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December 18, 1998
The APA Council on Psychiatric Services has launched a pilot program for psychiatrists who practice in unique settings to make it easier for them to caucus with colleagues from similar practice settings.
The caucus pilot project was launched at the urging of APA President Rodrigo Muņoz during this year's Institute for Psychiatric Services in Los Angeles.
Four caucuses met. They were the State Hospital Psychiatrists' Caucus, the Veterans Affairs Psychiatrists' Caucus, the Rural Psychiatrists' Caucus, and the Caucus of Psychiatrists Practicing in Criminal Justice Settings. The four caucuses will meet again at APA's annual meeting in Washington, D.C., in May, and at the 1999 Institute for Psychiatric Services in New Orleans.
The entire program will be evaluated at the end of 1999 to see if it should be continued. If successful, the caucuses will remain permanently under the umbrella of APA.
The report below was drawn from summaries prepared by caucus organizers with the assistance of Heather Whyte, the APA staff liaison to the Consortium on Special Delivery Settings.
This caucus generated a substantial turnout, with members from 13 different states attending the meeting. The caucus also drew some former members of APA who said they had previously seen APA as disinterested in the problems of state hospital psychiatrists and the conditions under which they worked and were excited that their interests were now being reflected.
Some of the common themes that emerged included concern over the closing, merging, and downsizing of state hospitals and the resulting discharge of many severely and persistently disturbed patients to often inadequate systems of community care. Psychiatrists from different states also found shared concerns over the erosion of their authority and the increasing delegation of responsibility to nonpsychiatric clinicians.
One particular issue led to an action paper at the Assembly's November meeting asking APA to develop a position statement to oppose permitting nonpsychiatrists to write orders for seclusion or restraint in psychiatric hospitals or psychiatric wards of general hospitals. There was general agreement that APA should act to reverse the loss of control by psychiatrists over the treatment and care of psychiatric patients.
Differences emerged from state to state, allowing members to hear descriptions of systems that could ultimately impact care in their state. For example, a discussion with Massachusetts psychiatrists helped clarify that state's evolving plan, which has allocated a number of state hospital beds for intermediate- and long-term care, with some of these beds being located outside the state hospital settings.
The Caucus of Psychiatrists Practicing in Criminal Justice Settings (CPPCJS) heard a presentation by Susann Steinberg, M.D., deputy director of the California Department of Corrections. The caucus voted to ask the APA Assembly to grant representation to the caucus in the near future.
Some of the topics discussed included civil commitment of sex offenders after prison, overcrowding in correctional facilities, and treatment within the criminal justice system. There was also a discussion of the new APA Guidelines on Psychiatric Services in Jails and Prisons. The CPPCJS is setting up an electronic bulletin board that members can use to communicate between meetings. Information on the bulletin board will be available early next year on APA's Web site, The Veterans Affairs Psychiatrists' Caucus discussed five key issues. These were threats to the quality of residency training in the VA, medical access and liability issues, lack of time to treat patients and supervise staff, federal budget issues impacting patient care and research, and chronic staff shortages.
Caucus co-chairs Frederick Guggen-heim, M.D., and Albert Gaw, M.D., were asked to contact APA Deputy Medical Director for Education James Thompson, M.D., to express the caucus's concerns about the quality of residency training in the VA and the need for greater cooperation between APA and the Association of American Medical Colleges.
The VA caucus is also planning to start a Web site early next year.
The Rural Psychiatrists' Caucus featured presentations dealing with the unique challenges of practicing psychiatry in settings as diverse as Nome, Alaska and rural Iowa. A key organizational issue that emerged was how the caucus could better relate to the American Association of Community Psychiatrists, the Rural Mental Health Association, and other medical organizations with rural components.
According to a report by Bernardo Ng, M.D., in the Rural Psychiatrists' Caucus Newsletter, one of the most common reactions was a sense of amazement by psychiatrists meeting colleagues from distant states who articulated similar concerns over similar challenges
The caucus wrestled with the definition of "rural psychiatrist" and concluded that it was both a psychiatrist living in a rural area and a psychiatrist who spent a significant amount of time serving a rural population.
The Rural Psychiatrists' Caucus and the Caucus for Psychiatrists Practicing in the Criminal Justice System have newsletters available for interested psychiatrists. The VA and State Hospital Psychiatrists' caucuses plan to have active electronic bulletin boards. The Rural Psychiatrists' Caucus also plans to communicate through an e-mail list serve. These electronic communication forums are for APA members and will be accessible through the APA Web site beginning early next year.
For more information contact:
State Hospital Psychiatrists' CaucusVeterans Affairs Psychiatrists
Rural Psychiatrists
Resources and Contacts
Seymour Gers, M.D., Chair
64 W. 15th Street
New York, N.Y. 10011
VA Psychiatrists' Caucus
Albert Gaw, M.D., Co-Chair
2 Springdale Road
Lexington, Mass. 02421
or
Frederick G. Guggenheim, M.D., Co-Chair
UAMS Mail Slot 554
4301 West Markham
Little Rock, Ark. 72205-7199
Rural Psychiatrists' Caucus
William Herz, M.D., Chair
P.O. Box 708
Bend, Ore. 97709-0708
Caucus of Psychiatrists Practicing in the Criminal Justice Setting
Henry Weinstein, M.D., Chair
125 E. 87th Street
New York, N.Y. 10128