In 1974, the American Medical Association (AMA) acknowledged physician impairment from alcoholism and drug dependence occurs, and recognized alcoholism and addiction as illnesses. Physician illness and impairment exist on a continuum with illness typically predating impairment, often by many years. This is a critically important distinction. Illness is the existence of a disease. Impairment is a functional classification and implies the inability of the person affected by disease to perform specific activities.
OBJECTIVE: Psychiatrists and other clinicians frequently prescribe psychotropic drugs that may prolong cardiac repolarization, thereby increasing the risk for torsades de pointes (TdP). The corrected QT interval (QTc) is the most widely used and accepted marker of TdP risk. This resource document was created in response to the paucity of strong evidence to guide clinicians in best practice prescription and monitoring of psychotropic medications that may increase risk of TdP.
Advocacy, generically defined as the active support for a particular cause, policy, or issue, is applicable to medicine and psychiatry as physicians’ responsible use of “their expertise and influence to advance the health and well-being of individual patients, communities, and populations” (Frank, 2005). Advocacy can be undertaken from within an organization or as an outside stakeholder, and it can focus on a single theme (e.g., Barber, 2008) or more generally on issues that relate to patient needs, including the social determinants of health (e.g., Chin, 2017). Although the concept of advocacy is commonly linked to legislative advocacy, a specific arena of advocacy that seeks to influence policy and politics, it is also applicable more broadly to other activities that physicians undertake to support specific causes (e.g., community-level advocacy to avert the shutdown of a homeless shelter, interviews with the lay media as advocacy to inform public opinion).
Resource Document on Core Principle for Alternative Payment Models for Behavioral Health The APA’s Position Statement enunciates 10 principles. These are presented below along with their supporting background information. The first principle declares that the predominant goals for behavioral health APMs should be defined as increasing access and improving quality of care for individuals with mental health and substance use disorders (MH/SUDs), in order to improve outcomes.
In 2014, the American Psychiatric Association (APA) published a “Resource Document on Access to Firearms by People with Mental Disorders,”1 which addressed the complex relationship between firearms, mental illness, suicide, and violence. The document highlighted the limitations of existing legislative strategies, such as the National Instant Criminal Background Check System (NICS), in combating the problems of gun-related suicide and violence in the United States. It noted that registries like NICS can be helpful in some situations, but they are minimally effective in identifying people at acute risk of harm to self or others. In addition, they can unfairly stigmatize individuals with mental illness.
The APA will advocate for: 1. Increasing telemedicine and telepsychiatry research. 2. Developing and promoting telepsychiatry best practices.
This Resource Document aims to highlight some important safeguards and best practices for Physician Health Programs (PHPs) for physicians who seek help voluntarily from PHPs as well as those who are mandated participants. These suggestions are intended to help PHPs and their affiliates to align their practices and procedures with the goals of treatment and to minimize the risk of adverse outcomes, both for the public and for the physicians who participate in PHPs.
Over the past two decades, a number of US states have enacted statutes legalizing the practice of physician-assisted death (PAD).12 In 1997, Oregon passed the first statute that legalized PAD. Washington (2008), Vermont (2013), California (2015), and Colorado (2016) have followed suit. In addition, a state court ruling in Montana legalized PAD in 2009. In 2015, the Supreme Court of Canada ruled PAD to be legal and the Canadian Parliament subsequently enacted a law to implement PAD. In February 2017, PAD was legalized in the District of Columbia. Legalization of PAD has been proposed in about half of all states in recent years (for details, see www.deathwithdignity.org). There appears to be a broad movement to consider legalization of PAD that may lead to legislation in other states. In the United States, PAD statutes have been restricted to patients with terminal illness, typically defined as an illness that is irreversible and likely to lead to death within six months.
Climate change is recognized as one of the top threats to global health in the 21st century. Mental Health impacts of climate change are significant sources of stress for individuals and communities. The social and mental health consequences of extreme and slow-moving weather events are well documented, ranging from minimal stress and distress symptoms to clinical disorder, including depression, anxiety, post-traumatic stress, and suicidal thoughts (Arnberg et al., 2013; Fullerton et al., 2013; North et al., 2004). High risk coping behavior, such as alcohol use, has been associated with climate related weather events (Flory et al.,2009; Rohrbach et al., 2009). Intimate partner violence may increase as well, with women being particularly effected (Harville et al., 2011; Fisher, 2010). Suicidal thoughts and behavior have been shown to increase following extreme weather events (Kessler et al., 2008; Larrance et al., 2007). In addition, population displacement and migrations, breakdown of community infrastructure, food scarcity, loss of employment, and poor sense of social support and connectedness have serious consequences for mental health (Chan et al., 2015; Benight et al.,1999; Ursano et al., 2014).
Synchronous video-conferencing in psychiatry began during the 1950s. Synchronous video-conferencing became increasingly common during the 1970s and 1980s. By the early 2000s, the Department of Veterans Affairs was building a national telemedicine program including video-conferencing.
The introduction of web search engines and their development in the 1990s dramatically changed the landscape of information gathering. With only a few clicks on a computer, cellphone or other device, an individual could access information on a wide range of topics in a matter of seconds, including personal information of others. To “Google” for information (i.e., to research something via Google or other search engines) has become routine in our daily endeavors. Search engines and social media such as Facebook, YouTube, Instagram, and so on, provide a ready trove of information on people, events, places and things. They encourage individuals to post personal information on these sites that can be easily accessed by others.
College homicides and suicides often precipitate reviews of regulations, statutes and case law governing treatment and confidentiality.1 In April 2007, for example, a college senior at Virginia Polytechnic Institute and State University killed 32 students and faculty, wounded many others and then killed himself. The review panel appointed by the Governor found significant confusion among university officials about the Family Educational Rights and Privacy Act (FERPA)2, the federal law governing confidentiality of educational records, leaving them uncertain about what information could be revealed to each other as well as to the student’s parents.3 Psychiatrists seeing students as patients in college settings, either as employees of student mental health services or as private practitioners in the community, have also been confused as to their relationship to the university and the effect of federal and state laws governing confidentiality. This resource document was prepared to give practitioners a guide to providing good clinical care within the framework of relevant law.