People with serious mental illness are substantially overrepresented in the criminal justice system. (Steadman, et al. 2009; Fazel et al. 2016) This results in a higher prevalence of mentally ill patients in correctional facilities than in the community and the high proportion of justice-involved patients in county and state mental health systems. State hospitals that remain after decades of deinstitutionalization have seen their beds fill with large proportions of criminal court commitments while civil commitments have diminished (Fuller et al. 2016). Public sector community mental health programs typically have sizable populations under an order for care and treatment through probation and parole conditions or conditional release from a hospital after an insanity acquittal (Fuller et al. 2016).
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.
Involuntary outpatient commitment is a form of court-ordered outpatient treatment for patients who suffer from severe mental illness and who are unlikely to adhere to treatment without such a program. It can be used as a transition from involuntary hospitalization, an alternative to involuntary hospitalization or as a preventive treatment for those who do not currently meet criteria for involuntary hospitalization. It should be used in each of these instances for patients who need treatment to prevent relapse or behaviors that are dangerous to self or others.
In this document, we address ethical and legal issues related to involving caregivers in the treatment of patients and provide a comprehensive approach to the engagement of caregivers in the treatment process. This approach revolves around the development and implementation of a caregiver plan (CGP). It is important to note that the development of a formal CGP does not reflect current practice in the field. The discussion of a CGP in this document is for education: to describe a potential best practice. Given the complexity of managing caregivers’ involvement, practitioners may find it useful to create formal CGPs.
Resource Document on the Need to Monitor and Assess the Public Health and Safety Consequences of Legalizing Marijuana
Resource Document on Psychotherapy as an Essential Skill of Psychiatrists
Gun violence is a major public health problem in our country. Recent data indicate that 19,392 people used a gun to kill themselves in 2010, and 11,078 killed someone else with a firearm (1). In 2003, the homicide rate in the United States was seven times higher than the average of other high-income countries (2). Although concern is understandably heightened when mass tragedies occur, the daily occurrence of scores of murders and suicides due to the use of guns rarely gets the attention afforded mass tragedies.
Resource Document on the Use of Antipsychotic Medications to Treat Behavioral Disturbances in Persons with Dementia
The goal of this resource document is to address the major areas of the use of the internet in communication with patients and the public in the practice of psychiatry. The rate of change of technological capabilities and their implementation is so rapid that the workgroup believes that it would be inappropriate to promulgate fixed rules for constantly changing situations. Rather, we seek to provide some questions to be considered when implementing any new communication technology with patients or the public. This document seeks to address professional use of the internet and does not discuss issues related to psychiatrists’ use of social media and social networking sites such as Facebook or Twitter. In order to assist the practitioner, references to resource materials will be given. However, the reference is not an endorsement by either the APA or the members of the work group of the material contained therein.
The medical use of marijuana has received considerable attention as several states have voted to remove civil and criminal penalties for patients with qualifying conditions. Yet, on a national level, marijuana remains a schedule I substance under the Controlled Substances Act (CSA), the most restrictive schedule enforced by the Drug Enforcement Administration (DEA) (1). The Food and Drug Administration (FDA), responsible for approving treatments after appropriate and rigorous study, additionally does not support the use of marijuana for medical purposes. This juxtaposition of practice and policy has prompted many professional medical organizations to issue official positions on the topic. This statement reflects the position of the American Psychiatric Association (APA) on the use of marijuana for psychiatric indications. It does not cover the use of synthetic cannabis-derived medications such as Dronabinol (Marinol), which has been studied and approved by the FDA for specific indications.
Upon full implementation of the Affordable Care Act, it is estimated that more than 32 million Americans will become insured and gain access to mental health and substance abuse services at parity (1). Despite considerable gains in the number of medical school graduates entering the field of psychiatry over the past ten years, it has become clear that the workforce of psychiatrists is not large enough, acting alone, to meet the needs of patients (2,3).
Cultural psychiatry as a specific field of study relevant to the assessment and care of all patients
The comparative study of mental health and mental illness among diverse societies, nations, and cultures and the multiple interrelationships of mental disorders with cultural environments have occupied the interest of individual psychiatrists and psychiatric organizations in the U.S. and abroad for many years. The growth of international collaboration in psychiatry since World War II, the many advances in clinical methods and research, particularly in the last several decades, have greatly enhanced interest in the field, as has the rapprochement of psychiatry with cultural anthropology, sociology, and behavioral sciences. The phenomena of globalization, the impact of migration, the progress in technology and its communication products, the ease of modern international travel, and a variety of other factors has quickened the pace of development.