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How Psychiatrists Can Talk to Patients and Families About Race and Racism
This document supports the APA’s goal of addressing structural racism in clinical practice by linking existing literature on the impact of race on patients’ lives with race as experienced in the clinical encounter. It provides psychiatrists with the necessary tools to speak with patients about race in a sensitive and professional manner using clinical vignettes. Incorporating these tools should increase understanding of how race and racism impact patients’ lives, decrease bias and enhance the therapeutic relationship. This document also encourages readers to seek to understand patients’ cultural and linguistic backgrounds as the beginning of any conversation about race, racism and discrimination. The authors believe this is the bedrock of culturally competent care, whether with a French speaking African immigrant, a Spanish speaking Latinx, or a Black teenager raised in the American South now living in the Northeast, as reflected in the included vignettes. The authors also acknowledge that racial groups are not homogeneous and that the focus on culture and language is intended to help psychiatrists focus on the unique aspects of an individual’s experiences in addition to talking about racial discrimination and bias.
Mental Health Courts
Mental health courts (MHCs) are one of a range of “problem-solving courts” operated on the premise that the criminal law can be used to therapeutic ends to the benefit of both individual defendants and society as a whole, a concept known as therapeutic jurisprudence (Winick 2003). Other examples of problem-solving courts include homelessness courts, veterans’ treatment courts, and domestic violence courts. Many psychiatrists are unfamiliar with MHCs despite their rapid expansion in recent years. The purpose of this resource document is to describe the concepts behind and operations of MHCs and review their role and effectiveness.
Non-Emergency Involuntary Medication for Mental Disorders in U.S. Jails
Psychiatrists who work in jail settings will encounter patients for whom the administration of non-emergency involuntary medication is clinically indicated for the stabilization of their serious mental illness. This resource document is intended to guide psychiatrists in decision-making about non-emergency involuntary psychiatric medication administration in U.S. jails by providing background information and highlighting issues for consideration.
Education and Training for Substance Use Disorders
Current training of physicians in the recognition and treatment of substance use disorders (SUD) is inadequate to meet the needs of such a diverse and growing population of patients. Medical schools, physician training (residency) programs, and continuing education programs for physicians in practice, provide limited training in the treatment of SUDs. The scope of training on SUDs is disproportionate to the population health need to address these problems, and many with SUDs go undiagnosed and untreated. In the past decade there have been marked advancements in the science of addiction, which includes an expanding range of evidence-based pharmacologic and behavioral treatments. Despite these advances and a growing knowledge base, the educational requirements in psychiatry and other medical residencies have not shifted, leaving many physicians ill-prepared to manage SUDs in practice (1).
The Interface of Religion, Spirituality, and Psychiatric Practice
Psychiatry has historically been known to have an adversarial relationship with religion. One example can be found in the writings of Sigmund Freud, who was dismissive of religion and viewed it as a form of mental illness. Freud drew parallels between the rituals of obsessional patients and those of very religious people and concluded that religion was a universal obsessional neurosis (Breakey 2001). However, there are also works throughout history demonstrating the harmonious relationship between psychiatry and religion, suggesting that the notion of an adversarial relationship between the two may not be a complete picture (Frankl 1975, Meissner 1984, Meissner 1987).
Mental Health Issues Pertaining to Restoring Access to Firearms
Mental health courts (MHCs) are one of a range of “problem-solving courts” operated on the premise that the criminal law can be used to therapeutic ends to the benefit of both individual defendants and society as a whole, a concept known as therapeutic jurisprudence (Winick 2003). Other examples of problem-solving courts include homelessness courts, veterans’ treatment courts, and domestic violence courts. Many psychiatrists are unfamiliar with MHCs despite their rapid expansion in recent years. The purpose of this resource document is to describe the concepts behind and operations of MHCs and review their role and effectiveness.
Social Determinants of Health
All of these variables impede access to care, which is critical to individual health, and the attainment of social equity. These are essential to the pursuit of happiness, described in this country’s founding document as an “inalienable right.” It is from this that our profession derives its duty to address the social determinants of health.
Developing a Global Mental Health Curriculum in Psychiatry Residency Programs
As the importance and centrality of mental health becomes apparent within and beyond the health care sector, so will opportunities for psychiatrists to apply their knowledge and skills to meet the growing needs. Through careful attention to the moral imperatives and explanatory models among cultures that differ from their own, psychiatrists have been very successful in engaging local entities and establishing partnerships that incorporate trust, credibility, transparency, and accountability to achieve mutual benefits with communities. The following is a guide to assist psychiatry residency programs interested in developing and implementing a global mental health (GMH) curriculum, but unfamiliar with the nuances of GMH education and training. It may also be useful to medical students and psychiatric residents with interest in GMH education and training opportunities. This guide takes into consideration both an international and a domestic scope of GMH with a key focus on curriculum development addressing inequalities among people from various cultures. This guide is developed by the American Psychiatric Association (APA) Council on International Psychiatry, with support by the APA Caucus on Global Mental Health and Psychiatry.
Responding to Negative Online Reviews
The American Psychiatric Association (APA) Ethics Committee occasionally receives inquiries from members who are troubled by negative reviews about them or their practice posted online by patients or other individuals. This often creates a difficult dilemma for the psychiatrist who must respect the patient’s voice but also desires to preserve the integrity of the psychiatrist’s public image. This resource document is offered to provide guidance to psychiatrists regarding receipt of negative online reviews.
Stalking Intrusive Behaviors and Related Phenomena by Patients
The doctor-patient relationship should ideally be a collaborative and mutually respectful one. In some instances, however, patients may engage in behaviors that can engender concern and even fear in the psychiatrist involved. When these behaviors are repeated, unwanted, and distressing, we might colloquially refer to them as “stalking.” In the midst of a stalking episode, it may be difficult for the psychiatrist to know how to proceed, what steps to consider to protect oneself and what choices to consider to manage the patient-physician relationship. In this document we provide practical guidance for psychiatrists who may face these situations in the course of their work with patients. It was drafted via the consensus of individuals whose practices intersect at the interface of law and psychiatry and represents a range of voices and recommendations. It provides general guidance and is not considered dispositive for any particular response to specific situations. Individual circumstances may require courses of action that differ from those noted in this document.
Across State Line Psychiatric Consultation Considerations Addendum to Risk
In 2013, an APA Resource Document on “Risk Management and Liability Issues in Integrated Care Models” was developed.1 This document outlined liability issues in a new and emerging area of collaborative /integrated care. In this model psychiatrists’ expertise is leveraged through curbside consultations and caseload reviews to provide more effective care for mild to moderate behavioral health conditions in the primary care setting. With the advent of CPT codes for the Collaborative Care Model, there has been a noticeable increase in the number of requests psychiatrists are receiving to do indirect consultations, caseload reviews, and education in states where they are not licensed. Further, the use of telecommunication solutions to enhance and expand existing services in one state can lead to increases in requests for psychiatric consultation to address patient choice, peer consultation, and workforce shortages in another state. States are actively developing policies to address the issue of licensure requirements for these consultation services, including physician to physician (P2P) consultation
Decisional Capacity Determinations in Consultation-Liaison Psychiatry: A Guide for the General Psychiatrist
Consultation-Liaison Psychiatrists are experienced in responding to requests from medical services for the determination of decisional capacity (DC). General psychiatrists are occasionally called upon to perform decisional capacity determinations, especially when functioning in a consultation-liaison role. Some may not have extensive prior or current experience in decisional capacity determinations. In recent years, there has been a significant amount of clinical research literature on DC, particularly in a consultation-liaison clinical context. As such, having a review of the recent literature leading to an evidence-based, standardized approach to DC determinations is of pragmatic value to the general psychiatrist.