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Approaches to Youth in Mental Health Crisis
This document provides an overview of contemporary approaches to youth in mental health crises with practical, solution-oriented recommendations. It provides developmental considerations when dealing with youth in crisis, the continuum of existing response models and encourages readers to understand their role in advocacy through clinical vignettes. The resource document emphasizes de-escalation and rapid linkage to clinical evaluation services and supports the APA’s goal of ensuring young people in mental health crises and their families receive support by first responders who are appropriately trained to address their needs. This document provides an overview of contemporary approaches to youth in mental health crises with practical, solution-oriented recommendations. It provides developmental considerations when dealing with youth in crisis, the continuum of existing response models and encourages readers to understand their role in advocacy through clinical vignettes. The resource document emphasizes de-escalation and rapid linkage to clinical evaluation services and supports the APA’s goal of ensuring young people in mental health crises and their families receive support by first responders who are appropriately trained to address their needs.
Ethics at the Interface of Religion, Spirituality, and Psychiatric Practice
Historically, psychiatry has had a fraught relationship with religion. One example can be found in the writings of Sigmund Freud, who was dismissive of religion and viewed it as a form of mental illness, drawing parallels between the rituals of obsessional patients and those of very religious people (Breakey 2001). However, there are also works throughout history demonstrating the harmonious relationship between psychiatry and religion, suggesting that the notion of an adversarial relationship between the two may not be a complete picture (Frankl 1975, Meissner 1984, Meissner 1987).
Safe Consumption Facilities
In 2019, there were nearly 72,000 U.S. overdose deaths, a new record high. Most of these overdose deaths involved opioids, with rising involvement of fentanyl and fentanyl analogues, which are increasingly found in street heroin and other opioids and often without the knowledge of the user. Even more concerning, it appears that the coronavirus pandemic is further worsening the overdose crisis.1 In the context of this ongoing crisis, psychiatrists must be aware of the full range of policy, organizational, and public health strategies impacting the lives of people who use drugs (PWUD). This document aims to inform psychiatrists about one such strategy: Safe Consumption Facilities (SCFs, also known as “supervised consumption sites”), an approach that has long been a feature of harm reduction efforts in certain countries and that has attracted increasing attention in the United States.
How Psychiatrists Can Talk to Patients and Families About Race and Racism
This document supports the APA’s goal of addressing structural racism in clinical practice by linking existing literature on the impact of race on patients’ lives with race as experienced in the clinical encounter. It provides psychiatrists with the necessary tools to speak with patients about race in a sensitive and professional manner using clinical vignettes. Incorporating these tools should increase understanding of how race and racism impact patients’ lives, decrease bias and enhance the therapeutic relationship. This document also encourages readers to seek to understand patients’ cultural and linguistic backgrounds as the beginning of any conversation about race, racism and discrimination. The authors believe this is the bedrock of culturally competent care, whether with a French speaking African immigrant, a Spanish speaking Latinx, or a Black teenager raised in the American South now living in the Northeast, as reflected in the included vignettes. The authors also acknowledge that racial groups are not homogeneous and that the focus on culture and language is intended to help psychiatrists focus on the unique aspects of an individual’s experiences in addition to talking about racial discrimination and bias.
Mental Health Courts
Mental health courts (MHCs) are one of a range of “problem-solving courts” operated on the premise that the criminal law can be used to therapeutic ends to the benefit of both individual defendants and society as a whole, a concept known as therapeutic jurisprudence (Winick 2003). Other examples of problem-solving courts include homelessness courts, veterans’ treatment courts, and domestic violence courts. Many psychiatrists are unfamiliar with MHCs despite their rapid expansion in recent years. The purpose of this resource document is to describe the concepts behind and operations of MHCs and review their role and effectiveness.
Non-Emergency Involuntary Medication for Mental Disorders in U.S. Jails
Psychiatrists who work in jail settings will encounter patients for whom the administration of non-emergency involuntary medication is clinically indicated for the stabilization of their serious mental illness. This resource document is intended to guide psychiatrists in decision-making about non-emergency involuntary psychiatric medication administration in U.S. jails by providing background information and highlighting issues for consideration.
Education and Training for Substance Use Disorders
Current training of physicians in the recognition and treatment of substance use disorders (SUD) is inadequate to meet the needs of such a diverse and growing population of patients. Medical schools, physician training (residency) programs, and continuing education programs for physicians in practice, provide limited training in the treatment of SUDs. The scope of training on SUDs is disproportionate to the population health need to address these problems, and many with SUDs go undiagnosed and untreated. In the past decade there have been marked advancements in the science of addiction, which includes an expanding range of evidence-based pharmacologic and behavioral treatments. Despite these advances and a growing knowledge base, the educational requirements in psychiatry and other medical residencies have not shifted, leaving many physicians ill-prepared to manage SUDs in practice (1).
The Interface of Religion, Spirituality, and Psychiatric Practice
Psychiatry has historically been known to have an adversarial relationship with religion. One example can be found in the writings of Sigmund Freud, who was dismissive of religion and viewed it as a form of mental illness. Freud drew parallels between the rituals of obsessional patients and those of very religious people and concluded that religion was a universal obsessional neurosis (Breakey 2001). However, there are also works throughout history demonstrating the harmonious relationship between psychiatry and religion, suggesting that the notion of an adversarial relationship between the two may not be a complete picture (Frankl 1975, Meissner 1984, Meissner 1987).
Mental Health Issues Pertaining to Restoring Access to Firearms
Mental health courts (MHCs) are one of a range of “problem-solving courts” operated on the premise that the criminal law can be used to therapeutic ends to the benefit of both individual defendants and society as a whole, a concept known as therapeutic jurisprudence (Winick 2003). Other examples of problem-solving courts include homelessness courts, veterans’ treatment courts, and domestic violence courts. Many psychiatrists are unfamiliar with MHCs despite their rapid expansion in recent years. The purpose of this resource document is to describe the concepts behind and operations of MHCs and review their role and effectiveness.
Social Determinants of Health
All of these variables impede access to care, which is critical to individual health, and the attainment of social equity. These are essential to the pursuit of happiness, described in this country’s founding document as an “inalienable right.” It is from this that our profession derives its duty to address the social determinants of health.
Developing a Global Mental Health Curriculum in Psychiatry Residency Programs
As the importance and centrality of mental health becomes apparent within and beyond the health care sector, so will opportunities for psychiatrists to apply their knowledge and skills to meet the growing needs. Through careful attention to the moral imperatives and explanatory models among cultures that differ from their own, psychiatrists have been very successful in engaging local entities and establishing partnerships that incorporate trust, credibility, transparency, and accountability to achieve mutual benefits with communities. The following is a guide to assist psychiatry residency programs interested in developing and implementing a global mental health (GMH) curriculum, but unfamiliar with the nuances of GMH education and training. It may also be useful to medical students and psychiatric residents with interest in GMH education and training opportunities. This guide takes into consideration both an international and a domestic scope of GMH with a key focus on curriculum development addressing inequalities among people from various cultures. This guide is developed by the American Psychiatric Association (APA) Council on International Psychiatry, with support by the APA Caucus on Global Mental Health and Psychiatry.
Responding to Negative Online Reviews
The American Psychiatric Association (APA) Ethics Committee occasionally receives inquiries from members who are troubled by negative reviews about them or their practice posted online by patients or other individuals. This often creates a difficult dilemma for the psychiatrist who must respect the patient’s voice but also desires to preserve the integrity of the psychiatrist’s public image. This resource document is offered to provide guidance to psychiatrists regarding receipt of negative online reviews.