December 4, 1998

The Assembly approved an action asking APA to develop a position statement affirming the role of psychiatrists as the appropriate clinicians in charge of the care of patients hospitalized in psychiatric facilities and psychiatric units in general hospitals.

An effort to alter the proposal to be more general by substituting the word "physicians" for "psychiatrists" failed. Those arguing for "physicians" said that although it is most desirable to have psychiatrists in charge of care for psychiatric patients, APA should focus on the role of psychologists.

They pointed out that the action described the problem by noting that "in many psychiatric facilities the care of mentally ill patients is compromised by policies that allow nonphysicians to be the clinicians ultimately responsible for the care of patients. In some states, legislative changes have permitted psychologists to be the attending clinicians in charge of hospitalized psychiatric patients. . . . This may adversely impact and thereby jeopardize the health and safety of the mentally ill subjected to such care."

In a related action, the Assembly approved a proposal that calls on APA to "develop a position statement specifying that a physician, preferably a psychiatrist, write seclusion and restraint orders for patients in psychiatric facilities or psychiatric units in general hospitals." The reasoning behind the action mirrored that of the action dealing with clinicians in charge.

Other Actions

• The Assembly voted to ask the Board of Trustees to authorize the establishment of an APA "disaster support grant." Under this program, a district branch president could ask the APA medical director to provide a disaster grant of up to $10,000 per disaster, not to exceed $30,000 per year. The action was widely supported, and members noted that it provided an opportunity for APA both to assist people in need and to present a positive image to the public during disasters.



• The Assembly voted to ask the APA Committee on Ethics to "review and offer an opinion on when sexual relationships with family members or with others intimately involved with patients or former patients is unethical."

The Assembly action paper noted that district branch ethics committees have ruled inconsistently in cases involving a psychiatrist who had developed a sexual relationship with family members of patients or former patients. Some of the committees have found the behavior unethical while others have not.

During a discussion of the action, several psychiatrists from small, rural communities commented that holding out of bounds any sexual relationship with any family member of a patient or former patient could make it virtually impossible for a psychiatrist in a small community to have a normal social life. But supporters noted that the action asked only that the APA Committee on Ethics "review and offer an opinion" on the matter and that further refinements could occur later.