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The use of restraint and seclusion in correctional mental health care
This resource document discusses the use of seclusion or restraint for purposes of mental health intervention in jails and prisons, in contrast to its use for correctional purposes (i.e., specifically custody reasons).** The use of seclusion or restraint for mental health reasons is an emergency measure to prevent imminent harm to the patient or other persons when other means of control are not effective or appropriate.
Psychiatrists' responses to requests for psychiatric information in federal personnel investigations
Psychiatrists routinely receive and respond to patient authorizations to release information to third parties. However, a security clearance-related request for information differs from an ordinary release of information generally encountered in clinical practice. An ordinary release specifies records, notes, admission or discharge summaries, or other information generated in the course of clinical care. Most often, the information is to be released to another provider or facility for use in a therapeutic context, for the benefit of the individual patient. In contrast, the security clearancerelease may call for the psychiatrist to make a judgment about his or her patient (i.e., does the patient have a condition that could impair judgment or reliability in the context of safeguarding national security information, or be at risk for future violent behavior) that could be disqualifying for employment. Although this resource document deals only with requests for psychiatrists' disclosures with regard to security clearances, the similarities to other work-related evaluations (e.g., can the individual return to work, can the individual function as a police officer), or to other circumstances in which disclosures may be used for legal or administrative purposes (e.g., forensic evaluations) should be noted.
Brain imaging and child and adolescent psychiatry with special emphasis on SPECT
Although knowledge is increasing regarding specific pathways and specific brain areas involved in mental disease states, at present the use of brain imaging to study psychiatric disorders is still considered a research tool. Continued study of child and adolescent psychiatric disorders using a variety of brain imaging methods, as well as refinements in imaging techniques, may result in evidence supporting the utility of these tools for clinical work in the future. Imaging research cannot yet be used to diagnose psychiatric illness and may not be useful in clinical practice for a number of years. In the future, imaging techniques may be useful to examine medication effects and predict medication response.
Alternatives to managed care
Although knowledge is increasing regarding specific pathways and specific brain areas involved in mental disease states, at present the use of brain imaging to study psychiatric disorders is still considered a research tool. Continued study of child and adolescent psychiatric disorders using a variety of brain imaging methods, as well as refinements in imaging techniques, may result in evidence supporting the utility of these tools for clinical work in the future. Imaging research cannot yet be used to diagnose psychiatric illness and may not be useful in clinical practice for a number of years. In the future, imaging techniques may be useful to examine medication effects and predict medication response.
Guidelines for psychiatric “fitness for duty” evaluations of physicians
Psychiatrists are often called upon to evaluate a physician’s fitness for duty. Specific questions may center on the presence of psychiatric or neuropsychiatric impairment. In these cases, the psychiatrist may be asked to examine the physician, prepare a report of detailed diagnostic findings and treatment options, and offer an opinion regarding fitness for duty.
Consensus statement on "Managing the risks of repetitive transcranial stimulation"
In response to the changing managed care environment, the APA Committee on Managed Care established a subcommittee to document the changes in managed care and to begin the process of thinking about alternative healthcare financing systems. The Committee undertook writing a resource document for APA members to identify and describe the changes that are occurring in the healthcare sector and to prepare them for changes that may occur so that psychiatry can be proactive in meeting these challenges
Psychotherapy notes provision of the Health Insurance Portability and Accountability Act (HIPPA) pri
The Final HIPPA Privacy Rule defines psychotherapy notes as an official record, created for use by the mentalhealth professional for treatment, “recorded in any medium…documenting or analyzing the contents of conversation during a private counseling session or a group, joint or family counseling session that are separated from the rest of the individual’s medical record...” 45 C.F.R. § 164.501 (65 Fed. Reg. at 82805) (emphasis added). The Rule does not protect psychotherapy notes when defending a malpractice suit brought by a patient or for satisfying documentation requirements of a licensing authority because it allows disclosure without authorization for these purposes. Save for very few other exceptions (1), “psychotherapy notes” cannot be disclosed to anyone without the patient’s specific authorization. Furthermore, such authorization cannot be compelled for payment, underwriting, or plan enrollment (emphasis added).
Mandatory outpatient treatment
Mandatory outpatient treatment refers to court-ordered outpatient treatment for patients who suffer from severe mental illness and who are unlikely to be compliant with such treatment without a court order. Mandatory outpatient treatment is a preventative treatment for those who do not presently meet criteria for inpatient commitment. It should be used for patients who need treatment in order to prevent relapse or deterioration that would predictably lead to their meeting the inpatient commitment criteria in the foreseeable future.
Peer review of expert testimony
The American legal system seeks justice through the adversarial process. The adversarial process, by its very nature, tends to highly polarize ideas. At times psychiatrists who testify as expert witnesses in court or similar settings have been perceived in the popular, legal and medical literature as either deficient in knowledge or to have knowingly behaved in an unethical manner to advance the cause of the party who hired them.(1-6) Sometimes these perceptions are not accurate. Other times they are true. This paper attempts to outline the problem and discuss possible solutions.
Guidelines to District Branches for a policy on physician impairment
The American Psychiatric Association has resolved to promote the mental and physical health of all physicians toward the goal of insuring optimum care of patients, protecting the public from possible harm by an impaired physician, preventing loss of valuable medical manpower, and helping the impaired physician regain health and productivity. The APA recognizes that psychiatrists, like other physicians, are at risk for impairment by mental and physical disorders, including addiction (or substance abuse). All physicians have an ethical obligation to assist colleagues who are impaired, including those who avoid and resist treatment.