The APA Board of Trustees voted last month to allocate more than $470,000 to begin forging a major alliance with business and corporate leaders in an effort to convince them of the benefits they will derive by offering their employees insurance policies that do not discriminate against mental illnesses.

Business executives often see insurance coverage for mental illness as an expense that would negatively affect their bottom line, failing to recognize the long-term benefits of employees who are healthier—and thus miss fewer work days—because their illnesses are accurately diagnosed and treated.

This sector was not a major focus of APA’s attention in the past but was given greater prominence under APA presidents Mary Jane England, M.D., and Rodrigo Muñoz, M.D.

At its September meeting, the Board endorsed such an outreach effort, but only allocated $50,000 for the rest of 1999 to allow a new oversight committee to begin planning how best to proceed with the project. But APA cannot achieve its goal of gaining insurance parity for workers without committing to a major outlay of funds, the Trustees acknowledged, and in December voted to appropriate the additional money.

The first task of the project’s steering committee will be to develop a three-year work plan whose initial focus will be on identifying the most critical issues APA needs to address with corporate leaders and devising a strategy for following up on those issues. The funds will be used to hire staff to administer the project and consultants to conduct focus groups that will help APA better understand how workers and business leaders view the issue of insurance coverage for mental health care. Information gleaned from the focus groups will also provide valuable data on how APA can best frame its message.

The Board also took these actions:

• Approved a resource document on mandatory outpatient treatment developed by the APA Council on Psychiatry and Law. This updates a 1987 task force report that backed court-ordered outpatient psychiatric treatment in certain cases in which patients are noncompliant with treatment. In the intervening 12 years a substantial number of studies have evaluated the efficacy of this treatment modality, most finding that it reduces rates of rehospitalization and increases treatment compliance for some seriously ill patients. Forty states and the District of Columbia now have such statutes, most of them passed since the 1987 APA report.

The new document "endorses the view that mandatory outpatient treatment can be a useful intervention for a small subset of patients with severe mental illness who suffer from chronic psychotic disorders and who come in and out of psychiatric hospitals through the so-called ‘revolving door.’ " These patients are ones who respond to treatment during inpatient stays, but decompensate after their release since they do not follow up on recommendations for outpatient care. APA hopes that district branches and state associations will use this resource document when their state legislatures discuss proposals about adopting or modifying outpatient commitment statutes.

• Created a caucus for psychiatrists who treat patients insured through managed care companies. Endorsed in November by the Assembly, proponents noted that these psychiatrists have professional concerns that differ from colleagues who work as reviewers, medical directors, or managers and would benefit from a forum in which they can discuss issues concerning patient treatment in a managed care environment.

• Allocated $5,000 to help the North Carolina Psychiatric Association develop an amicus brief in the case Williamson v. Liptzin. Liptzin is a Chapel Hill psychiatrist who was successfully sued for malpractice by a former patient who killed two people at random several months after his treatment ended. Liptzin is appealing the $500,000 judgment awarded to the killer, whom a jury found not guilty by reason of insanity.

• Approved a request for $7,500 from the California Psychiatric Association (CPA) to defray some of its costs in filing an amicus brief in the case Ford v. Norton. The suit challenges a trial court’s ruling that psychologists can authorize early release of a mentally ill inpatient who is on a 72-hour involuntary hold. State law permits only psychiatrists to evaluate involuntary patients for early release and thus gain immunity from malpractice lawsuits as long as they follow proper procedures, but in 1984 the state supreme court handed psychologists a victory in a suit known as CAPP v. Rank that granted them the right to admit and discharge patients independently in hospitals.

In the current suit, soon after a psychologist discharged the patient when his insurance stopped paying for care, the patient stabbed his roommate multiple times. He was found not guilty by reason of insanity and was involuntarily committed, but then sued the psychologist for malpractice because of the early release. A trial court ruled that CAPP v. Rank extends the same rights and protections to psychologists regarding hospital care as those granted to psychiatrists by state statute. The CPA is participating in an appeal of the trial court’s dismissal of the malpractice suit that maintains that the judge misapplied CAPP v. Rank by extending the immunity from malpractice suits to psychologists when state law limits it to psychiatrists in cases such as this one involving early release procedures.

• Ratified an executive action taken in November by the APA president, speaker, and medical director to authorize an initial payment of $25,000 from the APA Litigation Fund to support the Pennsylvania Psychiatric Society’s (PPS) potentially precedent-setting lawsuit against managed care insurer Highmark, Inc., and behavioral carveout company Green Spring. The suit, which the PPS filed on behalf of its members, charges that the companies misrepresent available services, harm patients by interfering with medical care, and unfairly restrict the number of psychiatrists allowed to join their network. After ratifying the executive action, the Trustees voted to add another $100,000 to help the PPS pursue this important case.

• Appointed a work group to work with the APA medical director and the director of the Resource Development Office to "review and update procedures" when APA seeks funds from the pharmaceutical industry to support its programs and projects.