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, organi

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 whe

Involuntary Outpatient Commitment

Involuntary outpatient commitment is a form of court-ordered outpatient treatment for patients who suffer from severe mental illness and who are unlikely to adhere to treatment without such a program. It can be used as a transition from involuntary hospitalization, an alternative to involuntary hospitalization or as a preventive treatment for those who do not currently meet criteria for involuntary hospitalization. It should be used in each of these instances for patients who need treatment to p

The Internet in clinical psychiatry

The goal of this resource document is to address the major areas of the use of the internet in communication with patients and the public in the practice of psychiatry. The rate of change of technological capabilities and their implementation is so rapid that the workgroup believes that it would be inappropriate to promulgate fixed rules for constantly changing situations. Rather, we seek to provide some questions to be considered when implementing any new communication technology with patients

Vagal nerve stimulation (VNS) white paper

Vagal nerve stimulation for treatment resistant epilepsy has been available in the United States since 1997, and improved mood noted in epilepsy patients led to studies examining the use of VNS for treatment resistant depression. VNS implantation consists of placement of the stimulator in the chest wall that is attached by wires tunneled through the skin to the left vagus nerve in the carotid sheath. Potential side effects include voice alteration, hoarseness, coughing, paresthesia, dyspnea and

Cultural Psychiatry as a Specific Field of Study Relevant to the Assessment and Care of All Patients

The comparative study of mental health and mental illness among diverse societies, nations, and cultures and the multiple interrelationships of mental disorders with cultural environments have occupied the interest of individual psychiatrists and psychiatric organizations in the U.S. and abroad for many years. The growth of international collaboration in psychiatry since World War II, the many advances in clinical methods and research, particularly in the last several decades, have greatly enhan

Access to firearms by people with mental ilnness

Resource Document on Access to Firearms by People with Mental Illness Approved by the Joint Reference Committee, June 2009 Reports of mass shootings and other serious firearmrelated violence, such as the Columbine shootings of 1999 and the Virginia Tech shootings in 2007, are often accompanied by indications that the perpetrator had some emotional disturbance or mental illness. These incidents have raised growing concern about access to firearms (1) by people with mental disorders. Current f

Suicide in Communications and Media

Suicide is a leading cause of death in the United States. Research demonstrates that how media reports on suicide and suicide attempts may either increase contagion risk or decrease the risk of future suicide attempts, rendering the issue a matter of public health and safety.

Addressing the Migration Emergency and Human Rights of Haitians

Thousands of Haitians are traveling to the U.S.-Mexico border to seek asylum in the U.S., with many settling in camps after being denied entry. The U.S. government is responding with the deportations of thousands to Haiti. These deportations put Haitians at risk of violence, being unhoused, and even death amid Haiti’s political, economic, and environmental crises.

Across State Line Psychiatric Consultation Considerations Addendum to Risk

In 2013, an APA Resource Document on “Risk Management and Liability Issues in Integrated Care Models” was developed.1 This document outlined liability issues in a new and emerging area of collaborative /integrated care. In this model psychiatrists’ expertise is leveraged through curbside consultations and caseload reviews to provide more effective care for mild to moderate behavioral health conditions in the primary care setting. With the advent of CPT codes for the Collaborative Care Model, the

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.

QTc Prolongation and Psychotropic Medications

Psychiatrists and other clinicians frequently prescribe psychotropic drugs that may prolong cardiac repolarization, thereby increasing the risk for torsades de pointes (TdP). The corrected QT interval (QTc) is the most widely used and accepted marker of TdP risk. This resource document was created in response to the paucity of strong evidence to guide clinicians in best practice prescription and monitoring of psychotropic medications that may increase risk of TdP.