Committee requested that the Council on International Psychiatry work to consolidate the PS Identification of Abuse and Misuse of Psychiatry and the PS Abuse and Misuse of Psychiatry.

Shaun Snyder, JD Margaret Cawley Dewar Allison Moraske Ranna Parekh, MD, MPH Ricardo Juarez

Assembly – November 2016 Deadline: 9/19/16 Council on International Psychiatry Report to JRC – February 2017 Deadline: 1/20/17

8.G.2 Retain Position Statement: Abuse and Misuse of Psychiatry (please see attachment 2) Will the Joint Reference Committee recommend that the Assembly vote to retain the Position Statement: Abuse and Misuse of Psychiatry and if retained, forward it to the Board of Trustees for consideration? Rationale: The reviewing Council work group determined that the content of the position statement was adequate, but that it may be impacted following the outcome of current discussions regarding the topic of physician assisted death/physician aid in dying.

The Joint Reference Committee recommended that the Assembly vote to retain the Position Statement: Abuse and Misuse of Psychiatry and if retained, forward it to the Board of Trustees for consideration.




Agenda Item #


8.G.3 Revised Position Statement: Use of Psychiatric Institutions for the Commitment of Political Dissenters (please see attachment 3) Will the Joint Reference Committee recommend that the Assembly vote to approve the revised Position Statement: Use of Psychiatric Institutions for the Commitment of Political Dissenters and if approved, forward it to the Board of Trustees for consideration? N.B. If the revised position statement is approved, the 1994 PS Use of Psychiatric Institutions for the Commitment of Political Dissenters will be retired.

The Joint Reference Committee recommended that the Assembly vote to approve the revised Position Statement: Use of Psychiatric Institutions for the Commitment of Political Dissenters and if approved, forward it to the Board of Trustees for consideration. N.B. If the revised position statement is approved, the 1994 PS Use of Psychiatric Institutions for the Commitment of Political Dissenters will be retired.



8.G.4 Revised Position Statement: Resolution Condemning the Role of Psychiatrist Radovan Karadzic in Human Rights Abuse in the Former Yugoslavia (please see attachment 4) Will the Joint Reference Committee recommend that the Assembly vote to approve the revised Position Statement: Resolution Condemning the Role of Psychiatrist Radovan Karadzic in Human Rights Abuse in the Former Yugoslavia, and if approved, forward it to the Board of Trustees for consideration? (see attachment 4) N.B. If the revised position statement is approved, the 2007 Resolution Condemning the Role of Psychiatrist Radovan Karadzic in Human Rights Abuse in the Former Yugoslavia will be retired.

The Joint Reference Committee deferred action on this request and requested that Council on International Psychiatry work on the 1992 Position Statement on Human Rights and consolidate the APA position statements on Human Rights into one comprehensive APA position statement on human rights. The Council on International Psychiatry (LEAD) is asked to work with the Council on Psychiatry and Law and the Division of Communications and provide a report to the JRC in October 2016.

Ranna Parekh, MD, MPH Ricardo Juarez, MS Ariel González, JD Lori Klinedinst Whitaker Glenn O’Neal

Council on International Psychiatry (LEAD) Council on Psychiatry and Law Division of Communications Report to JRC – February 2017 Deadline: 1/20/17


Agenda Item #


8.G.5 Retain Position Statement: Denial of Human Rights Abuses (please see attachment 5) Will the Joint Reference Committee recommend that the Assembly vote to retain the Position Statement: Denial of Human Rights Abuses, and if retained, forward it to the Board of Trustees for consideration? Rationale: The reviewing Council work group determined that the content of the position statement was sufficient.

The Joint Reference Committee deferred action on this request and requested that Council on International Psychiatry work on the 1992 PS on Human Rights and consolidate the APA position statements on Human Rights into one comprehensive statement on human rights. As noted in 8.G.4, the Council is asked to work with the Council on Psychiatry and Law and the Division of Communications to provide a draft statement back to the JRC in October 2016.

Ranna Parekh, MD, MPH Ricardo Juarez, MS Ariel González, JD Lori Klinedinst Whitaker Glenn O’Neal

Council on International Psychiatry (LEAD) Council on Psychiatry and Law Division of Communications Report to JRC – February 2017 Deadline: 1/20/17

8.H Council on Medical Education and Lifelong Learning Please see item 8.H for the Council’s report, summary of current activities and information items.

8.H.1 Referral Update – no action required Strengthening the Role of Residency Training to Improve Access to Buprenorphine (ASMNOV1512.I; JRCJAN166.7) This action was discussed previously at Council on Medical Education. The APA Division of Education has taken the following steps: 1) submitted proposal to SAMHSA to update and fund APA’s online buprenorphine training. The online training can be provided without charge to APA member residents. 2) reduced cost of buprenorphine training at the Annual Meeting and IPS; 3) added buprenorphine 201 sessions at the IPS to provide technical assistance to buprenorphine prescribers; 4) submitted a renewal application of the PCSS-MAT program

The Joint Reference Committee thanked the Council for this update.

N/A


Agenda Item #


8.H.2 Referral Update – no action required Partial Hospital Training in Psychiatric Residency (ASMNOV1512.L; JRCJAN166.9) At ACGME's Psychiatry RRC winter meeting, Dr. Gorrindo noted that the APA was currently examining the issues surrounding Partial Hospital Training in residency education. The RRC was receptive to these comments and noted that the appropriate pathway for these kinds of changes would be to submit a comment during the next ACGME curriculum revision.


N/A

8.H.3 Referral Update – no action required Equality in Permanent Licensure Policy (ASMNOV1512.K; JRCJAN166.8) At ACGME's Psychiatry RRC winter meeting, Dr. Gorrindo noted that the APA was currently examining the issues surrounding parity in licensure policy. The Council remains supportive of this issue.


N/A

8.I Council on Minority Mental Health and Health Disparities Please see item 8.I for the Council’s report, summary of current activities and information items. The Council does not have action items.

8.J Council on Psychiatry and Law


Agenda Item #


8.J.1 Retire Position Statement: Confidentiality of Medical Records and Physician Right to Privacy Concerning His/Her Own Health Record (1981) (please see attachment 2) Will the Joint Reference Committee recommend that the Assembly retire the Position Statement: Confidentiality of Medical Records and Physician Right to Privacy Concerning His/Her Own Health Record (1981) and if retired, forward it to the Board of Trustees for consideration? Rationale: The Council on Psychiatry and Law reviewed the 1981 Confidentiality of Medical Records and Physician Right to Privacy Concerning His/Her Own Health Record Position Statement and felt that there is no longer a need for the position paper. The Council felt that the issue is no longer relevant and the current position paper on Discrimination against Persons with Previous Psychiatric Treatment would cover any outstanding issues. The Council is asking for the position paper to be sunset.

The Joint Reference Committee recommended that the Assembly retire the Position Statement: Confidentiality of Medical Records and Physician Right to Privacy Concerning His/Her Own Health Record (1981) and if retired, forward it to the Board of Trustees for consideration?




Agenda Item #


8.J.2 Proposed Position Statement: Location of Civil Commitment Hearings (please see attachment 3) Will the Joint Reference Committee recommend that the Assembly approve the proposed Position Statement: Location of Civil Commitment Hearings and if approved, forward it to the Board of Trustees for consideration? The Council on Psychiatry and Law has developed a position statement on the Location of Civil Commitment Hearings. The position statement was developed from the JRC referral of an action paper passed at the May 2015 Assembly (ASMMAY1512.V; JRCJULY156.16).

The Joint Reference Committee recommended that the Assembly approve the proposed Position Statement: Location of Civil Commitment Hearings and if approved, forward it to the Board of Trustees for consideration.



8.K Council on Psychosomatic Medicine


Agenda Item #


8.K.1 Revised Position Statement: Recognition and Management of HIV-Associated Neurocognitive Impairment and Disorders (HAND) (please see attachment 1) Will the Joint Reference Committee recommend that the Assembly approve the revised Position Statement: Recognition and Management of HIV‐Associated Neurocognitive Impairment and Disorders (HAND) and if approved, forward it to the Board of Trustees for consideration? Rationale: HIV‐associated neurocognitive impairment and disorders (HAND) may develop in the HIV infected person at almost any point during the infectious process, although it remains most common in the latest stage of systemic disease ‐‐AIDS. While HAD predominated early in the epidemic, the most common conditions now are less severe (ANI and, less frequently, MND); however, the prevalence rate of these disorders as a group has remained high (approximately 50%). This is an updated position paper authored/updated by the APA Steering Committee on HIV. The Council on Psychosomatic Medicine approved the document at its May meeting.

N.B. If the revised position statement is approved, the 2012 PS on Recognition and Management of HIV-Related Neuropsychiatric Findings and Associated Impairments will be retired.

The Joint Reference Committee recommended that the Assembly approve the revised Position Statement: Recognition and Management of HIV‐Associated Neurocognitive Impairment and Disorders (HAND) and if approved, forward it to the Board of Trustees for consideration. N.B. If the revised position statement is approved, the 2012 PS on Recognition and Management of HIV-Related Neuropsychiatric Findings and Associated Impairments will be retired.




Agenda Item #


8.K.2 Revised Position Statement: Screening and Testing for HIV Infection (please see attachment 2) Will the Joint Reference Committee recommend that the Assembly approve the revised Position Statement: Screening and Testing for HIV Infection and if approved, forward it to the Board of Trustees for consideration? Rationale: HIV remains a major health issue. People who are diagnosed and treated early can live long, healthy lives. Testing alone even before or without treatment has been shown to help people modify risk behavior and decrease transmission of the virus. The development of rapid HIV testing is of major significance as it provides results during a single session. Identification of asymptomatic HIV positive patients by rapid testing benefits the individual's and the public's health. Positive patients can be referred for treatment and taught about practices that will help reduce the risk of infecting others earlier. Although discrimination and stigma remain significant problems, federal and state statutes that offer protection are now in place, and the general population is better informed about the disease and the epidemic. All these factors have increased the benefits of HIV antibody testing relative to its risks. Consistent with these developments, the latest recommendations of the U. S. Preventative Services Task Force/CDC (2) and the National HIV/AIDS Strategy for the United States: Updated to 2020 (3) advise routine HIV infection screening. This is an updated position paper authored/updated by the APA Steering Committee on HIV. The Council on Psychosomatic Medicine approved the document at its May meeting.

N.B. If the revised position statement is approved, the 2003 PS on HIV Antibody Testing will be retired.

The Joint Reference Committee recommended that the Assembly approved the revised Position Statement: Screening and Testing for HIV Infection and if approved, forward it to the Board of Trustees for consideration. N.B. If the revised position statement is approved, the 2003 PS on HIV Antibody Testing will be retired.




Agenda Item #


8.K.3 Resource Document: Bariatric Surgery and Psychiatry Care (please see attachment 3)

Will the Joint Reference Committee approve the Resource Document on Bariatric Surgery and Psychiatric Care? Background: The purpose of this resource document is to highlight the role of psychiatrists in the care of patients undergoing bariatric surgery. The document identifies key psychiatric components to pre-bariatric surgery assessment and aftercare, which underscore the need for integrated psychiatric services throughout patients’ bariatric surgery care. The document was drafted as a result of ongoing efforts by the Council on Psychosomatic Medicine to provide important information to APA members and leadership about psychiatric issues and practice on the interface with Medicine and Surgery.

The Joint Reference Committee approved the Resource Document: Bariatric Surgery and Psychiatry Care. In the event that the Council would like to publish the resource document, the JRC looks forward to receiving a request to seek outside publication.

Shaun Snyder, JD Margaret Cawley Dewar Laurie McQueen Division of Communications Council on Psychosomatic Medicine


8.L Council on Quality Care Please see item 8.L for the Council’s report, summary of current activities and information items.

8.L.1 APA EHR Evaluation Tool Will the Joint Reference Committee recommend that the Board of Trustees approve the development of an APA EHR Evaluation Tool with a target budget not to exceed $200,000.00? The EHR Workgroup, chaired by Lori Simon, M.D. met with Caterina Luppi, APA Chief Information Officer (CIO) and is currently working with other APA Administration in order to determine whether the organization can build a psychiatry EHR online comparison tool. A draft work plan was circulated, as well as a list of EHR comparison tools available on the web. APA’s CIO received a quote from APA’s preferred vendor in the amount of $200,000.00.

The Joint Reference Committee does not recommend that the Board of Trustees approve the development of an EHR Evaluation Tool. The Committee on Mental Health Information Technology is currently developing FAQs and a scorecard on existing EHRs. As this is a rapidly evolving field, the APA’s energies and resources are best spent providing information and guidance to our members and directing them to existing tools.

Kristin Kroeger Nathan Tatro

Department of Practice Management and Delivery Systems Policy Report to JRC – October 2016 Deadline: 10/05/16


Agenda Item #


8.L.2 Request for Meeting: Committee on Mental Health and Information Technology Will the Joint Reference Committee approve extra support and funding for equipment and 3 hours of meeting space is reserved for the Committee on Mental Health Information Technology to meet during the October 2016 IPS meeting? The estimated cost is $700 for an LCD screen and projector. With several members planning to attend the IPS meeting this coming October, it would be beneficial to provide a space for members to meet to continue to drive their full agenda forward. (2016-2017 goals and project plans (i.e., Apps review tool, Electronic Decision Making Feasibility.) Funding is to cover the cost of LCD screen and projector, not to reimburse any members for travel.

The Joint Reference Committee approved the request for funding for equipment and 3 hours of meeting space for the Committee on Mental Health Information Technology to meet during the October 2016 IPS meeting at an estimated cost of $700. The costs will be taken from the budget of the Council on Quality Care.

Kristin Kroeger Nathan Tatro Shaun Snyder, JD Cathy Nash

Council on Quality Care Department of Meetings and Conventions

8.L.3 Request for Meeting: Clinical Decision Support Workgroup Will the Joint Reference Committee approve extra support and funding for equipment and 3 hours of meeting space is reserved for the Clinical Decision Support Workgroup at the October 2016 IPS meeting? The estimated cost is $700 for an LCD screen and projector. With several members planning to attend the IPS meeting this coming October, it would be beneficial to provide a space for members to meet face-to-face to begin discussion of feasibility of developing an APA clinical decision support tool. Funding is to cover the cost of the LCD screen and projector, not reimburse any members for travel. The funding will come from the Council’s budget.

The Joint Reference Committee approved the request for funding for equipment and 3 hours of meeting space for the Clinical Decision Support Workgroup to meeting during the October 2016 IPS at an estimated cost of $700. The costs will be taken from the budget of the Council on Quality Care.

Kristin Kroeger Nathan Tatro Shaun Snyder, JD Cathy Nash

Council on Quality Care Department of Meetings and Conventions


Agenda Item #


8.L.4 IPS Program: Inclusion of Innovation Lab Will the Joint Reference Committee recommend to the APA Administration that the successful Innovation Lab be repeated at IPS and expanded to a full-day activity (funding from external sponsors)? The Psychiatry Innovation Lab set the stage for the formation of innovative ideas and ventures that improve the delivery of mental health care. Cost of this event was estimated at $3,000, and while it has not been secured for the IPS, there are interested sources.

The Joint Reference Committee approved the request that the APA Administration repeat the Innovation Lab at the IPS in October 2016 and expand it to a full-day activity and seek outside funding from external sponsors. The APA Administration will report to the JRC in February 2017 the outcome of the Innovation Lab.

CEO/Medical Director’s Office

Report to Joint Reference Committee – February 2017 Deadline: 1/20/17

8.L.5 Resource Document: Assessment and Treatment of Gender Dysphoria and Gender Variant Patients: A Primer for Psychiatrists (please see attachment 1) Will the Joint Reference Committee approve the manuscript Assessment and Treatment of Gender Dysphoria and Gender Variant Patients: A Primer for Psychiatrists as a Resource Document of the APA?

The Joint Reference Committee approved the resource document entitled Assessment and Treatment of Gender Dysphoria and Gender Variant Patients: A Primer for Psychiatrists. In the event that the Council would like to publish the resource document, the JRC looks forward to receiving a request to seek outside publication.


Association Governance FYI: Board of Trustees – July 2016


Agenda Item #


8.L.6 Representatives to the Practice Guideline Writing Groups Will the Joint Reference Committee recommend to the Board of Trustees that a representative of the APA Committee on Performance Measurement be assigned to each APA Practice Guideline writing group? This assignment would assist the guideline writing groups with APA-member-experts in the area of performance measurement. By ensuring that accurate language and acknowledgement of quality improvement and performance measurement are included in the APA guidelines, the APA will continue to maintain ownership of what is an acceptable (or unacceptable) standard to measure.

The Joint Reference Committee referred the action to the CEO/Medical Director’s office to develop the necessary procedures for implementing this request as it relates to the COI vetting process and appointment process. The Joint Reference Committee recommended that the Board of Trustees approve a representative of the APA Committee on Performance Measurement be assigned to each APA Practice Guideline writing group.

Saul Levin, MD, MPA CEO/Medical Director Shaun Snyder, JD Margaret Cawley Dewar Ardell Lockerman

APA Administration Board of Trustees – July 2016

8.L.7 Referral Update – no action needed Ad Hoc Workgroup to Explore the Feasibility of Developing an Electronic Clinical Support Product (ASMNOV1512.E; JRCJAN166.3) In response to the request that the Council on Quality Care determine the feasibility of developing an electronic clinical support product (ASMNOV1512.E), a workgroup reporting to the CMHIT, who reports to the Council on Quality Care has begun working on this determination.


N/A


Agenda Item #


8.L.8 Referral Update – no action needed Systems to Coordinate Psychiatric Inpatient Bed Availability (ASMNOV1512.O; JRCJAN166.11) The Council wishes to inform the Joint Reference Committee of the findings of joint work between the Council on Quality Care and the Council on Healthcare Systems and Financing. These groups were tasked with considering Action paper 12.O, which asks for a review of existing models and programs of online registered psychiatric bed availability and presentation of their recommendations to develop and promote this approach to facilitating access to care. (please see attachment 2)


N/A

8.L.9 Referral Update – no action needed Reaffirm APA’s Adoption of the AMA’s 2010 Position Statement: Direct to Consumer (DTC) Advertising of Prescription Drugs and Implantable Devices (JRCJUL158.B.1; ASMNOV154.B.5; JRCJAN166.14) The Council wishes to inform the Joint Reference Committee of their decision to accept the language of the recently approved position statement by the Assembly (May 2016) of the statement on Direct to Consumer Advertising (JRCJAN16.6.14). Please see the explanation for the concurrent Joint Reference Committee Referral and Assembly Action Paper, attachment #3 Please see attachment #3A – the original action paper

The Joint Reference Committee thanked the Council for this update and noted that an action from the Assembly would be sent directly to the Board of Trustees at their July 2016 meeting.

N/A

8.M Council on Research Please see item 8.M for the Council’s report, summary of current activities and information items.


Agenda Item #


8.M.1 Position Statement: Mental Health and Climate Change (please see attachment 1) Will the Joint Reference Committee recommend that the Assembly approve the proposed Position Statement on Mental Health and Climate Change and if approved, forward it to the Board of Trustees for consideration?

The Joint Reference Committee recommended that the Assembly approve the proposed Position Statement: Mental Health and Climate Change and if approved, forward it to the Board of Trustees for consideration



8.M.2 Resource Document: Mental Health and Climate Change (please see attachment 2) Will the Joint Reference Committee approve the Resource Document Mental Health and Climate Change? In January 2016, the Committee on Psychiatric Dimensions of Disaster (CPDD) was charged by the JRC to develop a position statement on the psychiatric impact of climate change. This charge stemmed from an action paper passed at the May 2015 Assembly entitled “The Impact of Global Climate Change on Mental Health.” The CPDD met with the authors of the action paper and APA members with interest and expertise in the subject during a March 2016 conference call and again during the APA Annual Meeting in May to finalize a draft position statement (Attachment1) and resource document (attachment 2), which was presented to and approved by the Council on Research.

The Joint Reference Committee approved the resource document entitled Mental Health and Climate Change.




Agenda Item #


8.M.3.a Resource Document: “Clinical Guidance on the Use of Ketamine in the Treatment of Mood Disorders: A Review of Related Literature to Date” (please see attachment 3) Will the Joint Reference Committee approve the resource document entitled Clinical Guidance on the Use of Ketamine in the Treatment of Mood Disorders: A Review of Related Literature to Date? This paper was created with authorship from the Council on Research’s Workgroup on Diagnostic and Treatment Markers and has been endorsed by the Council.

The Joint Reference Committee approved the resource document entitled Clinical Guidance on the Use of Ketamine in the Treatment of Mood Disorders: A Review of Related Literature to Date.



8.M.3.b Request to Publish: Resource Document Entitled: Clinical Guidance on the Use of Ketamine in the Treatment of Mood Disorders: A Review of Related Literature to Date Will the Joint Reference Committee recommend that the Board of Trustees approve granting permission to the authors to submit for publication to a high profile general medical journal (e.g., NEJM) the resource document entitled Clinical Guidance on the Use of Ketamine in the Treatment of Mood Disorders: A Review of Related Literature to Date?

The Joint Reference Committee recommended that the Board of Trustees approve granting permission to the authors to submit for publication to a high profile general medical journal (e.g., NEJM) the resource document entitled Clinical Guidance on the Use of Ketamine in the Treatment of Mood Disorders: A Review of Related Literature to Date?




Agenda Item #


8.M.4 Request to Publish: Manuscript entitled S-Adenosylmethionine (SAMe) for Neuropsychiatric Disorders: A Clinician-Oriented Review of Research (please see attachment 4) Will the Joint Reference Committee recommend that the Board of Trustees approve the submission of the Council on Research’s review article S-Adenosylmethionine (SAMe) for Neuropsychiatric Disorders: A Clinician-Oriented Review of Research to the American Journal of Psychiatry for publication? This article was developed primarily by members of the APA Caucus on Complementary and Alternative Medicine in collaboration with the Council on Research’s Workgroup on Diagnostic Treatment Markers. The authors would like to submit this manuscript to the AJP and await the JRC’s approval. This version of the SAMe manuscript incorporates revisions from the Council on Research, specifically to include the latest AJP reference on nutraceuticals as adjuncts for depression.

The Joint Reference Committee recommended that the Board of Trustees approve the submission of the Council on Research’s review article S-Adenosylmethionine (SAMe) for Neuropsychiatric Disorders: A Clinician-Oriented Review of Research to the American Journal of Psychiatry, or another APA journal, for publication.



9 Old Business – 2016 Jacob Javits Award Will the Joint Reference Committee recommend that the Board of Trustees approve the 2016 Jacob Javits Award nominee, US Representative Tim Murphy (R-PA)?

The Joint Reference Committee reviewed the request to recommend the 2016 Jacob Javits Award nominee, and voted to defer action on this item until the October 2016 Joint Reference Committee meeting.

Shaun Snyder, JD Margaret Cawley Dewar

Report to JRC – October 2016 Deadline: 10/05/16 FYI – Council on Advocacy and Government Relations

Item 2015A2 12.A

Assembly October 30-November 1, 2015

ACTION PAPER

FINAL TITLE: Access to Care Provided by the Department of Veterans Affairs WHEREAS: Whereas, The Department of Veterans Affairs’ (VA) mandate, as first articulated by President Lincoln, in his Second Inaugural Address, is to:

“Care for him who shall have borne the battle and for his widow, and his orphan.”

Whereas, with these words, rendered more than a century ago, President Lincoln affirmed the government’s obligation to care for those injured during war and to provide for the families of those who perished on the battlefield, Whereas, veteran access to Psychiatric Care, continues to be inadequate, according to the August 20152 and September 20151 Inspector General of the Department of Veterans Affairs reports, and the listings of vacancies in USAJOBS.GOV for available psychiatrist positions. Whereas, many long-time employed VA psychiatrists, under the current pay structure, are often paid less than new hires based on personal knowledge and survey data from the VA Caucus members. Whereas, new hires with loan repayment obligations have limited access to receiving loan forgiveness based on length of employment with the VA compared to those employed by other federal agencies. BE IT RESOLVED: That the APA support any and all clinical activities that can improve the mental health care and treatment of veterans. That the APA correspond with the Secretary of the VA, Robert MacDonald, to actively solicit his support for arranging for fairness in pay for those physician-psychiatrists with more seniority and more administrative responsibility and for those physician-psychiatrists initially entering VA service with educational loans. That the APA actively support and advocate for Congressional appropriations for the loan repayment program provision of the Clay Hunt Suicide Prevention for American Veterans Act also known as the Clay Hunt SAV Act which is intended to funds mental health care and suicide prevention programs within the VA. AUTHORS: Harold Ginzburg, M.D., J.D., M.P.H., Representative, Oklahoma Psychiatric Physicians Association Jenny L. Boyer, M.D., J.D., Ph.D., Immediate Past Speaker

ESTIMATED COST: Author: $2,940 APA: $4,106.67 ESTIMATED SAVINGS: none ESTIMATED REVENUE GENERATED: More psychiatrists working for the VA would mean more potential members of APA and VA Caucus. ENDORSED BY: Area 5 KEY WORDS: Department of Veterans Affairs, Access to Care APA STRATEGIC PRIORITIES: Advancing Psychiatry, Education, Diversity REVIEWED BY RELEVANT APA COMPONENT: Council on Advocacy and Government Relations REFERENCES:

1. Report No. 15-03063-511, OIG Determination of Veterans Health Administration’s Occupational Staffing Shortages, September 1, 2015.

2. Report 13-03917-487, OIG Report, Audit of VHA’s Efforts To Improve Veteran’s Access to Outpatient Psychiatrists August 25, 2015.

Report to the Assembly Executive Committee – July 2016 Access to Care Provided by the Department of Veterans Affairs The following information is being provided as directed by the Joint Reference Committee. The JRC requested for the Council on Advocacy and Government Relations to submit a written report identifying specific concerns related to the Council’s recommendation on the aforementioned Action Paper. Below are meeting minutes compiled from two discussions held by the Council. I. First Review of Pre-Submitted Action Paper (September 2015)

In advance of submitting the Action Paper to the Assembly, in fall 2015, the authors requested the Council to review and offer substantive feedback. Prior to the September Component Meeting, APA Administration solicited feedback from Council members to share with the author. Giving members an additional period to comment on the Action Paper entitled, “Access to Care Provided by the Veterans Administration,” the Council reviewed and discussed the document during the fall meeting. As a coauthor to the Action Paper, Dr. Boyer spoke to the frequency of pay inequity among VA psychiatric physicians, particularly the more senior staff in comparison to the new hires. Council members called for more detail on the issue to be included in the Action Paper.

One member offered a direct suggestion for the authors to reference a recent Medscape report on medical school debt. She also stressed that the current pay rate in California VA facilities was not comparable to the amount of debt accumulated out of medical school.

A member spoke in strong support of the Action Paper. However, indicated they would like to see more defined details as to how they propose to change the current pay and loan repayment systems, in order to reach their goals.

A member spoke in support the first Resolve, to which APA would write a letter to Secretary McDonald for fairness in pay for senior psychiatrists as well as for new hires. However, they would not support APA to request a study of why VA loan repayment programs are not adequately supported. The VA bureaucracy is largely to blame for this; e.g., our local VA facility said there was no money available for loan repayments, whereas the network (VISN) indicated that only about 1 % of the loan repayment money the VISN held had been requested by the facilities.

A member suggested the issue of loan repayment for VA psychiatrists is a subject of recent APA lobbying efforts, should first be directed to APA Gov’t Relations staff to provide an update/progress report to both CAGR and the Assembly. This was a recent effort and it may be early too have seen much change.

From the discussion, the Council agreed they could not support the Action Paper as currently drafted. They recommended including facts on additional areas, such as:

Measures of school debt versus loan forgiveness repayment;

The varying loan forgiveness allocations in each state; and

Increasing physician’s compensation. II. Second Review of Action Paper (May 2016)

In the June 2016 report to the Joint Reference Committee, the Council on Advocacy and Government Relations (CAGR) provided a recommendation on the Action Paper, “Access to Care Provided by the Department of Veterans Affairs.” As directed through the January JRC summary of actions, the Council discussed and considered the recommended actions and the political aspects of the Action Paper. Through a majority vote, it was recommended the Action Paper not move forward. The Council proposed the Action Paper be returned to the author for review and to incorporate substantive changes as previously recommended by the Council. (DISCUSSED VIA FEBRUARY CONFERENCE CALL) Prior to the Council’s monthly conference call, Chairman Dr. Barry Perlman requested APA Administration to solicit feedback from Council members regarding the paper. Members were vocal in not supporting the Action Paper as written.

Drs. Koh and Lowenthal noted the author had not incorporated any changes or additions suggested by the Council upon the initial discussion at the September Component Meeting.

Dr. Koss acknowledged the Action Paper addresses a very important issue for both member and patient advocacy. As did Dr. Zarling, recognizing that the Action Paper supports both recruitment issues for the VA as well as member advocacy.

Dr. Malveaux identified minor adjustments had been added to the original document, including the mention of the loan repayment-debt reduction program. However, the Action Paper remains ambiguous in what the actions propose to do. Nor is there mention of the recommended data from the Medscape article suggested during the Council’s meeting.

Dr. Perlman agreed the Action Paper is still non-specific. Dr. Boyer, co-author of the Action Paper, described the objective of the paper as a means to address how the APA can identify and undertake these issues in the VA health care system. She emphasized the Council should consider recommending APA to move forward in implementing second Resolve, because APA Administration is actively advocating to the third Resolve. Dr. Perlman emphasized the Council had discussed the Action Paper prior to submitting to the November Assembly, and it is evident the suggested changes were not incorporated. It was moved and seconded to not support the Action Paper as written. By a voice vote, the Council (majority) voted to not support the Action Paper. Dr. Perlman acknowledged Dr. Boyer’s vote to support the Action Paper.

Assembly May 13-15, 2016 Atlanta, Georgia DRAFT SUMMARY OF ACTIONS

Agenda Item #

Action Comments/Recommendations Governance Referral/Follow-up

2016 A1 1.A.1

Ratification of APA Bylaws: Ratification of the Board-approved language of the International Resident-Fellow Member Category to be incorporated into the APA bylaws

The Assembly voted to ratify the Board-approved language of the International Resident-Fellow Member Category to be incorporated into the APA bylaws.


Association Governance Chief Membership & RFM-ECP Officer

Membership FYI- Board of Trustees, July 2016

2016 A1 4.B.1

Proposed Position Statement: Integrating Opioid Use Disorders Treatment with Buprenorphine and Naltrexone with that of Co-Occurring Mental Illnesses

The Assembly voted, on its Consent Calendar, to approve the Proposed Position Statement: Integrating Opioid Use Disorders Treatment with Buprenorphine and Naltrexone with that of Co-Occurring Mental Illnesses.

Board of Trustees, July 2016 FYI- Joint Reference Committee, June 2016 [Update: The Board of Trustees voted to approve the position statement.]

2016 A1 4.B.2

Revised Position Statement: The Role of Psychiatrists in Assessing Driving Ability

The Assembly voted, on its Consent Calendar, to approve the Revised Position Statement: The Role of Psychiatrists in Assessing Driving Ability.


2016 A1 4.B.3

Proposed Position Statement: Patient Access to Electronic Mental Health Records

The Assembly voted, on its Consent Calendar, to approve the Proposed Position Statement: Patient Access to Electronic Mental Health Records.


2016 A1 4.B.4

Proposed Position Statement: Trial and Sentencing of Juveniles in the Criminal Justice System

The Assembly voted, on its Consent Calendar, to approve the Proposed Position Statement: Trial and Sentencing of Juveniles in the Criminal Justice System.


2016 A1 4.B.5

Retire 2005 Position Statement: Adjudication of Youths as Adults in the Criminal Justice System

The Assembly voted, on its Consent Calendar, to approve the retirement of the 2005 Position Statement: Adjudication of Youths as Adults in the Criminal Justice System.


2016 A1 4.B.6

Retire Position Statement: Infectious Disease Epidemics Including H1N1

The Assembly voted, on its Consent Calendar, to approve the retirement of the Position Statement: Infectious Disease Epidemics Including H1N1.


2016 A1 4.B.7

Revised Position Statement: Sexual Harassment

The Assembly voted, on its Consent Calendar, to approve the Revised Position Statement: Sexual Harassment.


Agenda Item #


2016 A1 4.B.8

Proposed Position Statement: Equitable Access to Quality Medical Care for Substance Related Disorders

The Assembly voted, on its Consent Calendar, to approve the Proposed Position Statement: Equitable Access to Quality Medical Care for Substance Related Disorders.


2016 A1 4.B.9

Retain Position Statement: Any Willing Physician

The Assembly voted, on its Consent Calendar, to retain the Position Statement: Any Willing Physician.


2016 A1 4.B.10

Revised Position Statement: Psychiatric Hospitalization of Children and Adolescents

The Assembly voted, on its Consent Calendar, to approve the Revised Position Statement: Psychiatric Hospitalization of Children and Adolescents.


2016 A1 4.B.11

Proposed Position Statement: Integrated Care

The Assembly voted, on its Consent Calendar, to approve the Proposed Position Statement: Integrated Care.


2016 A1 4.B.12

Proposed Position Statement: Off-Label Treatments

The Assembly voted to approve the Proposed Position Statement: Off-Label Treatments.


2016 A1 4.B.13

Retire Position Statement: Patient Access to Treatments Prescribed by Their Physicians

The Assembly voted to approve the retirement of the Position Statement: Patient Access to Treatments Prescribed by Their Physicians.


2016 A1 4.B.14

Proposed Position Statement: The Call to Action: Accountability for Persons with Serious Mental Illness

The Assembly voted, on its Consent Calendar, to approve the Proposed Position Statement: The Call to Action: Accountability for Persons with Serious Mental Illness.

Board of Trustees, July 2016 FYI- Joint Reference Committee, June 2016 [Update: The Board of Trustees voted to approve the Proposed Position Statement: The Call to Action: Accountability for Persons with Serious Mental Illness as amended below. Ensuring appropriate treatment, rehabilitation, and opportunities for recovery of persons with serious mental illness is a public health responsibility. Federal, state, and local governments must be accountable for ensuring access to comprehensive assessment, treatment, and evidence-based care and evidence based treatments. Psychiatrists have a unique role and responsibility for developing strategies to address these challenges.]

Agenda Item #


2016 A1 4.B.15

Retire Position Statement: A Call to Action for the Chronic Mental Patient

The Assembly voted, on its Consent Calendar, to approve the retirement of the Position Statement: A Call to Action for the Chronic Mental Patient.


2015 A1 4.B.16

Proposed Position Statement: College and University Mental Health

The Assembly voted, on its Consent Calendar, to approve the Proposed Position Statement: College and University Mental Health.


2016 A1 4.B.17

Retire Position Statement: College and University Mental Health

The Assembly voted, on its Consent Calendar, to approve the retirement of the Position Statement: College and University Mental Health.


2016 A1 4.B.18

Retain Position Statement: Policy on Conflicts of Interest Principles and Guidelines: With Special Interest for Clinical Practice and Research

The Assembly voted to retain the Position Statement: Policy on Conflicts of Interest Principles and Guidelines: With Special Interest for Clinical Practice and Research.


2016 A1 4.B.19

Proposed Position Statement: Emergency Department Boarding of Patients with Acute Mental Illness

The Assembly voted, on its Consent Calendar, to approve the Proposed Position Statement: Emergency Department Boarding of Patients with Acute Mental Illness.

Board of Trustees, July 2016 FYI- Joint Reference Committee, June 2016 [Update: The Board of Trustees voted to approve the position statement only of the Proposed Position Statement: Emergency Department Boarding of Patients with Acute Mental Illness. The Board of Trustees voted to refer the “Issue” section of the document back to the Joint Reference Committee to consider possible subsequent revision.]

2016 A1 5.A

Will the Assembly vote to approve the minutes of the October 30-November 1, 2015 meeting?

The Assembly voted to approve the Minutes & Summary of Actions from the October 30-November 1, 2015 meeting.



2016 A1 6.B

Will the Assembly vote to approve the Consent Calendar?

Items 2016A1 4.B.18, 12.BB and 12.FF were removed from the Consent Calendar. The Assembly approved the Consent Calendar as amended.



2016 A1 6.C

Will the Assembly vote to approve the Special Rules of the Assembly?

The Assembly voted to approve the Special Rules of the Assembly.



2016 A1 7.A

2016-2017 Election of Assembly Officers

The Assembly voted to elect the following candidates as officers of the Assembly from May 2016 to May 2017: Speaker-Elect: Theresa Miskimen, M.D. Recorder: James R. Batterson, M.D.



Agenda Item #


2016 A1 7.B.1

Will the Assembly vote to approve the recommended amendment to Article IV of the Assembly Procedural Code incorporating the minimum requirement to be included in the governing documents of the M/UR caucuses to align with changes to the District of Columbia’s “The Non-profit Corporation Act of 2010”?

The Assembly voted to approve the recommended amendment to Article IV of the Assembly Procedural Code incorporating the minimum requirement to be included in the governing documents of the M/UR caucuses to align with changes to the District of Columbia’s “The Non-profit Corporation Act of 2010”.



2016 A1 7.B.2

Will the Assembly vote to approve the proposed language to incorporate the approved Action Paper 12.B: Directions to the Area Nominating Committees in the Assembly Procedural Code, allowing Areas latitude to nominate more than two candidates?

The Assembly voted to approve the proposed language to incorporate the approved Action Paper 12.B: Directions to the Area Nominating Committees in the Assembly Procedural Code, allowing Areas latitude to nominate more than two candidates.



2016 A1 7.B.3

Will the Assembly vote to approve the proposed language to incorporate the approved Action Paper 12.T: Election of Assembly Officers in the Assembly Procedural Code, making the election of Assembly Officers based on a majority of votes with each member of the Assembly casting one vote?

The Assembly voted to postpone this action item until the November, 2016 Assembly meeting.

Assembly, November 2016 Chief Operating Officer


2016 A1 7.B.4

Will the Assembly vote to approve the proposed language in the Assembly Procedural Code, disallowing dual representative roles of APA members serving on both the Board of Trustees and the Assembly?

The Assembly voted to approve the proposed language in the Assembly Procedural Code, disallowing dual representative roles of APA members serving on both the Board of Trustees and the Assembly



2016 A1 12.A

Performance in Practice Certification by the American Psychiatric Association

The Assembly voted to approve action paper 2016A1 12.A, which asks the APA Division of Education along with the Council on Medical Education and Lifelong Learning explore the possibility of the APA creating a program whereby the currently existing products that satisfy MOC requirements such as PIPs, Self-Assessment CME and the safety course be packaged together and if required elements are met, the physician would receive a certificate recognizing participation in the program. The certificate could be used by the member to satisfy Part 4 of MOC if they are participating in MOC or used to prove participation in quality improvement for federal reimbursement if not participating in MOC.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper to the Council on Medical Education and Lifelong Learning and requested a report back to the JRC in October 2016.]

2016 A1 12.B

Standards for Inpatient Psychiatric Care

The Assembly voted to approve action paper 2016A1 12.B, which asks that the APA Council on Quality Care explore the APA developing a practice guideline for inpatient psychiatric care. The Council will report back to the Assembly by the May 2017 Assembly meeting.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper to the Council on Quality Care and requested a report in October 2016.]

Agenda Item #


2016 A1 12.C

APA Position Statement on Mental Health Hotlines

The Assembly voted to approve action paper 2016A1 12.C, which asks the Council on Quality Care to develop a Position Statement presenting minimum uniform standards for mental health hotlines in the United States and Canada and to present such Position Statement to the Assembly during the November 2016 meeting for approval.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper to the Council on Quality Care (LEAD) and the Council on Communications and requested a report in October 2016.]

2016 A1 12.D

Position Statement on Migrant and Refugee Crisis around the World

The Assembly voted to approve action paper 2016A1 12.D, which asks that the appropriate component of the APA develop a position statement on the mental health impact of the migrant and refugee crisis in time for review at the Assembly meeting in the fall of 2016. The APA supports the intent and sentiment as expressed by The World Association of Cultural Psychiatry’s Call for Action on the Position Statement Migrant Crisis Around the World.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper to the Council on Minority Mental Health and Health Disparities (LEAD), the Council on International Psychiatry, the Council on Psychiatry and Law and the Council on Children, Adolescents and Their Families. The Councils are asked to develop a position statement as noted in the action paper and to include legal and human rights perspectives.]

2016 A1 12.E

Eliminate Federal Parity Opt-Out

The Assembly voted, on its Consent Calendar, to approve action paper 2016A1 12.E, which asks that the American Psychiatric Association lobby for elimination of the federal "opt-out" provisions so that self-funded, nonfederal governmental health plans are no longer permitted to opt-out of parity, ensuring that all health insurance plans are subject to the same parity requirements.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred action paper to the Department of Government Affairs and the Department of Parity Implementation and Enforcement Policy. The JRC requested that a report on the APA’s current “opt-out” lobbying activities be provided to the Assembly in November 2016.]

2016 A1 12.F

Making Access to Treatment for Erectile Disorder Available Under Medicare

The Assembly voted, on its Consent Calendar, to approve action paper 2016A1 12.F, which asks that the APA seek to collaborate with other medical societies, including the American Urological Assoc., AMA, etc., as well as organizations devoted to advocacy for those with illness which may result in Erectile Disorder to assure access to a full range of evidence based pharmaceutical, mechanical and surgical treatment options for dealing with Erectile Disorder in a cost effective manner. That the Council on Advocacy and Government Relations and the Council on Healthcare Systems and Financing advocate, along with other professional societies and advocacy groups, for legislation to allow access to the full array of medications, mechanical therapies, and other treatments for Erectile Disorder which are currently excluded from coverage under Medicare.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper to the Council on Government Relations (LEAD) and the Council on Healthcare Systems and Financing. The councils were asked to broaden the scope of the action paper to include all sexual side effects regardless of gender and provide a report by October 2016.]

2016 A1 12.G

Providing Recordings of Individual Presentations from the APA Annual Meeting

The Assembly voted to approve action paper 2016A1 12.G, which asks that the APA Board of Trustees direct the appropriate component and/or staff department to require that any Annual Meeting recording vendors it engages make available for purchase both individual session recordings as well as recordings of the Meeting as a whole.

Joint Reference Committee, June 2016 Chief of Policy, Programs & Partnerships

Education [Update: The Joint Reference Committee referred the action paper to the Division of Education. The Division of Education is asked to develop an analysis of the pros and cons of providing this service and recommendations for potential alternatives and report back to the JRC in October.]

Agenda Item #


2016 A1 12.H

Third Party Coverage of Medication Found to Be Beneficial to an Individual Patient

The Assembly voted to approve action paper 2016A1 12.H, which asks that the APA instruct its delegation to the American Medical Association House of Delegates to promulgate and promote legislation mandating that health insurance companies be required to provide coverage of a particular patient’s ongoing costs for the purchase and use of any medication and its dose and schedule from which that patient has empirically experienced two months or more of continuous benefit with respect to a particular condition, regardless of the FDA’s stated indications for that medication’s use.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper Third Party Coverage of Medication Found to be Beneficial to an Individual Patient (ASMMAY1612.H) to the Council on Healthcare Systems and Financing. The Council is asked to review the current policies on this issue and provide a report to the JRC in February 2017. The JRC will consider the report from the Council and determine next steps, which may include referral to the APA AMA Delegation.]

2016 A1 12.I

Pharmacists Substituting Medications with Similar Mechanisms of Action

The Assembly voted to approve action paper 2016A1 12.I, which asks that the Joint Reference Committee refer this Action to the Council on Quality Care and Council on Advocacy and Government Relations re: scope of practice issues to update the APA’s 2009 "Position Statement on Medication Substitutions,” incorporating such considerations as “therapeutic class” and/or “mechanisms of action,” and to present the draft Position Statement to the Assembly in May, 2017. That among these considerations be included the following concerns: There are vast inter-individual differences in genetics and biology. Medications may be lumped together and described as a “therapeutic class,” but which are not therapeutically equivalent as there are frequently significant differences in metabolic pathways, drug interactions, multiple receptor actions and adverse reactions.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper to the Council on Quality Care (LEAD), Council on Healthcare Systems and Financing and the Council on Advocacy and Government Relations. The JRC requests the identified councils (Quality Care, Healthcare Systems and Financing, Advocacy and Government Relations) communicate and provide reports back in October 2016. At that time, the JRC will determine what additional action is indicated.]

2016 A1 12.J

Eliminate Out Of Pocket Cost Barriers to Care for Patients with Serious and Recurrent Disabling Mental Disorders

The Assembly voted to approve action paper 2016A1 12.J, which asks: 1. That APA will develop a Position Statement through the Council on Health Care Systems and Financing, asserting that Care Managing Entities, public and private, should waive or minimize co-pays, deductibles and share of costs for patients with serious, recurrent or disabling mental disorders including child, adolescent and adult patient populations, (this is based on development of a Position Statement) and; 2. That the APA will advocate through legislative and regulatory lobbying and state legislative outreach, and; 3. That the APA, through its AMA delegation, advocate for a similar resolution for all patients with serious, recurrent or disabling illness.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper first to the Council on Healthcare Systems and Financing to draft a position statement (item #1). The JRC requests a draft position statement from the Council for review at the JRC February 2017 meeting. The JRC will then determine, based on the outcome of the report from the council, next steps which could include referral to the Council on Advocacy and Government Relations for advocacy efforts and to the APA AMA Delegation.]

2016 A1 12. K

Coding Suicidal Ideation The action paper was withdrawn by the author.

N/A

2016 A1 12.L

Exercise: Too Little, Too Much The action paper was withdrawn by the author.

N/A

2016 A1 12.M

Inclusion of Racism in ICD-10-CM and DSM 5

The action paper was withdrawn by the author. N/A

Agenda Item #


2016 A1 12.N

Improving Electronic Medical Record (EMR) Psychiatric Documentation

The Assembly voted to approve action paper 2016A1 12.N, which asks that the APA will take action to facilitate the improvement of efficiency and quality of Electronic Medical Records and psychiatric documentation. The APA will explore developing specific and practical templates to improve clinical utility. The issue should be referred to the Committee on Mental Health Information Technology, Assembly Executive Committee and the Board of Trustees for further consideration.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred action paper to the Council on Quality Care and its Committee on Mental Health Information Technology with reports back to JRC in October 2016.]

2016 A1 12.O

Direct to Consumer Advertising

The Assembly voted to approve action paper 2016A1 12.O, which asks that: 1. The American Psychiatric Association shall sunset: Position Statement on Direct-to-Consumer (DTC) Advertising of Prescription Drugs and Implantable Devices Adoption of AMA Policy H-105.988, approved 2010. 2. The American Psychiatric Association shall adopt the Position Statement on Direct to Consumer Advertising, 2016. 3.The Speaker shall report out this Action Paper to the Board of Trustees (BOT) for action by the Board of Trustees at the next BOT meeting.[Vote on the referral to the BOT for consideration – July 2016: APPROVED]

Board of Trustees, July 2016 [Update: The Board of Trustees voted to approve action paper 12.O: Direct to Consumer Advertising.]

2016 A1 12.P

Improving the Efficacy of Prescription Drug Monitoring Programs

The Assembly voted to approve action paper 2016A1 12.P, which asks that the American Psychiatric Association support the inclusion of methadone and buprenorphine dispensed or prescribed from opioid treatment programs in all Prescription Drug Monitoring Programs in an effort to decrease the risk of serious drug interactions, overdose, and death.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper to the Council on Addiction Psychiatry (LEAD) and the Council on Healthcare Systems and Financing, and also to the Council on Psychiatry and Law for a review of the HIPAA and confidentiality issues. A report is requested in October 2016.]

2016 A1 12.Q

Develop an APA Resource Document on the Use of Patient Information Discovered in Targeted Internet or Social Media Searches in Various Practice Settings

The Assembly voted to approve action paper 2016A1 12.Q, which asks that the APA assist the Ethics Committee or an ad hoc work group appointed with representation from various components of the APA (e.g., Ethics, Psychiatry and Law, Communications, etc.) in developing a detailed resource document on patient targeted internet and social media searches to provide guidance on when (if) and how to use the internet and social media clinically, and disseminate the position statement to its members. Finally, that the work group develop a resource document, and include at least two resident and /or early career psychiatrist consultants to assist in developing this resource document, as there may be generational differences in the thinking and approach to patient targeted internet and social media searches.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred action paper to the Ethics Committee, the Council on Psychiatry and Law and the Office of Communications with a report due in October 2016.]

Agenda Item #


2016 A1 12.R

Encouragement of Senior Psychiatrists to Maintain Active Membership in APA

The Assembly voted to approve action paper 2016A1 12.R, which asks: The APA Membership Division to look back over their records for the last 5 years and determine: 1. The percentage of psychiatrists over the age of 55 who resign, fail to renew membership, or request Inactive Status 2. The percentage of psychiatrists who reach Life status who do not continue to renew membership until their 11th year of Life status, either by attrition or by death 3. How the loss of these members’ dues revenues currently impacts the functioning of the APA and whether it would be worth changing the structure of the dues formula to charging Life Members in years 1-3 to two-thirds of dues and 4-6 to one third of dues and making the 7th year on as free membership. This would almost certainly be useful in maintaining more senior members as it would mean 4 less years of dues that need to be paid. Continuing their membership would generate more income when they continue to participate in APA meetings as qualified members, rather than not participating. 4. The Membership Committee, following its review, will recommend the appropriate action or ask for further study to the JRC/Board of Trustees or Assembly with a report back to the Assembly by May 2017.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper to the Membership Department and requests that the Membership Committee communicate to the Assembly its report on Senior Psychiatrists to the Assembly.]

2016 A1 12.S

Enhancing Ethical Knowledge of APA Members

The Assembly voted to approve action paper 2016A1 12.S, which asks: The APA supports the importance of ethics by recommending continuing medical education in ethics. The APA offers identified ethics content at its Annual Meeting each year. The APA offer an educational activity that can be performed online for credit with an ethical focus and that this activity be offered for free to members as one of the monthly free courses offered online and that this course be updated at least every 2 years.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper to the APA Administration and requested that a report on the current ethics education activities underway at the APA be submitted in October 2016.]

Agenda Item #


2016 A1 12.T

Protecting Senior Psychiatrists from Mandatory Competency Testing

The Assembly voted to approve action paper 2016A1 12.T, which asks that: 1. The Council on Medical Education and Lifelong Learning

A. Identify the best interests of psychiatrists who may be subject to mandatory competency testing.

B. Consider developing informational and support

resources for members who face mandatory competency testing, similar to the information and support the AMA provides its members but more specific to psychiatrists.

2. The Delegation to the American Medical Association collaborate with the AMA to ensure psychiatrists’ best interests are represented in AMA activities that are related to mandatory competency testing. 3. The Council on Advocacy and Government Relations

A. Advocate the interests of psychiatrists as proposals for state and federal regulations related to mandatory competency testing of physicians are being considered.

B. Collaborate with the American Medical Association

to ensure the interests of psychiatrists are represented in current and future guidelines for physicians competency testing.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred action paper to the APA Administration and requested that the AMA’s position on this issue be determined and reported to the JRC when it becomes available. The JRC will then determine the best course of action.]

2016 A1 12.U

Psychiatrist Involvement in Medical Euthanasia and Physician-assisted Suicide of the Non Terminally Ill

The Assembly voted to approve action paper 2016A1 12.U, which asks that the Board of Trustees of the American Psychiatric Association adopt the following position statement: “The American Psychiatric Association holds that a psychiatrist should not deliberately prescribe or administer any intervention to a non-terminally ill person for the purpose of causing death.”

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper to the Council on Psychiatry and Law.]

2016 A1 12.V

A Psychiatric Response to Human Trafficking

The Assembly voted, on its Consent Calendar, to approve action paper 2016A1 12.V, which asks that the American Psychiatric Association write a position statement acknowledging human trafficking as a public health issue which impacts the mental health of its victims and advocating for improved research and education surrounding issues of identifying victims and treating their mental health needs.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper to the Division of Diversity and Health Equity (LEAD), the Council on International Psychiatry. Council on Children, Adolescents and Their Families. The Council on Psychiatry and Law is included in the referral as the issue may also pertain to asylum and refugee issues. A report is requested for the October 2016 JRC meeting.]

2016 A1 12.W

APA Takes a Neutral Stand on Physician Aid in Dying

The Assembly did not approve action paper 2016A1 12.W. N/A

2016 A1 12.X

Disapproval of the Detention of Central American Asylum Seeking Children and Families in Need of International Protection

The Assembly voted to approve action paper 2016A1 12.X, which asks that the APA reaffirm its position statements on “Detained Immigrants with Mental Illness” and “Xenophobia, Immigration, and Mental Health”. The APA strongly supports efforts to provide access to mental health services for children and families seeking asylum.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper to the Council on International Psychiatry, the Council on Children, Adolescents and Their Families and the Division of Diversity and Health Equity no later than the JRC meeting in October 2016.]

Agenda Item #


2016 A1 12.Y

Develop an APA Resource Document Regarding the Ethical Tensions Faced by Psychiatrists Serving as Third Party Utilization Management Reviewers under the Parity Law

The Assembly voted to approve action paper 2016A1 12.Y, which asks: 1. That the Board of Trustees shall create an ad hoc committee to develop a resource document to educate and inform psychiatrists about the competing ethical tensions faced by psychiatrists serving as managed care utilization reviewers, or as managed care medical directors developing utilization review management standards. 2. The committee shall include members of the Council on Healthcare Systems and Finance, the Committee on Managed Care, psychiatrist ethicists familiar with the 2015 Commentary on Ethics in Practice, at least one member of the Assembly, and a member of the Ethics Committee or their designee. 3. The resource document shall define and elaborate the ethical tensions, described in the 2015 APA Commentary on Ethics in Practice under Topic 3.4.1, that are encountered by psychiatrist utilization management reviewers and managed care medical directors, with special regard to the implications of the parity law on these tensions.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper to the Ethics Committee (LEAD) and the Council on Healthcare Systems and Financing. A report to the JRC is requested for October 2016.]

2016 A1 12.Z

US Joint Statement on Conversion Therapy

The Assembly voted, on its Consent Calendar, to approve action paper 2016A1 12.Z, which asks that the American Psychiatric Association sign on as a signatory to the US Joint Statement on Conversion Therapy which cautions mental health professionals that conversion or change therapies for Lesbian, Gay, Bisexual and Transgendered patients are unethical and embody a risk of harm to those patients.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred action paper to the APA Administration for a review of the implications if the APA were to become a signatory on the Joint Statement. The Council on Minority Mental Health and Health Disparities was referred the action paper for follow-up on these issues. The Joint Reference Committee recommended that the Board of Trustees approve the APA including “T” for “Transgender” and “Q” for “Questioning/Queer” in the acronym LGBT in all APA communications.]

2016 A1 12.AA

Enhancing the Retention of Resident Fellow Members (RFMs) Who Have Received APA Funding Following the End of their Terms

The Assembly did not approve action paper 2016A1 12.AA. N/A

2016 A1 12.BB

Utilization of DSM-5 Terminology in APA Publications and Communications

The Assembly voted to approve action paper 2016A1 12.BB, which asks that the American Psychiatric Association will make every effort to see that every new program, publication, and public communication utilizes up-to-date-language that reflects DSM-5.

Joint Reference Committee, June 2016 [Update: The Joint Reference Committee referred the action paper to the Division of Communications for implementation.]

Agenda Item #


2016 A1 12.CC

Increasing the Opportunity for Involvement of Resident Fellow Members (RFMs) and Early Career Psychiatrists (ECPs) in the APA Assembly

The Assembly voted to approve action paper 2016A1 12.CC, which asks: That a description of the Area ECP Rep/Dep be posted and clearly articulated on the APA website and That the Area ECP Rep/and Dep Rep position be advertised in the Member Benefit area of the website (in addition to other areas within the website), so as to promote engagement of the member in the organization as a benefit to the ECP member, which will ultimately boost membership. That the basic application for Area RFM Rep/Dep Rep and Area ECP Rep/and Dep Rep would be available for download on the APA website. That the Assembly Procedures Committee create a uniform application process for all Area RFM and ECP Dep Rep positions. This would not prevent Area Councils from having additional requirements. That the APA use the AADPRT listserv of Program Directors to target new faculty members that are recent graduates, so that information can be further distributed to more ECPs. That the Chief-Resident listserv be used as a way to spread information to about-to-become ECPs on opportunities for Area ECP Rep/Dep Rep positions.

Chief Membership, RFM & ECP Officer Assembly Executive Committee, July 2016

2016 A1 12.DD

Allow Deputies to Vote The Assembly voted to refer action paper 2016A1 12.DD, which asks that the Assembly allows its elected Deputies to vote, to the Assembly Committee on Procedures.

Assembly Executive Committee, July 2016

2016 A1 12.EE

Increasing Members’ Involvement in APA Policy

The action paper was withdrawn by the author. N/A

2016 A1 12.FF

APA Referendum Voting Procedure

The Assembly voted to approve action paper 2016A1 12.FF, which asks that the American Psychiatric Association distribute the ballot for referendum, the ballot for officers, polls on issues identified by the Assembly and the yearly dues statement concurrently, by both paper and electronic media at the members’ choice.

Joint Reference Committee, June 2016 [Update (JRC): The Joint Reference Committee reviewed the history of the requests for changes to the APA Referendum voting procedures. After an extensive discussion of the issues, the JRC determined that implementing this action paper is unfeasible and not in the best interests of the APA. The JRC therefore recommended that the Board of Trustees reaffirm the JRC’s action. Update (Board of Trustees): The Board of Trustees reaffirmed the JRC decision that approval and implementation of action paper APA Referendum Voting Procedure is not feasible.

Agenda Item #


2016 A1 14.A

APA Endorsement of the Position Statement of AGLP on Discrimination against LGBT Citizens Based on Arguments of Religious Liberty

The Assembly voted to approve new business action item 2016A1 14.A, which asks that the sudden proliferation of “religious liberty” legislation requires an immediate response by the American Psychiatric Association to prevent psychiatric and psychological harm to LGBT people in the interim between passage and legal challenge; That the Assembly of the American Psychiatric Association emergently endorse the position statement of the Association of Gay and Lesbian Psychiatrists: Discrimination against LGBTQ Citizens under the Guise of Religious Liberty and requests similar endorsement by the Board of Trustees of the American Psychiatric Association

Joint Reference Committee, June 2016 [Update (JRC): The Joint Reference Committee discussed the action paper. In a substitution action, the Joint Reference Committee forwards to the Board of Trustees the following statement for their consideration. The APA reaffirms its opposition to discrimination against LGBTQ citizens including those with arguments based on claims of religious liberty. Update (Board of Trustees): The Board of Trustees voted to approve the following statement: The APA reaffirms its opposition to discrimination against LGBTQ citizens including discrimination based on arguments of religious liberty.]

2016 A1 14.B

Task Force on Fighting Mental Health-Injurious Discrimination

The Assembly did not discuss/vote on the new business action item 2016A1 14.B due to lack of time.

N/A

DRAFT SCHEDULE OF THE ASSEMBLY AND RELATED EVENTS

Omni Shoreham, Washington, DC

November 4-6, 2016

Thursday November 3

9:00 am 4:00 pm Administration Office

12:00 noon 5:00 pm

Area 5 Council

Friday November 4


9:00 am

9:00 am

3:00 pm

10:30 am

Registration

Committee on Procedures Meeting

10:00 am 12:00 pm Assembly Executive Committee Meeting

12:30 pm 2:00 pm Area Council Meetings

Area 1 Council

Area 2 Council

Area 3 Council

Area 4 Council

Area 5 Council

Area 6 Council

Area 7 Council

2:00 pm 3:00 pm Plenary Session 1

3:00 pm 6:00 pm Reference Committee Meetings — Action Item Review

Reference Committee 1: Advancing Psychiatry

Reference Committee 2: Supporting Research

Reference Committee 3: Education & Lifelong Learning

Reference Committee 4: Diversity & Health Disparities

Reference Committee 5: Membership & Organization

6:00 pm 7:30 pm Nominating Committee Meeting

7:00 pm 9:00 pm M/UR Committee Meeting

7:00 pm 9:00 pm ACROSS Committee Meeting

7:00 pm 9:00 pm RFM Committee Meeting Offsite (?)

7:00 pm 9:00 pm ECP Committee Meeting Offsite (?)

OVER

Saturday November 5


7:00 am 8:00 am Women of Assembly

7:00 am

8:00 am

8:00 am

10:30 am

Assembly Group Breakfast

Area Council Meetings

Area 1 Council

Area 2 Council

Area 3 Council

Area 4 Council

Area 5 Council

Area 6 Council

Area 7 Council

10:30 am

12:00 pm

12:00 pm

12:55 pm

Plenary Session 2

Assembly Group Luncheon

1:00 pm

3:15 pm

3:00 pm

4:15 pm

Plenary Session 3

Assembly Work Group/Committee Meetings

Assembly Work Group on Access to Care

Assembly Work Group on Metrics

Assembly Work Group on Maintenance of Certification

Assembly Committee on Public & Community Psychiatry

Assembly Work Group on ASM/Foundation Initiatives

4:30 pm 6:00 pm Area Council Meetings

Area 1 Council

Area 2 Council

Area 3 Council

Area 4 Council

Area 5 Council

Area 6 Council

Area 7 Council

6:00 pm 7:30 pm Assembly Reception

Sunday November 6

7:00 am 12:00 noon Administration Office

7:00 am 7:55 am Assembly Group Breakfast

7:00 am 7:55 am ACROSS Committee Meeting

7:00 am 7:55 am ECP Committee Meeting

7:00 am 7:55 am M/UR Committee Meeting

7:00 am 7:55 am RFM Committee Meeting

8:00 am 11:00 am Plenary Session 4

11:05 am 2:00 pm Assembly Executive Committee Meeting

Special Rules of the Assembly

1) There will be a maximum of three minutes for each presentation during debate. 2) The author or presenter has priority in making statements. 3) The Speaker will attempt to solicit a balance of pros and cons. 4) The Speaker will entertain a motion for the question when it is felt that there has been sufficient debate, both positive and negative on the motion. 5) A Reference Committee model is being used as an alternative to Area Council review for some Action Papers. The Rules Committee will select the papers to be processed in this way. The Reference Committee will be selected by the Speaker from nominees submitted by the Area Councils, the ECP Committee, the RFM Committee, the M/UR Committee, and the ACROSS Committee, to equalize participation as much as possible. Council Chairs may be appointed as non-voting participants in the Reference Committees. The Reference Committees may modify or combine Action Papers. Their recommended actions will be distributed in time for discussion in the Area Council meetings before being brought to the floor. 6) Presenters of reports should be limited to spelling out clearly the title and identification of the report, giving a short summary of the salient points if necessary, calling for action if indicated, and being available for questions from the floor. 7) New Business should be kept to a minimum, particularly if the issue is already reflected in another Action Paper on the Agenda that was emailed before the meeting. 8) The author will move his or her paper. The Reference Committee will give a report of recommendations to approve, not approve, amend, or otherwise act on the paper. If the Reference Committee proposes amendments, they will move them en bloc as an amendment by substitution, which does not require a second or acceptance by the author. The discussion will be on the amendment by substitution. Two additional levels of amendment will be permitted to this amendment by the Reference Committee. At the end of the discussion, if the Reference Committee’s wording with any passed amendment fails, then discussion will revert to the original paper. 9) The question of direct referral of an Action Paper to the Board of Trustees will be divided and handled as a separate motion following passage of the Action Paper, even if direct referral is included in the Action Paper’s “Be it Resolved.” The Reference Committee’s input regarding the direct referral motion will be taken into consideration. Debate on this motion will be limited as to timeliness and thus the appropriateness of a direct referral.

PROCEDURAL CODE OF THE ASSEMBLY OF THE AMERICAN PSYCHIATRIC ASSOCIATION

Table of Contents

ARTICLE I: THE ASSEMBLY ...................................................................................................................................... 2

1. Authority ........................................................................................................................................................ 2 2. Purpose ......................................................................................................................................................... 2 3. Composition .................................................................................................................................................. 2 4. Voting ............................................................................................................................................................ 2 5. Meetings ....................................................................................................................................................... 3 6. Order of Business ......................................................................................................................................... 4 7. Officers .......................................................................................................................................................... 6 8. Executive Committee .................................................................................................................................... 6 9. Committees and Task Forces ....................................................................................................................... 7

ARTICLE II: AREA COUNCILS ................................................................................................................................. 12 1. Authority ...................................................................................................................................................... 12 2. Purpose ....................................................................................................................................................... 12 3. Composition ................................................................................................................................................ 13 4. Voting .......................................................................................................................................................... 13 5. Assessments of District Branches .............................................................................................................. 13 6. Area Representatives and Deputy Area Representatives .......................................................................... 13 7. Area Procedural Codes .............................................................................................................................. 13 8. Area Nominating Committees ..................................................................................................................... 13 9. Elections ..................................................................................................................................................... 14

ARTICLE III: DISTRICT BRANCHES ........................................................................................................................ 14 1. Purpose ....................................................................................................................................................... 14 2. Establishment ............................................................................................................................................. 14 3. Authority ...................................................................................................................................................... 15 4. Elections ..................................................................................................................................................... 15 5. Representatives to the Assembly ............................................................................................................... 15 6. Dissolution .................................................................................................................................................. 16 7. Membership ................................................................................................................................................ 16 8. Membership Processing ............................................................................................................................. 17 9. State Organizations of District Branches .................................................................................................... 17 10. Transfer of a District Branch From One Area to Another ........................................................................... 17 11. Merger of District Branches ........................................................................................................................ 17 12. Chapters ..................................................................................................................................................... 17

ARTICLE IV: MINORITY/UNDERREPRESENTED GROUPS ................................................................................... 18 1. Representation for Minority/Underrepresented Groups of Members ......................................................... 18 2. Formal Representation within the Assembly of Subsequent Underrepresented Groups ........................... 19

ARTICLE V: ACROSS ................................................................................................................................................ 19 ARTICLE VI: SECTIONS ............................................................................................................................................ 21 ARTICLE VII: AMENDMENTS ................................................................................................................................... 22

1. Method of Initiation...................................................................................................................................... 22 2. Submission of Proposed Amendments....................................................................................................... 22 3. Voting .......................................................................................................................................................... 22

SAMPLE BYLAWS ..................................................................................................................................................... 23 CHAPTER ONE: NAME; PURPOSES; LEGAL IDENTITY ................................................................................. 23 CHAPTER TWO: MEMBERS .............................................................................................................................. 23 CHAPTER THREE: COUNCIL ............................................................................................................................ 25 CHAPTER FOUR: OFFICERS ............................................................................................................................ 26 CHAPTER FIVE: REPRESENTATIVES ............................................................................................................. 27 CHAPTER SIX: COMMITTEES AND OTHER ORGANIZATIONAL ENTITIES .................................................. 27 CHAPTER SEVEN: ETHICS COMPLAINTS AND DISCIPLINARY PROCEDURES ......................................... 28 CHAPTER EIGHT: CHAPTERS .......................................................................................................................... 28 CHAPTER NINE. AMENDMENTS OF THE BYLAWS ........................................................................................ 29

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ARTICLE I: THE ASSEMBLY

1. Authority

The powers and responsibilities of the Assembly are defined by the Bylaws of the American Psychiatric Association.

2. Purpose

The Assembly of the American Psychiatric Association is a deliberative body which recommends action to the Board of Trustees. The Assembly is composed of representatives elected from the district branches; representatives of other groups of members; and the Assembly officers.

a. The Assembly establishes and supports forums for discussion of the issues facing our profession.

These forums include the District Branch, State Associations, Area Councils, Reference Committees, the special groups identified by the Assembly, and the Assembly meeting as a whole.

b. The Assembly receives reports from the President of the APA, the Treasurer, the CEO and Medical Director, the chair of the APA delegation to the AMA, and others.

c. District Branches of the APA are established, continued, or dissolved by The Assembly. (see Bylaws - District Branches shall be established, continued, or dissolved according to the procedural code of the Assembly.)

d. The Assembly shares responsibility with the Board for developing and reviewing official Position Statements of the Association.

e. The Assembly establishes awards for outstanding contributions and selects recipients. f. The Assembly has a formal process for leadership development and provides opportunities for

representatives to the Assembly to exercise those skills. g. The Assembly, representing the members, can ratify proposed amendments to the by-laws of the

Association. (bylaws 11.2) h. The Assembly reviews and endorses Practice Guidelines developed by the Association.

3. Composition

The Assembly shall be composed of Representatives selected by the District Branches/State Associations; a Representative and Deputy Representative from each Minority/Underrepresented Group; a Resident-Fellow Member (formerly Member-in-Training) Representative and Deputy Representative from each Area; an Early Career Psychiatrist Representative and Deputy Representative from each Area; a Representative from each Assembly Allied Organization and Section; two non-voting Minority Fellows; and the Assembly Executive Committee. Representatives of the Assembly may only be voting representatives of one organization or entity as an Assembly member. In addition, members of the APA Board of Trustees may not concurrently serve as a regular District Branch, ACROSS, Early Career Psychiatrist, Minority and Underrepresented Group or Resident-Fellow Member Representative or Deputy Representative. A member of the Board of Trustees may serve as an Alternate Representative on a case by case basis (but not permanent), as authorized by the Recorder. Further, an Area Representative or Deputy Representative may not concurrently serve as a District Branch Representative. District Branch Representatives are eligible to be apportioned according to the following formula, except that for states with more than one district branch will have 1 Representative for District Branches with 450 or less:

Numbers of Voting Members Reps. 450 or less 2 451-900 3 901-1350 4 1351-1800 5 1801 or more 6

4. Voting

a. Voting members of the Assembly include the duly elected Representatives of a District Branch

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and each Officer of the Assembly, the two immediate Past Speakers, each Area Representative and each Deputy Area Representative, each Representative from Minority/Underrepresented Groups, each Area Resident-Fellow Member Representative, each Area Early Career Psychiatrist Representative, and each ACROSS Liaison. In the event of an absence of a voting member, the Deputy votes for that member. If both the Representative and the Deputy are absent, or if there is no Deputy, a duly appointed and certified replacement shall have these privileges.

b. For the ordinary conduct of business, voting may be by voice vote or by standing vote. Voting shall be restricted to the voting members of the Assembly.

c. Votes by Strength. On those occasions when the issue seems in doubt, and other methods of

voting seem not to reflect the will of the membership, a vote by strength may be used. Votes by strength shall be initiated if called for by at least 6 voting members from at least 2 Areas of the Assembly representing State Associations, or the District Branches of Western Canada, Ontario, Quebec & Eastern Canada, Puerto Rico, the Washington Psychiatric Society and the Society of Uniformed Services (hereby referred to as groups in this article.) Each of the groups‘ voting strength is based upon its membership. The total number of votes to which a group is entitled shall be determined by a report from the APA membership database run the last working day in December of each year. These numbers will take effect at the end of the subsequent May Assembly and be in effect through the next May Assembly meeting. Additionally, each Officer of the Assembly, the two immediate Past Speakers, each Area Representative and each Deputy Area Representative, each Representative from Minority/Underrepresented Groups of each Area Resident-Fellow Member Representative, each Area Early Career Psychiatrist Representative, and each ACROSS Liaison shall have one vote. Every group can be fully represented in votes by strength so long as any one Representative or a Deputy Representative is present at the Assembly. All group Representatives are authorized to apportion the votes they cast according to instructions from the group or their assessment of prevailing opinion in their group. When more than one Representative is elected from a group, the Secretary of that group may inform the Recorder of the Assembly of the number of votes each Representative is authorized to cast for the group. A Deputy Representative is authorized to cast an ordinary vote or to vote by strength only in the absence of the group Representative.

5. Meetings

a. Frequency. There shall be at least two meetings of the Assembly annually. The Annual Meeting shall be at the time and place of the Annual Meeting of the Association; the other shall be a Fall Meeting at the time and place designated by the Assembly. The interval between the Fall APA Component Meetings and the Fall Assembly will be at least four weeks to allow adequate time for reproduction and distribution of reports prior to the convening of the Assembly.

b. Special Meetings. The Speaker may opt to call a special meeting of the Assembly whenever the business of the Assembly requires it. The Speaker shall call a special meeting of the Assembly upon the request of any ten voting members of the Assembly Executive Committee, or in response to a request of one-fourth or more of the members of the Assembly.

c. Quorum. A quorum of the Assembly shall consist of one-third of the Representatives or Deputies acting as Representatives, provided they represent at least 50% of the voting strength of the full Assembly.

d. Attendance. Any person in attendance at any meeting of the Assembly will be one of these classes:

- Officers - Executive Committee - Members (Representatives and Deputy Representatives) - Privileged Guests - Observers - Staff Personnel

e. Privileged Guests. Privileged guests are those invited by the Speaker or a majority of the Assembly. Privileged guests shall have the privilege of the floor (the right to discuss a matter when recognized by the chair, but not the right to vote.)

f. Observers. Observers are those in attendance at a meeting who are not classified as members,

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staff persons or privileged guests. The Assembly may grant observers floor privileges and the right to address the Assembly.

g. Staff. Staff personnel are those staff, reporters and employees of the American Psychiatric Association and District Branches or of the Assembly attending meetings in their official capacities.

h. Executive Sessions. The Speaker, in consultation with legal counsel, may determine that full and proper discussion of a report or action is likely to involve the exchange of confidential and highly sensitive information and legal advice with counsel may lead to exposure for the membership. In such cases, the Speaker shall determine that the report or action should be considered in executive session. In order to preserve and protect the client-attorney privilege for the Assembly and its membership, the Speaker shall refer any such report or action to the Assembly Executive Committee for consideration in executive session. The Assembly Executive Committee may review the Speaker's decision and reverse the referral, returning the matter to the full Assembly. If the Assembly Executive Committee proceeds to consider the matter in executive session, at its next meeting the Assembly Executive Committee may review the matter and vote to return it to the full Assembly for consideration.

6. Order of Business

a. At each meeting the order of business shall include, but not be limited to, the following: - Call to Order - Roll Call - Statement of Recorder Regarding a Quorum - Minutes - Reports - Action Papers - Unfinished Business - New Business - Adjournment

b. Parliamentary procedure shall be governed by The Standard Code of Parliamentary Procedure

by Alice Sturgis. The Speaker may designate a Parliamentarian to advise and assist the presiding officer in the interpretation of parliamentary procedure. Rulings of the presiding officer will be subject to appeal to the Assembly.

c. Procedure for Action 1) All business of the Assembly will be provided to Representatives at least two full weeks in

advance of the meeting. There will be only two exceptions: - Reports of some officers and guests; and - Reports from Committees and Task Forces that meet just before or during the

meeting of the Assembly. 2) Special Rules of the Assembly. The Rules Committee shall be responsible for proposing

any special rules for a session of the Assembly. 3) Format of Reports. All reports, as well as action papers will conclude with a specific

statement of action requested of the Assembly (e.g., receive the report for information; adopt the report as policy of the Assembly; appoint a task force; refer to a committee, etc.) Since members will already be familiar with the contents of the report when, in its turn, it comes to the floor of the Assembly, the person responsible for the report will not have to read it, or paraphrase it, or summarize it, but will simply move the actions recommended, and these will be open for immediate debate.

4) Reports of officers and guests will be kept to a minimum and where at all possible will be in writing. The person will be introduced and the contents of his/her report will be open for questions and discussion by the members of the Assembly. Any ensuing action proposals, however, will be treated as New Business.

5) Format of Action Papers. The format for an Assembly action paper includes:

- Title (Subject):

- Whereas Statements Listing Reason for Action:

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- Be It Resolved: (This is a statement of what action the APA should take and who should carry it out. It should include recommended components for action or review, such as the Council on Addiction Psychiatry, the APA/AMA Delegation, the Membership Committee, etc.) N.B.: Action Papers are normally first referred to the Joint Reference Committee before further action. The Assembly Executive Committee and the Speaker of the Assembly have the authority to refer time-sensitive matters directly to the Board of Trustees when necessary. The Assembly can also direct such time-sensitive matters as a referral to the Board of Trustees as a ‘resolved’ in the Action Paper, or after the Action Paper is passed in the form of a separate motion. Whether through a "Be it resolved" or separate motion, the Speaker moves such an Action Paper at the next Board of Trustees meeting.

- Author or Authors: (First listed author must be a member of the Assembly and all authors must be members of the APA)

- Estimated Cost:

- Estimated Savings:

- Estimated Revenue Generated:

- Endorsed By: The definition of endorsement is positive support by the reviewing body. Groups limited to District Branches, Area Councils, Committees of the Assembly (M/UR, ECP, RFM (formerly MIT), ACROSS, Public & Community Psychiatry) and the Assembly M/UR caucuses (American Indian, Alaska Native, and Native Hawaiian; Asian-American; Black; Hispanic; International Medical Graduates; Lesbian, Gay & Bisexual; Women) can endorse an action paper.

- Key words:

- APA Strategic Goal:

- Reviewed by Relevant APA Component (with attached comments as appropriate):

6) The Rules Committee will meet before the Assembly convenes to review all proposals and

the reports produced by the Committees and Task Forces since the last Rules Committee meeting. This Committee will make any non-substantive changes necessary in the final form of presentation, and will report these changes at the opening session of the Assembly. Changes made by the Rules Committee will stand unless reversed by a majority floor vote. The Rules Committee will continue its meetings during the Assembly as needed to consider any proposals introduced as New Business.

7) New Business is defined as any item not included in the previously described agenda. Any New Business must first be presented to the Rules Committee, which will review it as to format and evaluate its importance in the light of time and other business. The Rules Committee may withhold an item from the floor of the Assembly for cause and may assign priorities to those items that it brings to the floor. A reversal of such a recommendation by the Rules Committee will require a two-thirds floor vote. New Business brought to the floor by the Rules Committee will not necessarily be referred to the Area Councils but may be directly opened to the floor for debate.

8) The Area Councils will meet as often as necessary during the Assembly. All material to be discussed will be ready after the first report of the Rules Committee and can be considered at the first Area Council meetings. Further Area Council meetings or caucuses to conduct Area business may be arranged as needed.

9) Proposed actions for the Assembly will be reviewed by Area Councils, Reference Committees, or the Committees of Early Career Psychiatrists, Resident-Fellow Members, Minority/Underrepresented Groups, or ACROSS Liaisons according to assignment by the Rules Committee. Each reviewing body will consider its assigned actions items according to its own established procedure and report its recommendation to the Assembly. The recommendation shall be distributed prior to the action being brought to the floor. After the author moves the paper to the floor for consideration the Chair or designee of the reviewing body will report to the Assembly. The reviewing body may recommend that the action be adopted, not adopted, amended or otherwise disposed of.

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7. Officers The Officers of the Assembly shall be the Speaker, the Speaker-Elect and a Recorder. All Officers must be elected members of the Assembly at the time of their nomination and election to office. a. Duties

1) The Speaker shall be the presiding officer of the Assembly and shall be responsible for the duties assigned by the Assembly, the Procedural Code and by the Bylaws of the American Psychiatric Association.

2) The Speaker-Elect shall be responsible for the duties assigned or delegated by the Speaker, the Assembly, the Procedural Code, and the Bylaws of the American Psychiatric Association. In the absence of the Speaker, the Speaker-Elect shall be the presiding officer of the Assembly and shall act for the Speaker in all official capacities.

3) The Recorder shall be responsible for the formal call to Assembly meetings, who shall be seated at Assembly meetings, the records of the Assembly and all duties assigned by the Speaker, the Assembly or the Procedural Code.

b. Term of Office

The Officers of the Assembly shall hold office for one year. After serving one full term, a Speaker may not be re-elected until after a period of five years.

c. Election 1) The Speaker-Elect and the Recorder shall be elected by the Assembly during the Annual

Meeting and shall assume office at the close of business at the Annual Meeting. 2) Election shall be by a majority vote of the Assembly. Balloting shall be by secret ballot and in

accord with the voting strength of each District Branch. In the event that more than two candidates are nominated for an office, balloting will be by preferential ballot.

3) Pre-election activities for the Assembly shall be simple and informal. Every attempt should be made for Assembly Officer candidates to have fair, timely, and equal access to the Area Councils and Assembly membership.

4) Assembly members' electronic addresses are available to Assembly candidates.

d. Vacancies. If the office of the Speaker becomes vacant before the expiration of the term due to illness, resignation, death or recall, the Speaker-Elect shall assume the Speaker's office immediately, serve the unexpired portion of the term assumed, and then serve the subsequent full term as Speaker as is entitled by the earlier election as Speaker-Elect. If the office of Speaker-Elect or Recorder becomes vacant due to illness, resignation, elevation to Speaker, death or recall, the Assembly shall elect a member of the Assembly to fill the unexpired portion of the term of office. Such elections will be held at either a regular or special meeting of the Assembly as determined by the Assembly Executive Committee and shall be conducted as any regular election. The Speaker-Elect who is elected by special election shall succeed to the office of Speaker when the Speaker's full term expires, or earlier if the office becomes vacant.

e. Recall of Officers. An action for recall of an officer of the Assembly may be initiated by a petition signed by at least twenty voting members of the Assembly or by a majority of the voting members of the Assembly Executive Committee. The petitioners shall set forth the reasons for initiating the petition. When the petition has been signed, it shall be forwarded to the Recorder for inclusion in the Assembly agenda and a copy shall be provided to the named officer. The petition shall take precedence over any other Assembly business at the next session of the Assembly. Ample time shall be provided for discussion and presentation of evidence. The vote on the petition may be called for by a majority vote of the Assembly. Action to recall shall require an affirmative vote from two-thirds of the Assembly voting by voting strength. If an office is vacated by the recall procedure, it shall be filled in the same manner as any other vacancy.

8. Executive Committee

a. Charge. The Assembly Executive Committee is charged as follows: 1) to act for the Assembly between Assembly meetings; however, proposed policy statements are to be made only in emergencies when actions clearly may not be deferred until the next meeting of the Assembly; 2) to promote interests and decisions of the Assembly within the rest of the APA, including evolving

7

strategies and tactics to enhance implementation of Assembly actions by appropriate APA components, and accept action papers referred to the AEC by the Assembly and determine the APA component to which they should be sent; 3) to address APA intercomponent affairs of the Assembly, i.e., relations with the Board of Trustees, components, Joint Reference Committee, and CEO and Medical Director's office; 4) to facilitate Assembly function by advising the Speaker, exchanging information and developing Assembly policies, including assisting the Speaker on planning for Assembly meetings, exchanging important information about arising issues, and developing policies about the Assembly's function; 5) to study the Assembly and its components and identify issues related to long range planning, addressing emerging issues that go beyond internal structural matters that address the future of the field of psychiatry and the APA; 6) to review the budget of the Assembly, in coordination with APA staff, and make decisions as needed during the fiscal year to assist staff in managing resources; 7) to prioritize passed Assembly action items in accordance with the APA mission and financial feasibility and provide progress updates to the Assembly.

b. Composition. The Assembly Executive Committee shall consist of the Speaker; Speaker-Elect; the Recorder; the two immediate Past Speakers; the Area Representatives and Deputy Area Representatives, elected from each geographical area of the American Psychiatric Association (see Appendix 1 for geographical areas), the chair of the Committee of Minority/Underrepresented Groups; the chair of the Committee of Resident-Fellow Member Representatives; the chair of the Committee of Early Career Psychiatrist Representatives; and the chair of the Assembly Committee of Representatives of Subspecialties and Sections. The Parliamentarian and CEO and Medical Director, or representative assigned by the CEO and Medical Director, are members with voice only.

c. Voting. Voting members shall include the Assembly Officers, Area Representatives and Deputy

Representatives, the chair of the Committee of Minority/Underrepresented Groups, the chair of the Committee of Resident-Fellow Member Representatives, the chair of the Committee of Early Career Psychiatrists Representatives, and the chair of the Assembly Committee of Representatives of Subspecialties and Sections (ACROSS). A Past Speaker shall be a voting member for one year and continue as a non-voting member for an additional one year. The Parliamentarian and the CEO and Medical Director are members with voice only. A quorum of the Executive Committee shall be composed of any thirteen voting members. The AEC shall not vote by strength.

d. Meetings. The Assembly Executive Committee will meet as often as may be necessary. Meetings of the Committee may be called by the Speaker or by thirteen or more voting members of the committee. There will be at least four regular meetings each year of the Committee.

e. Contingency Fund. The Contingency Fund of the Assembly shall be called the Assembly

Executive Committee Contingency Fund, and the AEC will be responsible for disbursement of funds. The fund will be used for operations that enhance or expedite the Assembly's work and for which the usual APA budget process would not be appropriate, but will not be used to establish new or ongoing components or programs. Disbursement of funds will be authorized by the AEC, as follows: between meetings of the AEC, requests for $2,000 or less will be authorized by the three Assembly officers, and requests for $2,000 or more will be authorized by the AEC via email, mail ballot or telephone conference.

f. Executive Sessions. The Assembly Executive Committee may go into executive session when

full and proper discussion of a report or action is likely to involve the exchange of confidential and highly sensitive information and/or include legal advice with counsel. In addition, the Committee will go into executive session for consideration of any matter referred to it by the Speaker pursuant to Article I, Section 8 (H). If after initial consideration, the Committee decides that the matter should not be considered in executive session, it will terminate the executive session and refer the matter back to the Speaker and the Assembly.

9. Committees and Task Forces

All Assembly Committees and Task Forces shall be chaired by members of the Assembly, and shall

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report to the Speaker of the Assembly. Permission of the Assembly committee chair is required for an ―acting representative‖ to substitute for a representative on a committee. a. Nominating Committee

1) Composition The Assembly Nominating Committee shall be selected in the following manner: (a) The chair shall be appointed annually by the Speaker. (b) Each of the Area Councils shall elect one Area Selector to this Committee and an

Alternate Selector to serve in the Selector‘s absence. Such election shall occur in the year following the election of the Area Representative. All such Selectors shall serve for a term of two years. In the event neither the Selector nor the Alternate can act, the Area Representative may fill the vacancy by appointment of a constituent District Branch Representative to serve until the next Annual Meeting when a successor shall be elected in the manner described above.

(c) The Committee of Minority/Underrepresented Groups, the Committee of Area Resident-Fellow Member Representatives, the Committee of Area Early Career Psychiatrist Representatives, and the Assembly Committee of Representatives of Subspecialties and Sections shall each elect a Selector and Alternate Selector to serve on the Assembly Nominating Committee in a manner comparable to the Area Selectors and Alternate Selectors given above in (b).

2) Function. A meeting shall be called at the discretion of the chair to nominate candidates for Assembly office. The Committee's nominees for the Offices of Speaker-Elect and Recorder shall be announced at the fall meeting of the Assembly, at which time additional candidates may be nominated from the floor. The names of all candidates, accompanied by a brief curriculum vita, shall be circulated to the Assembly for review prior to the Annual Meeting at which the election is to be held.

b. Rules Committee

1) Composition. The Assembly Rules Committee shall be selected in the following manner: (a) The chair shall be the Past Speaker of the Assembly and appointed annually by the

Speaker. (b) Each of the Area Councils shall select one of its members and another member as an

alternate to this Committee and an alternate. Such selection shall occur in the year following the election of the Area Representative. They shall serve a two year term. In the event neither can serve, the Area Representative may fill the vacancy by appointing of an Area Council member to serve until the next Annual Meeting when a successor shall be selected.

(c) The Committee of Minority/Underrepresented Groups, the Committee of Area Resident-Fellow Member Representatives, the Committee of Area Early Career Psychiatrist Representatives, and the Assembly Committee of Representatives of Subspecialties and Sections shall each select a representative and alternate representative to serve on the Assembly Rules Committee.

2) Function. The Committee shall consider all new business and action papers to be presented to the Assembly, help in preparing such items for presentation, rule on their appropriateness for consideration by the Assembly, and report them to the Assembly. The chair of the Rules Committee, in consultation with the Speaker and APA staff, sets the deadline for all action papers prior to each Assembly meeting. The deadline is applicable to all Area Councils and District Branches regardless of their meeting date. The Rules Committee may refer directly to other components those action papers that only request information from or convey information to components, bypassing Assembly review. The Rules Committee may place on the consent calendar those action items that are thought to not require further debate or clarification. In the event that Committee does not approve presentation of an action paper, a two-thirds vote of the Assembly shall be required to bring it to the floor. The Rules Committee shall be strict in their approval of new business, reserved for urgent business that cannot wait until the next meeting of the Assembly or Assembly Executive Committee.

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c. Committee on Procedures 1) Composition. The Committee shall consist of one Assembly member from each Area, plus

one member each from the Minority/Underrepresented, Resident-Fellow Member, Early Career Psychiatrist, and ACROSS Liaison Representatives. The members representing Areas shall have staggered three-year terms. Members representing special groups shall have one to three year terms. Each member must retain Assembly membership. The Speaker shall appoint replacement members if and as vacancies arise during that Speaker's term of office and shall appoint the chair. Ex officio members with voice only shall include the Assembly Parliamentarian.

2) Function. The Committee shall monitor the workings of the Assembly for effectiveness and efficiency; interpret the Procedural Code with regard to specific issues, challenges, or questions; shall receive, study, and initiate proposals for changes in the Procedural Code of the Assembly and the mechanisms of operation of the Assembly. It will also review the Procedural Codes of the Area Councils and the Constitutions and Bylaws of the District Branches to assure consistency with the APA Bylaws, the Operations Manual and the Procedural Code of the Assembly. It may serve as liaison with the Board in the preparation and modification of the Operations Manual. (a) The Committee on Procedures shall arrange for an updated ―sample‖ Bylaws or

Procedural Code to be available to each District Branch and each Area Council within 3 months of when any amendment to the APA Bylaws or Assembly Procedural Code is adopted by the Assembly. Each updated version shall call attention to substantive changes or modifications in the document. The Committee will review and the Constitutions and Bylaws of the District Branches on a rotating 5-year basis.

(b) The following provisions must be included in the DB Bylaws and will be reviewed periodically by the Committee for compliance: a. Dissolution of DB, b. Requirements for Membership, c. Membership Qualifications, d. Categories of District Branch membership, e. Voting members, f. Election to Membership, g. Transfer and Advancement of membership, h. Application of Fellows and Nomination of Distinguished Fellows, i. Inactive Status and Due waiver of membership, j. Representation to Assembly, k. Assumption of Office, l. Recall of Officer or any members of the Council of the DB, m. Representative to the Assembly, n. Code of Ethics, and o. Ethics Complaints.

Other bylaws provisions are included in the Addendum of the Procedural Code as an example of provisions sometimes included in bylaws for the District Branch‘s reference. Each District Branch is responsible for compliance with state laws governing nonprofit corporations.

(c) The Assembly's Parliamentarian shall continue to advise on questions from District

Branches, Area Councils, or the Assembly Executive Committee, with respect to specific issues, challenges by individual members, or questions of interpretation. If the Assembly does not have a Parliamentarian, the Speaker shall arrange another mechanism for such advice.

d. Committee of Representatives of Minority/Underrepresented Groups

1) Composition. The Committee shall consist of the duly elected Representatives and Deputy Representatives of the Minority or Under-represented Groups as identified by the Assembly. These Representatives elect their own chair and vice chair. The chair of this Committee is a member of the Assembly Executive Committee.

2) There shall be one liaison member from the Resident-Fellow Member and Early Career Psychiatrist Representatives who will be appointed by the chairs of their respective Assembly

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committees.

e. Committee of Area Resident-Fellow Member Representatives (ACORF), formerly Committee of Area Member-in-Training Representatives (ACOM) 1) Composition. The Committee shall consist of the Area Resident-Fellow Member

Representatives and Area Resident-Fellow Member Deputy Representatives. These Representatives elect their own chair. The chair of this Committee is a member of the Assembly Executive Committee.

2) The chair shall appoint a liaison to the Committee of Representatives of Minority/Underrepresented Groups.

3) Two non-voting Minority fellows will serve as Resident-Fellow Member liaisons.

f. Committee of Area Early Career Psychiatrist Representatives 1) Composition. In March 2000, the Assembly and Component ECP committees were

combined. The Committee shall consist of 14 members, 7 of whom are elected and 7 of whom are appointed from a slate of Early Career Psychiatrists not currently members of the Assembly elected by the Area Councils. The combined committee shall report to the Council on Medical Education and Lifelong Learning and the Assembly. These representatives elect their own chair. The chair of this committee is a member of the Assembly Executive Committee.

2) The chair shall appoint a liaison to the Committee of Representatives of Minority/Underrepresented Groups.

g. Assembly Committee of Representatives of Subspecialties and Sections (ACROSS)

1) Composition. The Committee shall consist of the Representatives of Assembly Allied Organizations and the Representatives of Sections as identified by the Assembly. The Representatives of Assembly Allied Organizations and Sections shall elect their own chair. The chair of this Committee is a member of the Assembly Executive Committee.

2) Each organization liaison must be a psychiatrist and a member of APA. Each allied organization liaison on this committee will have one vote whether by ballot or strength

3) Each section liaison must be a psychiatrist and a member of APA.

h. Committee on Public and Community Psychiatry 1) Composition. The Committee is composed of seven members, one from each Area, plus

one member each from the Assembly Minority/Underrepresented, Resident-Fellow Member, Early Career Psychiatrist, and ACROSS Liaison Representatives, appointed by the Speaker.

2) Function. The Committee is charged to promote the proper use and the proper role of psychiatrists at all levels in all public psychiatric settings, to ensure quality psychiatric care for the patients treated in the public sector, and to coordinate the work of the existing APA components dealing with public psychiatry (see November 1985 Action Paper for origin). Also, the interests of psychiatrists working in jails and prisons are represented on this Committee.

i. Awards Committee

1) Composition. The Committee is composed of seven members, one from each Area, plus one member each from the Assembly Minority/Underrepresented, Resident-Fellow Member, Early Career Psychiatrist, and ACROSS Liaison Representatives, appointed by the Speaker. The Speaker also appoints the chair of the Committee (usually a Past Speaker).

2) Function. The Committee meets (usually by conference call) to choose the Assembly Profile of Courage awardee in the fall and meets (usually by email) to choose the District Branch Best Practices awardee in the spring. The Chair of the Committee presents the awards to the winners during plenary sessions of the Assembly.

j. Assembly Committee on APA Budget Planning 1) Composition. This committee is composed of Assembly members appointed by the Speaker

including Assembly officers as members. The chair of the committee shall be appointed by the Speaker.

2) Function. This committee will review and evaluate the draft APA annual budget at a point no

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later than at its first dissemination to the Finance and Budget Committee and serve as a resource to the Speaker and Speaker-Elect in preparation for their deliberations in the Finance and Budget Committee in the budget planning process. In addition, the committee will report to the AEC.

k. Assembly Committee on Psychiatric Diagnosis and the DSM

1) Composition. The Committee is composed of one member from each Area, and one member each from the Assembly Resident and Fellow Members, the Assembly Early Career Psychiatrists, the Assembly Minority/Underrepresented Members, and the Assembly Committee of Representatives of Subspecialties and Sections. Members shall be elected by the relevant group annually, to serve no more than four consecutive years. The Chair shall be appointed from among this group annually by the Speaker.

2) Function. The Committee will serve to receive concerns and opinions from the members of

the Assembly, and from the Association membership as a whole through the Assembly Representatives, about the American Psychiatric Association‘s ongoing or actively considered activities regarding psychiatric diagnosis and nomenclature, including but not limited to the Diagnostic and Statistical Manual (DSM). The Committee will deliberate about matters brought to it, and when appropriate, transmit recommendations for actions to the Assembly for approval and referral to the Board of Trustees or its authorized components then operating in these matters. From time to time the Assembly Committee may solicit input or opinion from the Assembly or the Association membership, especially regarding the applications of diagnosis and diagnostic criteria in clinical practice, and the perceptions of clinicians on the need for or advisability of change.

l. Assembly Task Forces

1) Composition. The Assembly Task Forces are appointed by the Speaker and their tenure is limited to the Speaker's term of office, though they may be reappointed. The chair of a Task Force shall be appointed by the Speaker.

2) Function. Task Forces are task-oriented groups and are appointed to accomplish a specific task in the judgment of the Assembly can be more easily and efficiently accomplished by a smaller group than by the Assembly as a whole. Task Force reports are made to the Assembly for consideration, approval, modification and/or implementation.

m. Reference Committees

1) Composition. Members on each reference committee are selected by the Speaker from names of Assembly members submitted by their Area Representatives and Group Chairs. The Speaker also appoints a chair from among this group. Assembly members are encouraged to volunteer for a Reference Committee. The Speaker determines the number of reference committees for each Assembly meeting. Proposed actions are grouped according to subject so that each reference committee has a particular focus. Often Reference Committees are grouped according to the strategic goals of the Association. Reference Committees can also focus on APA governance, membership, and district branch issues at the Speaker's discretion.

2) Function. Reference Committees assigned by the Speaker, are designed to be impartial groups assembled for the purpose of evaluating information stemming from an open, balanced discussion of a particular subject, and making a recommendation on the floor of the Assembly regarding merits of the matter under consideration. The Committees function as a facilitator in extracting as much information as is possible to come to an informed decision before making its recommendation to the Assembly. Through the instruction of the Speaker and the direction of the Reference Committee Chairs, views presented are balanced, time-limited, and succinct.

3) Procedures. The Rules Committee determines the assignment of action items to appropriate Reference Committees. All Assembly members are expected to attend and participate in the meeting of the Reference Committees of their choice. Reference Committee chairs lead the discussion of action items, seeking a balance of opinions. The author of an action paper should be in attendance and participate in but not dominate the discussion of the proposed action.

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At the Reference Committee meetings, Reference Committee members do not enter into debate with members of the audience regarding issues presented. Following formal presentation by the author(s) and an opportunity to hear discussion of varying views by Assembly members, other APA members, and APA staff present, private Reference Committee deliberation occurs, during which time non-Reference Committee members may be present, but not participate in the discussion unless specifically queried by a member of the Committee.

(a) The Chair of a Reference Committee will not accept for Committee deliberation an Action

Paper to which he/she is an author. In cases in which this inadvertently occurs, the Chair will inform the Speaker and the Assembly Rules Committee Chair and ask to have the Action Paper reassigned.

(b) When a Committee member's Action Paper is ready for presentation, the Committee member will identify himself/herself as an author, join members of the audience, present the paper as would any member of the audience, and in doing so relinquish his/her Committee member responsibility for that portion of the meeting.

(c) Following the closure of open Action Paper discussion and during the deliberation phase in which the Action Paper in question is being considered, the author/Committee member will recuse himself/herself from the Reference Committee deliberation—and like other authors, may be available to answer questions from the Reference Committee Members. The member will not have a vote on that specific Action Paper, nor will enter into this discussion, unless specifically queried by members of the Reference Committee. Participatory deliberation regarding other Action Papers being considered will not be affected.

At the conclusion of the discussion, Reference Committees meet to arrive at a recommendation to the Assembly for each action item reviewed. The author or any member may be present for this discussion. The Reference Committee may recommend that an action paper be adopted, not adopted, amended, or otherwise disposed of. As a courtesy, the chair should let the author know of the Committee‘s recommendation. After the author moves the paper to the floor of the Assembly the Reference Committee presents its recommendations.

ARTICLE II: AREA COUNCILS

1. Authority

The authority for the Assembly to establish geographical areas is defined in the Bylaws of the American Psychiatric Association. The Assembly Procedural Code is the authority for the establishment of an Area Council in each of the geographical areas.

2. Purpose

The Area Council shall provide a regional organizational structure as the interface between the Assembly and the District Branches to:

a. Promote relationships between organized psychiatry and state governments; b. Enhance and provide cross-fertilization in District Branch activities with regard to, membership,

mental health services, insurance, continuing education, public affairs, government relations, judicial action, and any other appropriate activities; and serve as venues for communication between and among individuals, District Branches, and the national organization;

c. Hold scientific meetings and other programs in continuing education; d. Provide a forum for discussion of regional issues and development of and debate about national

policy proposals; providing regional view points and a unique source of institutional memory; e. Consider action papers from individuals and District Branches prior to submission to the

Assembly and from other Areas during the Assembly meeting at the request of the Speaker and serve as substantive deliberative bodies on matters before the Assembly;

f. Enhance the involvement of all members in the APA by providing a venue for the participation of Resident-Fellow Member (RFM), Early Career Psychiatrists (ECP), Minority/Underrepresented Groups (MUR), and ACROSS Psychiatrists;

g. Provide loci of leadership development for the Assembly and APA.

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3. Composition

An Area Council shall consist of the Area Representative and Deputy Representative, the Representatives of District Branches within such Areas, the Area RFM Representative and Deputy Representative, the Area ECP Representative and Deputy Representative, and any MUR representatives and deputy representatives and ACROSS representatives who reside in the Area. However the Speaker may reassign the individual members of MUR and ACROSS in order to provide a balance representation. Some Area Councils may include their Area Public Affairs and Government Relations Representatives. The addition of other members is optional and to be determined by the needs and wishes of the individual Area Councils and shall be specified in their procedural codes.

4. Voting

If requested by at least two Area Council members from different District Branches and specified by the Area Procedural Code, a roll call vote by strength is permissible and shall be held according to the Procedural Code of the Area.

5. Assessments of District Branches

Area Councils are authorized to receive, hold or invest funds to fulfill their functions. Under provisions of specific Area Procedural Codes, they may request assessments of their district branches or the district branch membership.

6. Area Representatives and Deputy Area Representatives

a. Qualifications. Area Representatives and Deputy Area Representatives shall be elected in accordance with the Procedural Code of each Area Council.

b. Term. Area Representatives and Deputy Area Representatives shall serve a period of two years and may be re-elected for another two years. After two terms as Deputy Area Representative and two terms as Area Representative (in any order, making no more than 8 uninterrupted years in these offices) a period of two years must elapse before election to either office is permissible. The amount of time served in fulfilling another person's unexpired term of office shall not count as part of this 8 year limit.

c. Duties. Area Representatives and Deputy Area Representatives shall be members of the Assembly Executive Committee. The Area Representative shall chair the Area Council and the Deputy Area Representative shall serve as the Recorder of the Council. Area Representatives or Deputy Area Representatives may not continue to function as Representatives or Deputies of their District Branches in the affairs of the Assembly.

d. Vacancies. If an Area Representative should, for any reason, be unable to perform the duties of the office, a duly elected Deputy shall serve until the Representative is formally replaced. In the event that the office of the Deputy Representative becomes vacant, members of the appropriate Area Council shall elect a Representative from a District Branch in the Area concerned to serve until the next meeting of the Assembly when a successor shall be elected in the manner prescribed by Article IV, Section 6.A above.

7. Area Procedural Codes

Each Area Council shall adopt and be governed by a procedural code that shall include provisions for amendments: nothing therein shall be inconsistent with the Bylaws of the American Psychiatric Association or with the Procedural Code of the Assembly. Area Procedural Codes shall contain provisions for recall of the Area Representative and Deputy Area Representative. Area Council Procedural Codes must be approved by the Assembly Committee on Procedures prior to adoption.

8. Area Nominating Committees

a. Composition. Area Nominating Committees shall be formed by each Area Council in a manner prescribed by its procedural code, and shall consist of at least three of its members, each from a different District Branch in the Area. One member shall be designated chair.

b. Procedure. The Area Nominating Committee shall report to the Area Council in the appropriate years its recommendations for offices of Area Representative, Deputy Area Representative, and Area Trustee. Further nominations may be made by the Area Council.

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c. Nomination of Trustees. The Area Nominating Committee shall select as candidates for the office of Trustee at least two voting members of the American Psychiatric Association residing in the Area who are not members of the APA Nominating Committee. The names of those selected shall be reported to the Area Council at which time the names shall be forwarded to the chair of the Nominating Committee of the American Psychiatric Association by September 1. Area Trustees shall be ex-officio members of their respective Area Councils; whether or not they have a vote in the Area Council Meeting shall be at the discretion of the Area Council. The terms of an Area Trustee being three years, the Areas shall elect their Trustees according to the following rotation: 2013, Areas 3, 6; 2014, Areas 2, 5; 2015, Areas 1, 4, 6, and so on.

d. Appointment of an Area Trustee if an in-term vacancy occurs:

If the vacancy occurs during the Area Trustee‘s term, the vacancy shall be filled in accordance with Section 4.9 of the American Psychiatric Association bylaws. Partial terms served by a replacement Trustee do not count for the maximum of two full terms that a Trustee may serve. As outlined in the APA‘s Operations (Ops) Manual: In the event of a vacancy in the position of Area Trustee, the Executive Committee of the Board of Trustees shall ask the Area Council from which there is a vacancy to submit three names of members in good standing from the Area for consideration as a replacement. The Executive Committee may also consider other members from the Area. The Executive Committee shall solicit from each member being considered to fill the vacancy the same materials required of candidates in the preceding national election (e.g. CV, biographical statement, disclosure statement) and put forth no fewer than two names to the Board of Trustees for final consideration. The Board of Trustees shall select one candidate to serve the remainder of the vacant Area Trustee term no later than its next scheduled meeting. The Board of Trustees shall inform the Area Council of its selection.

9. Elections

Areas designated by means of odd numbers, e.g., Area 1, 3, 5, and 7 shall elect their respective Area Representatives in odd-numbered years, e.g., 2013, 2015, etc. Areas designated by means of even numbers shall elect their respective Area Representatives in even-numbered years.

ARTICLE III: DISTRICT BRANCHES

[A model Bylaws for District Branches is included as Appendix 1.] 1. Purpose

The objectives of the District Branch shall be to foster the science and enhance the progress of psychiatry, in cooperation with and as a constituent part of the American Psychiatric Association; to promote the maintenance of high professional and administrative standards thereto related; and to assist the American Psychiatric Association in promoting its aims and objectives. These are to: (a) promote the common professional interests of its members; (b) improve the treatment, rehabilitation, and care of persons with mental disorders (including mental retardation and substance-related disorders); (c) advance the standards of all psychiatric services and facilities; (d) promote research, professional education in psychiatry and allied fields, and prevention of psychiatric disabilities; (e) foster the cooperation of all who are concerned with the medical, psychological, social, and legal aspects of mental health and illness; (f) make psychiatric knowledge available to practitioners of medicine, scientists, and the public; (g) promote the best interests of patients and those actually or potentially making use of mental health services; and (h) advocate for its members.

2. Establishment A District Branch may be established by the following procedures:

a. Single Statewide District Branches. There is no minimum membership requirement for establishment of a single statewide District Branch. A District Branch may be established by

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submitting the following documents to the Recorder, reviewed by the Assembly Committee on Procedures prior to presentation to the Assembly: (1) a petition signed by a majority of APA members eligible to vote residing in that state; and (2) a proposed Bylaws for the District Branch that includes a description of the geographical area of the District Branch.

b. To establish more than one District Branch in a state, the following minimum requirements must be met:

1) The application must include a statewide plan for the geographical division of the state with

the rationale for the proposed subdivisions; 2) There must be a minimum of 200 APA members eligible to vote within each of the

geographical subdivisions; 3) A plan and a procedural code for a state council of District Branches to represent the District

Branches and the APA to the state government and legislature. The individual District Branches must be subordinated to the state council for these purposes and this must be clearly defined in the procedural code for the state council;

4) Approval of the state plan by a majority of a mail ballot distributed to all of the APA members eligible to vote in each proposed geographical subdivision; and

5) The proposal for subdivision of a state must be approved by the appropriate Area Council and by the Assembly.

c. A state with more than 2500 members and multiple District Branches may elect to become an

Area with the Area Council serving as the state coordinating body. d. The Board of Trustees of the Association may establish alternative requirements for creation of

the District Branch with subsequent concurrence by the Assembly. 3. Authority

Each district branch will elect its own officers, arrange its own programs and provide for its own expenses. All officers of a district branch must be voting members of the association. District branch officers will assume their duties at the close of business of the next annual meeting of the American Psychiatric Association following their election. They must be formally installed within thirty days prior to or subsequent to that date.

4. Elections

The following procedures for election of officers, including Representative and Deputy Representative, shall apply to all District Branches of the American Psychiatric Association:

a. The District Branch bylaws shall provide for nomination of alternate candidates from the floor or

by petition from an appropriate number of voting members; b. Balloting shall be by means of a mail ballot distributed to the entire voting membership of the

District Branch; and c. The District Branch constitution shall provide for a recall election procedure which may be

instituted either by petition from an appropriate number of members or by action of the Executive Council of the District Branch.

5. Representatives to the Assembly

a. Election and Term of Office 1) Each District Branch shall elect one or more Representative to represent its members in the

Assembly of the American Psychiatric Association and in the Area Council. These Representatives must be voting members of the Association. (See also Article I, Section 6.A.)

2) The term of office for Representatives shall be not less than two years and not more than three years, with the number of terms of office determined by the District Branches; notification of the Representatives and their terms of office shall be given to the APA Central Office no later than 15 days prior to the Annual Meeting of the APA.

3) District Branches may also become eligible for an additional voting Representative when the number of voting members in the branch increases according to the apportionment formula for District Branch Representation in the Assembly. (See Article I, Section 3, above.) The official number of voting members reported for the May Assembly meeting and for the

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November Assembly meeting will be used to determine the order for seating in the Assembly. Elections for an additional Representative shall be conducted according to the Assembly Procedural Code for a term consistent with the bylaws of the District Branch. The term shall begin at the time of the next meeting, and continue for the duration of the customary term of office as prescribed in the bylaws of the District Branch.

4) An Alternate, selected from among the voting members of a District Branch, may be appointed by the District Branch, when the regular (i.e., elected) Representative is unable to attend an Area or Assembly meeting. Alternates shall present to the Recorder of the Assembly or Chair of the Area Council a letter of appointment from the District Branch President. The Alternate shall be accorded the privilege of the floor of the Area Council or Assembly and, if functioning as an Alternate Representative, shall be accorded the vote as well. An Alternate will be accorded the vote of a regular Representative only when the regular Deputy Representative is not present to vote.

5) Representatives and Alternates are reimbursed for two Area Council meetings a year and the fall Assembly from national funds in the Assembly Budget. An additional Representative elected during the summer becomes eligible for reimbursement from national funds for the one fall Area Council meeting and the fall Assembly meeting.

b. Role of the Assembly Representative The Assembly Representative communicates information between the District Branch or specially identified group and the Area Council or Assembly. Communication flows in both directions. S/he encourages input from members and is non-judgmental in response to their queries or requests. His/her primary role is to serve the organization.

c. Responsibilities: In order to represent the views of the District Branch, the Assembly Representative shall have the following responsibilities: 1) Attend District Branch, Area Council, and Assembly meetings and be actively involved in

Reference Committee and liaison work with other components. 2) Serve on the DB Executive Council. 3) Know the views of the DB or represented group leadership and membership, bring their

concerns and requests for action to the Area Council and Assembly, solicit their views regarding already proposed Assembly actions, and represent those views in Area Council and Assembly discussion and floor debate.

4) Craft action papers addressing members concerns, proposing effective and feasible actions, and present such action papers to DB or represented group and Area Council for review before submission to the Assembly.

5) Report the activities of the Assembly back to the membership, both verbally and in writing, through such available means as Executive Council meetings, DB or represented group listservs, and newsletters.

6) Act as a resource for the general membership regarding other mechanisms by which the APA may respond to their needs (e.g., in initiating local legislative efforts and public relations efforts on issues important to psychiatrists and their patients).

7) Recruit members among psychiatrists and trainees, encouraging their participation in DB and national activities, and mentor any members interested in Assembly office.

d. Performance Assessment The Executive Council of the DB or represented group shall provide annual feedback to each Assembly Representative about the satisfactory quality of his/her performance.

6. Dissolution

A District Branch may be dissolved at the request of a majority of the members of that Branch, the request being presented by the President, Secretary, or a Representative of the Branch to the Assembly for approval or disapproval. District Branches may be dissociated from the Assembly and from the American Psychiatric Association for due cause, by a majority vote of the Assembly with the concurrence of the Board of Trustees.

7. Membership

Qualifications and categories of membership in a District Branch shall be the same as for membership in the American Psychiatric Association as defined in the Constitution and Bylaws of the Association. All District Branch members must be members of the American Psychiatric Association.

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8. Membership Processing

An applicant for membership in the American Psychiatric Association shall apply to the appropriate District Branch. Election to membership in a District Branch shall constitute election to membership in the Association. All District Branches must include in their constitutions the proper procedures for processing applications for membership in the American Psychiatric Association.

9. State Organizations of District Branches

In states where more than one District Branch is established, the District Branches shall form a state organization to provide for coordination of efforts to advance the aims and objectives of the Association with state agencies, institutions and governments. The type of organization and its composition will be determined by the respective District Branches involved.

10. Transfer of a District Branch From One Area to Another

District Branch membership in Area Councils is defined by the most reasonable geographic affiliation. Transfer from one Area Council to another requires the following protocol:

a. All members of the District Branch shall be informed of the proposal to transfer the District

Branch. The vote to transfer will be by mail ballot to all eligible voting members. A two-thirds majority of the ballots cast is required for District Branch approval.

b. Approval requires a two-thirds majority vote in each of the two Area Councils involved. c. Upon the approval of both Area Councils the requesting District Branch shall submit the action to

the Speaker for thorough consideration by the Assembly. After ample time for discussion, a simple majority of the Assembly is required for ratification.

d. Following ratification by the Assembly, the District Branch transfer will be effective at the end of the Annual Meeting.

11. Merger of District Branches

The merger of two or more District Branches within the same Area requires the following protocol:

a. All members of the merging District Branches shall be informed of the proposed merger. Each District Branch‘s vote to merge will be by a mail ballot to all eligible voting members. A minimum of forty-five days after the mailing will be allowed for voting. Approval by a majority of the voting members of a District Branch shall be required for it to participate in a merger. The percentage of the voting membership that constitutes a majority in this vote shall be that which is specified in their respective Constitution or Code of Procedures for dissolution.

b. Approval by the Area Council requires a simple majority. c. Upon approval by the Area Council, the District Branches requesting merger shall submit the

action to the Speaker of the Assembly. A simple majority of the Assembly will be required for ratification.

d. The merger shall be effected within one year of Assembly ratification, the specific date to be set by these District Branches.

e. All financial assets of the merging District Branches shall pass to the new District Branch. f. It will be the responsibility of the merging District Branches to select the officers (with the

exception of Representatives) of the new District Branch prior to the merger. g. The Representatives of the merging District Branches may serve up to a maximum of one and

one half years of their terms in the Area Council and Assembly. However, the determination of the Assembly Representation and Assembly votes accorded the newly created District Branch will be as set forth in Article I, Section 6.A and Article V, Section 5.A. If this necessitates the elimination of one or more Representatives, it will be done by procedure to be determined by the new District Branch. The most economical representation option, consistent with the needs of governance, is recommended.

12. Chapters

a. Procedure for Chapter Formation in District Branches The Policy Committee (now known as the Executive Committee) of the Assembly adopted the following resolution in regard to Chapters in October 1959: "It is the consensus of the Policy

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Committee that for the time being the establishment of Chapters within a District Branch is an internal affair of the District Branch, and is a matter for determination by the District Branch membership; provided, however, that the resulting arrangement does not contravene the rules of the Assembly in its relationship to the District Branch. Any changes in the District Branch constitutions needed to implement such action will be submitted to Policy Committee for review and approval." The above resolution was presented to the APA Council (now the Board of Trustees) for its approval and this promoted the Council's request for a ruling by the Parliamentarian as recorded above.

1) Revision of the District Branch constitution to provide for chapter formation. 2) After the District Branch constitution is revised to provide for Chapter formation and is

approved by the membership of the District Branch, it should be certified by the officers of the District Branch giving the date of certification and then sent to the Parliamentarian of the Assembly of the American Psychiatric Association for review. In that review of the constitution, the Parliamentarian will be sure that none of the rules of the Assembly are contravened in the new arrangement.

3) If the revised constitution is acceptable, the Assembly Committee on Procedures will present the revised constitution to the Executive Committee for approval.

4) The revised constitution concerning Chapter formation defines clearly the relationship that will exists between the Chapter and the District Branch with respect to the processing of new membership applications.

5) All correspondence and the negotiations on membership issues shall be held directly between the District Branch and the Association only.

ARTICLE IV: MINORITY/UNDERREPRESENTED GROUPS

1. Representation for Minority/Underrepresented Groups of Members

a. The identified minority groups to have representation in the Assembly are: American Indian, Alaska Native, and Native Hawaiian; Asian-American; Black; Hispanic; Lesbian, Gay and Bisexual; Women; and International Medical Graduate psychiatrists.

b. Prior to each annual meeting, there will be an opportunity for psychiatrists who qualify for inclusion within one of the Minority/Underrepresented (MUR) groups and who are voting members of the APA to choose to enroll with the Central Office as a member of a minority/underrepresented group. A member may enroll in more than one M/UR caucus but may vote and/or hold elected office only in one M/UR caucus one group. The enrollment will be implemented through the Membership Department of the Association and the opportunity for enrollment and the date of each caucus meeting will be publicized in Psychiatric News accompanied by an enrollment form. Members will identify their voting caucus at the time of enrollment and may change it only once per year (on a May to May schedule).

c. Selection Assembly of Representatives and Caucus Executive Committee Each caucus will develop election procedures to select nominees for Representative and Deputy Representative to the APA Assembly, President and up to two other caucus Officers. Together, these Officers shall be the Executive Committee of the Caucus. These nominees must be APA voting members and voting members of the caucus for which they seek office. Nominations for these offices shall take place at the annual caucus meeting and by petition, with election to be hosted by the APA Central Office through electronic survey. The term of office for any position on the Executive Committee shall be three years and no Officer shall hold the same office for more than two consecutive terms or be a member of the Executive Committee for more than twelve consecutive years without a two year hiatus between elections. Notification of the Executive Committee members and their terms of office shall be given to the APA Central Office no later than 15 days prior to the APA Annual Meeting.

d. Voting and Responsibilities of Assembly Representatives from M/UR Caucuses 1) The Representatives will each have one vote in the Assembly and will have all of the

privileges of any other Representative of the Assembly. The Deputy Representative will have all the privileges of any Deputy Representative of the Assembly.

2) It will be the responsibility of the Representative to provide a report to the minority group after each Assembly meeting regarding all issues considered and the Representative's vote on those issues that come to vote.

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e. The Representative and Deputy Representative must belong to the District Branch of their

residence or professional practice and will be members of their respective or assigned Area Councils with a vote.

f. The representatives from the seven Minority/Underrepresented Groups are members of the Assembly, and will continue as permanent members until the Assembly or the respective caucuses from which they are elected determine that potential patients and other citizens with similar minority characteristics no longer have needs which are repeatedly neglected, ignored, or violated within the society and that their mental health has not been adversely affected in a significant way. Caucuses shall meet in person at least once at the Annual Meeting and are encouraged to have quarterly meetings by telephone. The regular reports of the Minority/Underrepresented Groups to the Assembly should reflect on an ongoing basis the problems and progress in solving the problems that affect minority/underrepresented psychiatrists and the patient populations that they reflect.

g. The designated underrepresented groups of members shall arrange mechanisms for recall of Minority Representatives and Deputy Representatives and for replacement of vacancies in those offices whenever such is necessary.

2. Formal Representation within the Assembly of Subsequent Underrepresented Groups

a. The category of "underrepresented" or "minority" necessitates certain elements; a previously and autonomously formed organization of such APA members, with recognizable common individual characteristics, must demonstrate that: 1) Underrepresentation of such members exists within APA's governing bodies and committee

structures, with such underrepresentation related to their characteristics as a minority; 2) Potential patients and other citizens with similar minority characteristics who have had

interests, rights, and needs repeatedly neglected, ignored, or violated within the society, such that their mental health has been adversely affected in a significant way; and

3) The number of APA psychiatrists with a potential to belong to such a designated group must be of significant size.

b. The group shall apply to the Assembly Speaker for consideration of such designation. c. The application shall be reviewed by the Committee on Procedures for procedural conformance

with the criteria listed under A. d. The Assembly may act to:

1) Recognize the APA Minority membership with such identifiable common individual characteristics and grant Assembly Minority representation status for such members;

2) Suggest special Assembly Observer status for the petitioning group; 3) Refer the issues with which the specific group is concerned to another APA component for

study and action; and/or 4) Deny the request.

e. If the Assembly acts to grant Assembly Representation Status (D-1 above) the procedure for nominating potential Assembly Minority Representatives and Deputy Minority Representatives in this category shall be instituted promptly, consistent with present practices in the Procedural Code of the Assembly.

f. The Assembly and the underrepresented group are encouraged to refine criteria for the determination as to when an underrepresented group has achieved the group's and the Assembly's common goals, and thus when special representation is no longer needed.

ARTICLE V: ACROSS

1. Professional organizations of psychiatrists with subspecialty skills and interest that have been in

existence for 5 years, have at least one meeting of its membership annually, and whose mission and code of ethics are not in conflict with those of the American Psychiatric Association, may apply for designation as Assembly Allied Organizations. If the organization is international, its US branch may apply for designation as an Allied Organization. Such organizations, not to exceed 25 at any one time, may be designated Allied Organizations if they meet the requirements below in Section 1 through 3.

a. The organization has a minimum of 100 APA member psychiatrists OR if the organization was an

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Assembly Allied Organization as of January 1, 2015, it has more than 60 but fewer than 100 member psychiatrists (grandfathered allied organizations).

b. Psychiatrists comprise a majority of voting members of the organization. c. At least 40% of the total number of psychiatrist members are members of the America Psychiatric

Association. 2. Application for designation as an Assembly Allied Organization shall be made to the Committee on

Procedures. Applications shall include a complete organizational membership list with name, address, professional degree and APA membership status, if known, so that items b and c above may be calculated. If APA member status is not known, the APA will use the membership list to ascertain APA membership status. Submitted membership lists of allied organizations will be kept confidential, used for the sole purpose of determining adherence to stated criteria and will not be used by the APA for any other means or distributed to other individuals or organizations.

2.1 An organization may request exemption from the requirement for providing a membership

list through a letter to the Assembly Speaker explaining why it would be a hardship or risk to the organization or its members to do so. Such organizations shall seek the alternative to 1 a, b and c above of providing the names of 100 APA member psychiatrists (or at least 60 APA member psychiatrists for grandfathered allied organizations) to the APA and the total number of psychiatrists and total members in the organization. In no instance shall an organization be approved for exemption from the requirement to provide a membership list if it makes its members‘ names available to the public or to other non-profit or commercial entities. The Speaker and Assembly Executive Committee shall review such letters and vote on the requested exemption. A majority vote of the Assembly Executive Committee is required to support the exemption, and the decision of the Assembly Executive Committee is final.

2.2 The names of those organizations that meet requirements will be forwarded to the

Assembly Executive Committee for review and recommendation to the Assembly, where authority for final approval as Assembly Allied Organizations resides, based on a majority vote of the Assembly. The Speaker may solicit applications from appropriate organizations.

2.3 The APA will establish a formal written agreement with each allied organization. The APA will explore the potential for a business arrangement with each allied organization; i.e., member recruitment via joint dues agreement, lobbying efforts, and other professional management services. All organizations shall work annually to increase the percentage of their members that are APA members and report these efforts to the APA at periodic reviews. Those organizations with less than 60% APA membership among psychiatrist members shall make such appeals at least twice annually to its members to join the APA.

3. Each Assembly Allied Organization shall choose or elect one member who is also a member of the American Psychiatric Association to be a subspecialty representative to the Assembly and an Area Council. Subspecialty representatives will become members of the Assembly, each with voice and one vote, but one vote for each organization in a vote by strength. Subspecialty representatives will be assigned by the Speaker to an Area Council and to Committees and Components where their expertise can be utilized at the Speaker‗s discretion. They will also have membership on the Assembly Committee of Representatives of Subspecialty and Sections (ACROSS).

3.1 Subspecialty representatives and their organizations shall have the following obligations:

a. The organization shall keep its Assembly Subspecialty representative informed of policy positions by the organization b. The subspecialty representative shall report to the organization about APA actions. c. The organization shall provide information about APA actions to its members. d. The organization shall report about performance of a through c above as part of the periodic review. e. The subspecialty representative will make a yearly report to the APA, via the Assembly Committee of Representatives of Subspecialty and Sections (ACROSS), on organizational activities relevant to the APA.

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4. Each Assembly Allied Organization shall have its status reviewed every five years by the Committee on Procedures for adherence to requirements in Sections 1 through 3 or at other intervals determined by the Assembly Executive Committee if it has reason to believe that adherence to the requirements is in question. Each Allied Organization shall submit documents proving their continuing adherence to Assembly requirements as part of the Five Year Review, Such documents will include a current membership list or request for exemption, as above. An allied organization falling below the established criteria for representation in the Assembly will be allotted two years to achieve adherence. Failure to do so may result in non-participation within the Assembly.

ARTICLE VI: SECTIONS

1. Definition: A section will be formed when a group of APA members join together, and are assigned

to the Assembly. That joining would follow the APA Operations Manual pertaining to Special Caucuses (Appendix R: Special Caucuses – Framework for Establishment and Operation), and would be dependent upon the recommendation of the Joint Reference Committee and the Assembly Executive Committee, and the approval of the Board of Trustees. A section, like any caucus can be formed only when there is no other vehicle or subspecialty organization with similar interests already related to the APA. Any section with at least 50 active members has a voice in the Assembly. Any section with at least 100 active members for at least one year has a vote in the Assembly. If the section maintains at least 100 active members for 2 years, the APA will fund a section representative for Assembly meetings at which Assembly Allied Organization Subspecialty Representatives are funded to attend.

Composition and Appointment/Tenure: Self-selecting. The APA President, with consultation from

the Speaker, appoints a section‘s first leader for a one year term. After this term, the leader and the representative (who can be the same person) have to be fairly elected for not more than a single 2 year term.

Budget/Conduct of Business: (1) Sections do not have staff support. (2) May meet at Annual

Meeting and/or Institute of Psychiatric Services at no cost to APA. (3) Each section shall have its status and active members reviewed by the Committee on Procedures and approved by the Assembly Executive Committee annually or at other intervals determined by the Assembly Executive Committee. Failure to do so may result in non-participation within the Assembly. (4) The Assembly Executive Committee reviews and identifies need for identical sections. (5) IT support for a listserv or similar online community will be provided by the APA as described in the operations manual.

2. Purpose: The purpose of an APA section is to promote communication and networking among

psychiatrists/members of the association who share a special interest; and to provide a voice to association members who share a common interest so that they may bring to the Assembly‗s attention important or emerging issues that will affect patient care and the practice of psychiatry within that special interest area.

3. Requirements:

• Section members have to be members of the APA. • Sections operate under the oversight of the Assembly Executive Committee. This oversight

includes having the Committee on Procedures identify active members and determine whether sections are maintaining minimum number of members. The Committee on Procedures will serve as a resource on APA policy and operations. The Assembly Executive Committee will approve and certify the sections‘ review by the Committee on Procedures.

• An established Caucus requesting to become a Section shall ask the JRC to be reassigned to the Assembly.

• Activity of section members must be more than signing up on a listserv, but may be varied based on the composition, geographic dispersion, etc. of the section. The section will be responsible for determining the conduct that will define a member as active, and this will be subject to review and approval by the Committee on Procedures and the AEC.

• Sections‘ representatives are members of the Assembly Committee of Representatives of Subspecialties and Sections (ACROSS).

• Sections will not count against the maximum of 25 Assembly Allied Organizations as stipulated in

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the Procedural Code Article V: Allied Organizations. At the time 10 sections are certified, the Committee on Procedures will undertake a review of the sections‘ approval process and their functioning in the Assembly and make any recommendations it sees fit to the AEC to modify the Procedural Code.

• If an established Section‘s activities appear to overlap or compete with another vehicle or subspecialty organization already relating to the APA, the Assembly Committee of Representatives of Subspecialties and Sections (ACROSS) and the Assembly Committee on Procedures will make a recommendation on a corrective action plan to the Assembly Executive Committee. This may include the loss of participation in the Assembly for the section or the Assembly Allied Organization.

• Heads of Councils and Special Caucuses not assigned to the Assembly, shall be Privileged Guests at the Assembly.

• Senior Psychiatrists are a one-time exception to the model and will be required to meet the qualifications of an Assembly Allied Organization but will not count against the 25 Assembly Allied Organization limit.

• No section may speak on behalf of the American Psychiatric Association. • No section may request outside funding for any activity without the specific written approval of the

APA CEO and Medical Director.

ARTICLE VII: AMENDMENTS

1. Method of Initiation

Proposals to amend this Procedural Code may be initiated by

a. petition signed by five or more members of the Assembly b. resolution of the Assembly Executive Committee c. resolution of the Committee on Procedures

2. Submission of Proposed Amendments

A proposed amendment signed by five or more members of the Assembly must be submitted to the Recorder at least thirty days prior to the convening of the Assembly meeting at which it is to be considered. Following review by the Assembly Committee on Procedures, the Speaker shall place the proposed amendment on the agenda of the next meeting of the Assembly. The Assembly Executive Committee may initiate a proposed amendment by resolution approved by a simple majority and the proposed amendment shall be placed on the agenda of the Assembly.

3. Voting

After a proposed amendment is read at a meeting of the Assembly, it may be adopted at once by two-thirds majority ballot of the full Assembly.

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SAMPLE BYLAWS

SAMPLE

1 BYLAWS OF THE (Name of District Branch) OF THE AMERICAN PSYCHIATRIC

ASSOCIATION

CHAPTER ONE: NAME; PURPOSES; LEGAL IDENTITY

Section 1.1 Name The name of this organization shall be the (herein after referred to as the ―District Branch‖) of the American Psychiatric Association., (herein after referred to as the ―Association.‖) Section 1.2 Purposes and Objectives The purposes for which the District Branch is organized are: (a) to promote the common professional interests of its members; (b) to improve the treatment, rehabilitation, and care of persons with mental disorders (including mental retardation and substance-related disorders; (c) to advance the standards of all psychiatric services and facilities; (d) to promote research, professional education in psychiatry and allied fields, and the prevention of psychiatric disabilities; (e) to foster the cooperation of all who are concerned with the medical, psychological, social, and legal aspects of mental health and illness; (f) to make psychiatric knowledge available to practitioners of medicine, to scientists, and to the public; (g) to promote the best interests of patients and those actually or potentially making use of mental health services; and (h) to advocate for its members.

2

Section 1.3 Legal Identity The District Branch is organized exclusively as a professional organization not organized for profit, within the meaning of [Section 501(c)(6) of the Internal Revenue Code of 1986, as amended.] No part of the net earnings of the Association shall inure to the benefit of, or be distributable to, its members, trustees, officers or other private persons, except that the Association shall be authorized and empowered to pay reasonable compensation for services rendered and to make payments and distributions in furtherance of the purposes set forth herein.

3

Section 1.4 Dissolution In the event of dissolution, all assets of this District Branch shall be forthwith distributed to the APA solely for scientific and educational purposes. Section 1.5 Territorial Jurisdiction For the objectives stated above, the territorial jurisdiction of the District Branch shall be delimited by the boundaries of the (state/county) of .

4

CHAPTER TWO: MEMBERS

Section 2.1 Requirements for Membership Requirements for membership in the District Branch shall be the same as those for the Association at the time of application.

5

1 The following is intended only as a guide and may be altered in form or wording to meet the needs of

the individual district branch. 2 Paragraph applies to 501(c)(6) organizations. For 501(c)(3) organizations, item (h) should read ―to

advocate for its members, to the extent consistent with Section 1.3 below.‖ Section 1.3 should read: ―No substantial part of the activities of the District Branch shall be the carrying on of or otherwise attempting to influence legislation, and the District Branch should not participate in or intervene in (including the publishing or distribution of statements of) any political campaign of any candidate for public office.‖ 3 Alternate wording: Change the bracketed portion to the applicable Section of the IRS code and include

the sentence: ―The shall remain/shall be incorporated under the laws of the State of as a nonprofit scientific organization.‖ 4 Alternate wording for branches not defined by geography: ―For the objectives stated above, the

jurisdiction of the District Branch shall be defined as .‖ 5 It is important to include a statement to this effect.

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Section 2.2 Qualifications Any physician who is eligible for the categories of membership below shall be eligible for membership. Section 2.3 Categories of District Branch membership There shall be the following categories of members who are to qualify according to the standards and procedures of the Association as set forth in Chapter 2.1 of the APA Bylaws. They are (a) Resident-Fellow Members; (b) Associate Members

6; (c) General Members; (d) Fellows; (e) Distinguished Fellows

(f) Life Members; (g) Life Fellows; (h) Life Associate Members; (i) Distinguished Life Fellows; (j) Inactive Members or (k) Inactive Fellows.

7

Section 2.4 Voting The right to vote shall be the same as in the APA Bylaws. Members with voting rights are Resident-Fellow Members, General Members, Fellows, Distinguished Fellows, Life Members, Life Fellows, and Distinguished Life Fellows. All other categories of membership are non-voting. Each voting member shall have one vote. Section 2.5 Election to Membership Election to membership in the District Branch shall be as follows

8:

(a) A Committee on Membership, consisting of members, shall be appointed by the President and

approved by Council. Each member of this committee will serve a three-year term, with one or more members of this committee rotating off each year. Terms of the first members appointed after adoption of this section shall be adjusted accordingly.

(b) Applications for membership in the District Branch shall be made in accordance with procedures

established at that time by the APA Board of Trustees through its Membership Committee. (c) Membership actions will become effective after initial approval by the APA and with input from the

District Branch if provided within the specified time period.

(d) Categories of membership and qualifications thereof in District Branches shall be consistent with

those of the Association. 9

Section 2.6 Transfer and Advancement Procedures for transfer of membership between District Branches and for advancement of membership shall be established by the Association. In the event of such a transfer or advancement being denied, any appeal shall be conducted in accordance with procedures to be established at that time by the Association. Section 2.7 Application of Fellows and Nomination of Distinguished Fellows Application of General Members for fellowship status is primarily the responsibility of the APA. Nomination of General Members or Fellows for distinguished fellowship status is primarily the responsibility of the District Branch. Election of Fellows and Distinguished Fellows is by the Board of Trustees of the Association upon recommendation of the Association‘s Membership Committee.

10

6 Associate Member category closed to new members since December 1989.

7 Some categories of APA membership are not required to join a district branch (Medical Student

Members, Honorary Fellows) or are outside the jurisdiction of a district branch (International Members and International Fellows). 8 APA moved all provisions for membership processing to its Operations Manual. Alternate wording for

Section 2.5 could simply be: ―Applications for membership in the District Branch shall be made in accordance with procedures established from time to time by the Council.‖ 9 As illustrated in Section 2.5 (a) – (d), the bylaws should describe (1) the procedures to be used for

applying for membership and (2) the agreement of the district branch to cooperate with the rules and regulations of the Association. 10

Criteria for these procedures are in Chapter 2 of the APA Bylaws and Chapter 5 of the Operations Manual of the Association; the appeals process is in Appendix K-5 of the Operations Manual of the Association.

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Section 2.8 Dues Every (Life Member, Life Fellow, Life Associate, Distinguished Life Fellow)

11 Fellow, Distinguished

Fellow, General Member, Associate Member, and Resident-Fellow Member shall pay both dues and assessments as determined by the District Branch. Section 2.9 Inactive Status and Dues Waiver Members of any category may be placed in inactive status by the Board of the Association and excused from paying dues in both the Association and the District Branch. Inactive members shall not receive credit toward the number of years of active membership required for Life status for those years of inactive status. Active members may be granted waiver of dues by the Board of the Association for sufficient reason, and such members shall receive credit toward the number of years of active membership required for Life status for those years the members are in the dues waiver status. Section 2.10 Dismissals and Resignations

(a) Any dues-paying member of the Association and/or the District Branches who fails to pay all dues and assessments will forfeit his or her memberships.

(b) See also Chapter Seven, Ethics Complaints and Disciplinary Procedures.

CHAPTER THREE: COUNCIL

Section 3.1 Number The voting members of the Council shall consist of a President, a President-Elect and/or Vice President, a Secretary and a Treasurer. These officers, the three immediate Past Presidents, Representative and Deputy Representative to the Assembly of the American Psychiatric Association, and other voting members duly elected as Councilors shall constitute the Council. In addition, Chapter Presidents (or their designates) shall also become members of Council

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Section 3.2 Nomination Procedures Only voting members shall be eligible for nomination and election to office. All officers shall be elected in the following manner:

(a) A Nominations and Elections Committee, composed of at least three (3) members who shall be appointed by the Council and announced to the District Branch.

13 This Committee will present its

recommendations to the District Branch at the __________ meeting.

(b) Any voting member may, on his or her own initiative, make a nomination for any office by a letter which reaches the President in time for him or her to present it to the District Branch at the next meeting. Nominations for more than one office may be made by such letter, if it is endorsed by a number of voting members equal to the number of nominations made.

(c) At the __________ meeting, the President will accept further nominations, if any, from the members present at this meeting. If there is no contest for any office after nominations are received at the __________ meeting, the President may call for an immediate vote of the membership and unanimous election of the proposed slate may be effected. If there is a contest for one or more office, the Secretary will send a mail ballot thereafter to all voting members with the ballot containing all nominations.

(d) Election will be affected in the following manner: all ballots received by the Nominations and

11

Requiring dues payments from Life Members, Life Fellows, Life Associates, and/or Distinguished Life Fellows is optional for the district branch. 12

The District Branch may have such officers as are felt to meet local needs. 13

Qualifications for members of the Nominations and Elections Committee should be spelled out. According to The Standard Code of Parliamentary Procedure by Alice Sturgis such members should not be appointed by the President.

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Elections Committee by the specified date will be tabulated, and an announcement will be made made at the __________ meeting of the District Branch. The candidate for each office receiving the greatest number of votes shall be declared elected.

Section 3.3 Quorum; Action A majority of the voting members of the Council shall constitute a quorum of the Council. % of active members of the District Branch shall constitute a quorum of the District Branch. Unless otherwise provided in these bylaws, the act of a majority of the voting members present at any meeting at which there is a quorum shall be the act of the Council. Section 3.4 Meetings Meetings of the Council/District Branch shall be held

14unless otherwise determined

by the Council. The annual business meeting shall be held in Special meetings may be called by the President or upon petition signed by members of the District Branch. Members shall be notified of meetings by the Secretary not less than one week before the meeting. The procedure of the District Branch shall be governed by The Standard Code of Parliamentary Procedure by Alice Sturgis.15

CHAPTER FOUR: OFFICERS

Section 4.1 Officers Designated The officers of the District Branch shall include a President, a President-Elect or Vice-President, a Secretary, a Treasurer, or a Secretary/Treasurer, and such other officers and assistant officers as the Council may from time to time determine. No two offices may be held by the same person. Section 4.2 President The President shall be the chief executive officer of the District Branch. The President shall preside at all meetings of the membership and of the Council and shall otherwise perform such duties as are customary for presiding officers. Section 4.3 President-Elect/Vice President The President-Elect or Vice President, in the absence of the President, shall perform the duties of the President. The President-Elect shall assume the office of President as of the last day of the Association annual meeting on or about one year following his/her election as President-Elect. The President-Elect shall assist the President by acting as overall coordinator of all committee functions. Section 4.4 Secretary The Secretary shall keep a record of the proceedings of all meetings of the District Branch and of the Council; keep a list of all members; issue notices of all meetings; notify officers and members of committees of their election or appointment; and certify all official records. Section 4.5 Treasurer The Treasurer or agents authorized by the Council to act for the Treasurer shall have charge of all funds and collect all dues; pay all expenses of the District Branch by and with the consent and approval of the membership; make an annual report to the District Branch on the official transactions of income and expenditures of the District Branch at a specified meeting; and sign all checks of the District Branch. Section 4.6 Representative to Assembly The Representative to the Assembly of the American Psychiatric Association shall represent the District Branch in the Assembly and/or its subgroups, at all official meetings of the Association, and report back to the District Branch.

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at least annually 15

The Assembly strongly encourages District Branches during the next review of their bylaws, to adopt the APA District Branch Model Bylaws (which is the source the Committee uses to review their bylaws) incorporating modifications in accordance with their state law.

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Section 4.7 Assumption of Office All officers shall assume their respective offices at the close of business on the last day of the Annual Meeting of the Association, and with the exception of the Representative to the Assembly, shall continue in office for one year/two years, or until their successors are duly elected and assume office. The Representative to the Assembly shall continue in office for two years (or three years), or until his/her successor is duly elected and assumes office. Section 4.8 Recall An action for recall of an officer or any member of the Council of the District Branch may be initiated by a petition signed by voting members of the District Branch or by a majority of the voting members of the Council. The petitioners shall set forth the reasons for initiating the petition and this shall be forwarded to the Secretary with a copy to the officer in question. A mail ballot shall then be sent to the general voting membership of the District Branch to be returned no later than days upon its issuance. Recall shall be effected if two-thirds of the voting membership so indicates. Section 4.9 Vacancies Vacancies among the officers shall be filled as follows:

(a) President If the office of President becomes vacant, the President-Elect will become Acting President for the remainder of the year and then will begin his/her term as President.

(b) President-Elect If the position of President-Elect becomes vacant, the President will request the Nominations and Election Committee to meet at an early date for the purpose of selecting one or more candidates for President-Elect. As soon as practical, at a regular or special meeting, a new President-Elect will be chosen. The person so chosen will serve as President-Elect until the end of the year, when he/she will become President.

(c) Representative to the Assembly If the position of Representative to the Assembly becomes vacant, the District Branch shall appoint a Representative to the Assembly who will assume the duties of the office until the following Annual Meeting, when a new Representative to the Assembly shall be elected.

(d) Other Vacancies In the event any other office becomes vacant before expiration of a term, the Council shall elect a member to serve for the remainder of the term.

CHAPTER FIVE: REPRESENTATIVES

The District Branch shall be represented at the meetings of the Assembly of District Branches of the American Psychiatric Association and the Area Council by a Representative and a Deputy Representative. Such Representatives shall be elected as other officers of the District Branch and shall serve for a term of two/three years or until a successor is elected. When appropriate, such Representatives shall be instructed by Council and/or District Branch as to its wishes on various matters. Representatives shall submit reports to the District Branch on the activities of the Assembly and the Area Council.

CHAPTER SIX: COMMITTEES AND OTHER ORGANIZATIONAL ENTITIES

There shall be the following standing committees: .

16 The functions

and procedures of such standing committees shall be established from time to time by the Council and published in the Operations Manual. The Council, upon recommendation of the President, shall establish or eliminate such other committees and organizational entities as may be necessary to implement the objectives of the District Branch. The Council, upon recommendation of the President, shall designate the

16

APA standing committees are Ethics, Membership, Nominating, Bylaws, Budget, Tellers, Elections, and Reference. Standing committees are those which cannot be eliminated without amending the bylaws.

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chair and members of each standing committee and each other committee or organizational entity from among the voting members

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CHAPTER SEVEN: ETHICS COMPLAINTS AND DISCIPLINARY PROCEDURES

Section 7.1 Code of Ethics All members of the District Branch shall be bound by the ethical code of the medical profession, specifically defined in the Principles of Medical Ethics of the American Medical Association and in the Association‘s Principles of Medical Ethics With Annotations Especially Applicable to Psychiatry. Section 7.2 Ethics Complaints Complaints charging members of the District Branch with unethical behavior or practices shall be investigated, processed, and resolved in accordance with procedures approved by the Assembly and the Board of Trustees of the Association. The name of a member who resigns during an ethics investigation will be reported to the membership.

CHAPTER EIGHT: CHAPTERS

Section 8.1 When a group of not less than ten members residing in a contiguous geographical locality within the State of __________ desire to create a Chapter of the __________ District Branch, they will proceed in the following manner:

(a) They will submit to the Secretary of the __________ District Branch a petition personally

approved by signed statement of the proposed Charter Members signifying their intention to conduct their chapter organization and business in accordance with the Bylaws of the __________ District Branch and proposing the designation by which it would be known and requesting a specific geographic jurisdiction.

(b) The Council will consider the application and make a report and recommendation to the membership of the District Branch at a regular or special meeting.

(c) If approved by a majority vote of the members present and voting, the Chapter will be created, subject to the provisions of Section 2 of this Article.

At the time when Chapters are first formed, a smaller group may petition for Chapter status and be approved by the Council on grounds of distance from the center of other Chapter groups. Section 8.2 Following the approval of the first Chapter, the rest of the state may thereafter be organized into one or more Chapters in accordance with the procedure above. Section 8.3 Classification of membership and qualification for membership shall be the same as for the District Branch and the APA. Application for membership in the District Branch from within the territorial jurisdiction of a Chapter shall be made in accordance with procedures established from time to time by the APA Board of Trustees through its Membership Committee. Members of Chapters and members of District Branches must be members of the Association. Members in the __________ District Branch residing or practicing within the political boundaries of the State of __________, but outside the territorial jurisdiction of any approved District Branch Chapter, may choose the Chapter to which they wish to belong until such time as a new Chapter may be formed to include their place of residence or practice.

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APA is incorporated under the laws of the District of Columbia, which requires that the Board of Trustees, not the president, be responsible for establishing or eliminating components and appointing their personnel. District Branches should write this section to reflect the laws of the jurisdiction under which they are incorporated.

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Section 8.4 The Officers of the Chapter will consist of a President, President-Elect, Secretary, Treasurer, and three Councilors, one of whom shall be, after the first year, the immediate Past-President. The President of the Chapter, or his or her designate, shall be a member of the Council of the __________ District Branch. Chapter Officers shall be elected at an annual meeting to take place prior to the Annual Meeting of the American Psychiatric Association, and will assume their new responsibilities each year at the close of business of that Annual Meeting in the same manner as the officers of the District Branch. Section 8.5 Chapters may form such committees as desired by the officers and the members. Chapters shall have equal representation on all District Branch committees insofar as possible, the members of which shall be chosen by the District Branch President or Council from nominees including those submitted by the Chapter President. Section 8.6 All meetings of each Chapter shall be open to attendance by any member of the District Branch. Each Chapter shall have sufficient meetings to conduct necessary business and to further the goals of the Chapter and the District Branch.

CHAPTER NINE. AMENDMENTS OF THE BYLAWS

Amendments to the Bylaws may be initiated by a majority vote of members present at a business meeting of the District Branch, a quorum being present. The Council will, at is next regular meeting, make a recommendation about the proposed amendment. Council may also originate amendments by three-fourths vote of its members. The Secretary will then send a mail ballot to all members, including the full text of the proposed amendment, the recommendation about it made by the Council, and stating the date on which the mail ballots are to be counted. The amendment will become effective, if approved by a majority of the mail ballots returned by the specified tabulation date. An amendment may alternatively be approved by a two-thirds vote of the members of a regular meeting. CERTIFICATE I, , Secretary of the (district branch) of the American Psychiatric Association, certify that the foregoing is a true copy of the current bylaws of the Association as amended on (date).

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AREAS OF THE ASSEMBLY (By State or Territory)

AREA 1 AREA 5

Connecticut Alabama Maine Arkansas Massachusetts Florida New Hampshire Georgia Ontario Kentucky Quebec and Eastern Canada (Nova Scotia, New Brunswick, Newfoundland, Prince Edward Is.)

Louisiana Mississippi

Rhode Island North Carolina Vermont Oklahoma

AREA 2 Puerto Rico

New York South Carolina

AREA 3 Tennessee

Delaware Texas Maryland (excluding suburban Maryland) Virginia (excluding suburban Virginia) New Jersey West Virginia Pennsylvania Uniformed Services Washington, DC (City of DC, suburban Maryland, suburban Virginia)

AREA 4 AREA 6

Illinois California

Indiana AREA 7

Iowa Alaska Kansas Arizona Michigan Colorado Minnesota Hawaii Missouri Idaho Nebraska Montana North Dakota Nevada Ohio New Mexico South Dakota Oregon Wisconsin Utah Washington Wyoming

Western Canada (Alberta, British Columbia, Manitoba Saskatchewan)

ALLIED ORGANIZATION LIAISONS 1. Academy of Psychosomatic Medicine 2. American Academy of Addiction Psychiatry 3. American Academy of Child & Adolescent

Psychiatry 4. American Academy of Clinical Psychiatrists 5. American Academy of Psychiatry & Law 6. American Academy of Psychoanalysis and

Dynamic Psychiatry 7. American Association for Emergency

Psychiatry 8. American Association of Community

Psychiatrists 9. American Association of Geriatric Psychiatry 10. American Association of Psychiatric

Administrators 11. American Association of Social Psychiatry 12. American Group Psychotherapy Association 13. American Psychoanalytic Association 14. American Society for Adolescent Psychiatry 15. Association of Family Psychiatrists 16. Association of Gay and Lesbian

Psychiatrists 17. Senior Psychiatrists 18. Southern Psychiatric Association

ASSEMBLY COMMITTEES AND TASK FORCES 1. Awards Committee 2. Committee of Area Early Career

Psychiatrists 3. Committee of Area RFM Representatives 4. Committee of Representatives of

Minority/Underrepresented Groups 5. Committee of Representatives of

Subspecialties and Sections (ACROSS) 6. Committee on Procedures 7. Committee on Public and Community

Psychiatry 8. Nominating Committee 9. Reference Committees

10. Rules Committee

assembly executive committee meeting the grand hotel ... library/about-apa/meet...assembly executive...

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