FALL/WINTER NEWSLETTER
August-December 2018, Vol. 9, Issue 2
In This Issue


 
 




Premium Corporate Sponsor 2018-2019
Arizona Psychiatric Society
Newsletter Committee
Jasleen Chhatwal, MD, and Jason Curry, DO, Editors

Gagandeep Singh, MD

Brian Espinoza, MD, FAPA, CME Features

Robin Reesal, MD, FAPA,
Wellness Psychiatry Features

SEASONS GREETINGS!

Jasleen Chhatwal, MD
Jason Curry, DO
Newsletter Editors


Colleagues,

There is that famous scene in the movie The Matrix, where protagonist Neo goes to visit the Oracle. Here he encounters the young boy who tells him, "There is no spoon." We realize referencing a 90's Sci-Fi action movie may not fill others with the warm-and-fuzzies commonly associated with the holiday season. Perhaps we should have opened with a reference to the Miracle on 34th Street.
 
Still "there is no spoon" is an allegory for life. It is an earnest message that there is only life as we choose to see it - from first choosing how we see ourselves. As 2018 draws to a close, we find ourselves reminiscing, grieving and celebrating the year. In this complex year what do we choose to see?
 
2018 has held many things. Recently, our own colleagues were told to stay in their lane. The outcry that followed showed the passion and involvement of physicians of all specialties in preventing trauma. There has been loss of dear colleagues at home and in other states from violence. We have ongoing worry about physician health and suicide, continuing stories of trauma at the US border, natural disasters, and an ever-increasing need for mental health providers. In this past year, we also have witnessed the completion of 10 years of federal legislation for mental parity, enactment and promotion of opiate medication laws and guidelines, advancement in the field with new interventional modalities and novel drug research, and an ever-outpouring of community support and human compassion. These and many others all issues integral to our practice of psychiatry.
 
We, as stalwarts of emotional health, see how such events leave lasting impact. We ask you to take a mindful minute to introspect on the impact these past 12 months have had on you. At this moment, in this season, there are many things that call for us to be grateful: colleagues, friends, family, a place to call home, a holiday meal, the chance to give, a purpose to serve, this moment that we breathe.
 
Perhaps we introspect our truth in a wayward scene from an iconic movie:

Spoon boy: "Do not try and bend the spoon. That's impossible. Instead... only try to realize the truth."
Neo: "What truth?"
Spoon boy: "There is no spoon."
Neo: "There is no spoon?"
Spoon boy: "Then you'll see, that it is not the spoon that bends, it is only yourself."
 
Or perhaps we manifest truth in the words of Rumi, the learned poet and teacher, that summarizes beautifully the spirit of wisdom and acceptance of change.

"Yesterday I was clever, so I wanted to change the world. Today I am wise, so I am changing myself." 
 
Wishing you well, we look forward to conversing with you again in 2019.
 
- Jasleen Chhatwal & Jason Curry

 
PRESIDENT'S MESSAGE


Mona Amini, MD, FAPA

Dear Colleagues:
 
As 2019 is headed our way, I thought it would be a perfect time to highlight how the Society will be serving you in the months ahead. This coming February, the Society's risk management event is set for both Phoenix and Tucson. We strive to serve our community better by having the event in two cities reaching more of our members. The 3rd annual Women's Afternoon Tea will be held in March, and our Annual Meeting will be in April at the Hilton Scottsdale. 
 
Your feedback and support has been instrumental in formulating these events. It is my goal to continue to support and enhance the career paths of our members, taking into account the unique challenges and exciting possibilities ahead. With the future of healthcare's landscape changing ever so rapidly, I look forward to our role in scientific advancements and the potential of digital health in support of our specialty.
 
If you have any questions or feedback on upcoming events or opportunities with the Society, feel free to contact me directly. I wish all of you a happy and healthy holiday season. See you soon in the new year.
 
Regards,

Mona   
From the Psychiatry Network 2018 Women Physicians Conference Networking Event
Clockwise from L: Drs. Monica Faria, Mona Amini, Maya Heck, and Judith Engelman; Conference Co-Chair Dr. Adrienne Yourek and Speaker Dr. Victoria Kelly; Dr. Cynthia Stonnington with Conference Co-Chair Dr. Christina Girgis
Corporate Sponsor 2018-2019

MEET FELLOW APS MEMBER:
MICHELLE SINGH, DO

Michelle Singh, DO
Psychiatric Resident, University of Arizona COM-Tucson

Hello! My name is Michelle Singh, and I am a current PGY-2 psychiatry resident at the University of Arizona COM-Tucson. I came to Tucson from LECOM-Seton Hill, where I received my degree in osteopathic medicine in 2017. When I abandoned the Pennsylvania clouds for good, I brought my then-partner Daniel with me.  In what has been the most challenging and exciting 18 months of my life, we've since married and adopted a furchild.

One of the things Daniel and I originally connected on was a shared passion for mental health. Psychiatry was always on my radar during medical school. Unfortunately,  teen suicide was, and is, far too prevalent in my home town of Palo Alto, California. As I studied Neurobiology, Physiology, and Behavior at UC Davis, I became increasingly interested in the intersection between physiology and mental health. This interest hasn't waned, and my consultation-liaison experiences in residency have been some of my favorite. The recent trend of a biologically focused approach to mental illness excites me greatly. I hope as our neuroimaging and lab tests advance that the artificial boundaries between "medical" and "psychiatric" illnesses fade away. I came to realize how this stigma, as if psychiatric illnesses are somehow separate and therefore not real , forces silence on the people who need help the most. I came to realize that for my personal practice I would need to gain a greater understanding of how various cultures approach and understand mental illness. On a larger scale, this has created a personal goal of mine to become an advocate for minority populations who may be reluctant to seek mental health help. Specifically, I hope to get involved with outreach in the Asian American and LGBTQ populations as my career advances.

There are far too many people I'd like to thank. First, I would like to shout out to my Associate Program Director and mentor Dr. Kalia for being a fierce advocate and sounding board. Drs. Curry (Program Director) and Chhatwal have encouraged my participation in the Arizona Psychiatric Society and recommended me for hospital leadership activities. This leadership experience will only help me achieve my goal to get involved in healthcare advocacy. I would also like to thank the PGY2 class-really all of my co-residents- who have become a second family. My siblings and parents deserve thanks just for putting up with my own pathology these last (almost) 29 years.

Last on this list but first in my heart, I would like to thank my husband, Daniel, for his infinite support and Kubo for being the best dog.  
APS ANNUAL MEETING, RISK MANAGEMENT EVENTS IN PHOENIX AND TUCSON, AND WOMEN'S GROUP AFTERNOON TEA SAVE THE DATES!

Mark your calendars for the following Arizona Psychiatric Society events.  We are wrapping up the event details--look for e-mail that registration is open, check back at the Society website, or e-mail teri@azmed.org regarding registration.

"Minimize Risk When Treating Suicidal and Violent Patients," presented by Moira Wertheimer, Esq., RN, CPHRM, FASHRM, AVP, Risk Management Group; Education and Resource Manager, AWAC Services Company, Member Company of Allied World, with two possible dates you may attend:

February 5, 2019, 6:30 pm to 8:30 pm, Phoenix
February 7, 2019, 6:30 pm to 8:30 pm, Tucson

Third Annual Women in Psychiatry Afternoon Tea, Sunday, March 3, 2019
A favorite networking and social event, there are seating limitations for this event, so plan to register as early as possible.

Arizona Psychiatric Society 2019 Annual Meeting
Saturday, April 27, 2019, at the Hilton Scottsdale Resort & Villas, Scottsdale Road & Lincoln, Scottsdale

To make this event more accessible to members from across the state, the Annual Meeting in 2019 will start the education at 8:50 a.m. (with walk-in registration, posters, and breakfast at 8:00 a.m.), and will conclude early enough to host our member social (held in the past on Friday evening) on that day from 5:30 to 7:00 pm.  A great day is planned with timely updates on physician safety, learning disabilities over the lifespan, boosting your mental health practice with technology, physician wellness and burn-out, and a psychopharmacological update.  Featuring noted speakers from Arizona and across the United States, a great meeting is planned, and we hope you are all able to attend.  For more details, view the Agenda.
ADVOCACY UPDATE: A Report from the 2018 State Advocacy Conference
 
Stephen Mecham, MD, Psychiatric Resident,
Banner UMC Phoenix

Dr. Don Fowls and I had the opportunity this past August to attend the APA's State Advocacy Conference. The State Advocacy Conference is a meeting held by the APA every few years to provide an opportunity for psychiatrists representing their state from across the United States to discuss trends and challenges with advocacy issues and collect valuable information regarding potential upcoming legislative issues in their state.   This year several advocacy issues were discussed that have been consistent amongst many states, including Arizona. The APA has identified a few major areas of advocacy work that can be impactful.
 
First, psychiatrists building and maintaining good relationships with state representatives is vitally important for times when legislation arises that could be impactful to our patients and our profession. A previously established relationship with a psychiatrist provides an opportunity for a legislator to have a point of contact when they have a question regarding a healthcare or mental health issue. Psychiatrist can also serve on health advisory boards as valuable resources. Furthermore, establishing a relationship before a legislative issue arises makes it far more likely that a phone call or visit to a legislator's office will be well received.
 
Another main issue that was discussed at the conference is non-physician scope of practice legislation. Legislation of this nature continues to be brought before legislative bodies across the United States, as it has for decades. Currently, psychologists in various states are lobbying and putting forth legislation to have prescribing rights for psychotropic medications. Unfortunately, this presents a possible serious risk to our patient population. We recognize the significant differences in levels of training required to safely prescribe, however some legislators may not even be aware that psychiatry is a medical specialty or recognize that psychiatrists are physicians. The task largely falls upon us to help educate our state representatives and protect the interests and health of our patients. As members of the Arizona Psychiatric Society, we have been fortunate to have been associated with Joe Abate for many years and have benefited from expertise and guidance in legislative matters. He and the APS Legislative Committee continue to watch for any such proposed legislation in Arizona.
 
Mental health parity was another topic that was discussed. The federal Mental Health parity and Addiction Equity Act (MHPAEA) of 2008 is legislation that requires insurance coverage for mental health and substance use disorder care to be no more restrictive than coverage for other medical care. Insurers are largely in compliance with the more straightforward aspects of parity, such as eliminating more restrictive inpatient day limits and cost sharing requirement for mental health care. However, when it comes to prior authorizations, frequency of utilization reviews, reimbursement rates, insurer networks, and coverage for clinically-appropriate treatment modalities there are areas for improvement and compliance. Working with policymakers and insurer stakeholders to provide equal coverage for patients will benefit both patients and psychiatrists. 
 
Other topics such as telemedicine, state and national political action committees, integrated care, and other important topics were also discussed. The APA has made this information available to members with easy to read toolkits through the APA website.
 
Working with policymakers and other stakeholders in our state is vital in the process of guaranteeing that our patients receive the highest quality care. Advocacy work can help to make sure that healthcare systems in Arizona value mental health. Involvement in advocacy thought the APS Legislative Committee is a great way to participate. APS members participate in and have hosted fundraisers for candidates, and APS helps to connect psychiatrists throughout the state with their representatives, and provides many other opportunities for members to be more involved in advocacy. Your participation is encouraged and incredibly valuable to your patients and the future of mental health care in Arizona.  If you would like to join the APS Legislative Committee, please contact Teri (teri@azmed.org).  
PHYSICIAN ADVOCACY; REGISTERING TO SPEAK

Physician Advocacy: It All Starts With Engagement

An Article from "The Arizona Pulse," A Digital Magazine of  the Arizona Medical Association

Written By: William C. Thompson IV, MD, FASA

It wasn't too long ago that I knew little about the manner by which our profession is guided by government. Certainly, like all physicians, I grew accustomed to regular mailers asking for PAC support and asking me to take action by contacting a legislator. I admittedly grew fatigued of these pleas at times. Yet I was fired up when a poorly thought out piece of legislation was passed that negatively impacted the practice of medicine. What I have come to learn is that my disconnect was fueled by a lack of understanding. There was an impact that I as a physician could make in the legislative process. I am here today to reinforce how powerful physicians can be when they step up and get
involved in advocating for their profession.  CLICK HERE to continue the article. 

Request to Speak: Have Your Voice Heard
An Excerpt from "The Arizona Pulse"

During committee hearings at the Arizona State Capitol, any individual has the opportunity to register with the Request to Speak system (RTS) and give a testimony to committee members, which becomes part of the permanent video archives. This allows an opportunity for the public to have their testimonies heard, regarding topics that they may have personal experience or opinions regarding. The Arizona State House of Representatives and Senate have separate committees and agendas, and are subject to change each legislative session. 

Why Request to Speak?  

The Request To Speak program is designed to allow the public to register an opinion on bills listed on Agendas, and request to speak on a bill during committee hearings. Requesting to speak is an opportunity to present personal knowledge or experience to the committee, regarding the relevant topic being discussed in the committee hearing. While each committee chairman/chairwoman varies, an individual may be asked to present new information or opinion regarding a specific topic, if there are many signed up to give testimony to the committee.  

Requesting to speak can be done online or through the kiosks located in the Senate and House of Representative's lobby. However, if it is your first time using the RTS system, you will be required to enable your account from one of the kiosks located in either the State Senate and House of Representative's lobbies, or the Tucson Legislative Office.  FOR MORE INFORMATION on registering to speak and the Committees of the House and Senate bodies, CLICK HERE.  If you are interested in registering to speak but unable to complete the initial registration at the Phoenix Capitol or the Tucson Legislative Office, please contact Teri (teri@azmed.org) and she will assist you with your initial registration.  
CALL FOR ABSTRACTS, CALL FOR NOMINATIONS
ARIZONA PSYCHIATRIC SOCIETY 2019 ANNUAL MEETING
APRIL 27, 2019

You are Invited to Share your Best!
Resident-Fellow Members and Medical Students are invited to submit an abstract for consideration for a judged and scholarshipped poster presentation at the APS 2019 Annual Meeting.  Review the APS RFM and MS Poster Guidelines for complete information.  

All Arizona psychiatric physicians are invited to submit an abstract for consideration for a peer juried poster presentation at the APS 2019 Annual Meeting.  The APS Psychiatric Physician Peer Poster Guidelines provides more complete information on participating.  

All are welcome to present your best work from recent meetings or preview new work.  The submission deadline is midnight on April 1, 2019.   Visit the submission link and provide the requested authorship information and submit your abstract of 3000 characters or less (including spaces).  We look forward to seeing you there!  

Recognize an Arizona Psychiatrist for a Distinguished Career in Psychiatry - Deadline to submit is January 15, 2019
Established in 2014, the APS Career Achievement in Psychiatry Award was created for the purpose of recognizing from within the Arizona Psychiatric Society a member whose career achievements have ennobled the profession of psychiatry and best exemplify the APS values of providing compassionate patient care and support of peers, leadership, community service, education, advocacy, and clinical excellence.  Past recipients of the Career Achievement in Psychiatry Award are: David J. Coons, MD, DLFAPA, 2014; Barry Morenz, MD, DFAPA, 2015; Martin B. Kassell, MD, DLFAPA, 2016; and Jehangir "Jay" Boman Bastani, MD, DLFAPA, 2017; and Michael Edward Brennan, MD, DLFAPA, 2018.  

Members are invited to nominate a fellow member who best exemplifies these values. The nominee must be in licensed to practice medicine and in good standing with the Arizona Board of Medical Examiners.   Nominations must be postmarked or e-mailed to teri@azmed.org by January 15th and the nomination letter must contain information documenting the candidate's achievements as outlined in the selection criteria above. Only one candidate may be nominated by a member.  CLICK HERE for more information.  
ASSEMBLY NOTES FROM APA ANNUAL MEETING 

Payam Sadr, MD, DFAPA, Arizona Assembly Representative;
Don J. Fowls, MD, President-Elect and Arizona Assembly Representative;  Jasleen Chhatwal, MD, Area 7 ECP Deputy Representative

Arizona was represented in full force at the APA November Assembly, with both the Arizona Assembly Representatives, Dr. Payam Sadr and Dr. Don Fowls, President-Elect, in attendance, together with Dr. Jasleen Chhatwal, representing the entirety of Area 7 ECP members as the Area 7 ECP Deputy Representative.  


The Assembly was engaged in a wide variety of discussion and decisions on issues affecting psychiatry.  An active debate was on the adoption of a position statement regarding safe prescribing.  Action papers and topics of more lengthy debate included: for the APA to monitor media for misinformation disseminated by Scientology and develop a corrective message campaign with talking points for APA members to use; to develop a position statement on unbiased and diverse expert panels for developing Treatment Guidelines particularly with regard to psychodynamic therapy and interpersonal therapy; and to urge the AMA for add-on billing codes for suicide risk assessments in primary and emergency care settings.  

Many attending the Assembly remarked at the impact of the November 1, 2018 Wreath Laying Ceremony  honoring the more than 200 psychiatrists who served during the Vietnam War and Dr. Peter Livingston, who gave his life in that conflict.  

Photo Collage includes: Action Paper sponsor Dr. Norman Camp with Mrs. Cynthia Livingston; APA Speaker Dr. James Batterson, Mrs. Livingston, APA CEO/Medical Director Dr. Saul Levin, and APA President Dr. Altha Stewart proceed to the memorial) (CLICK ABOVE for link to video of this special ceremony.)

LOCAL ADDICTION INTER-DISCIPLINARY FELLOWSHIP SLOTS OPEN; APA FELLOWSHIPS APPLICATION PERIOD OPEN AND CONCLUDES JANUARY 31st

Banner - University Medical Center Phoenix and Phoenix VA Health Care System Inter-Disciplinary Addiction Fellowship 
Two Slots Open for 2019-2020

Dr. Anita Karnik, Program Director, and Dr. C. Luke Peterson, Associate Program Director, for the new Addiction Medicine Fellowship program in partnership with Banner - University Medical Center Phoenix and the Phoenix VA Health Care System, invites interested applicants to apply for a one-year inter-disciplinary  training program in Addiction Medicine. Fellowship positions are completely funded, with two fellow positions available each year beginning on July 1, 2019.  


Applicants will be accepted from various specialties including but not limited to: Psychiatry, Family Medicine, Internal Medicine, Emergency Medicine, Obstetrics and Gynecology, Anesthesiology, Pediatrics, and Preventative Medicine.  This training program  is dedicated to training well-rounded Addiction Medicine physicians who will become the future leaders of Addiction Medicine and change agents in our community. The focus is people first, and providing compassionate, evidenced-based, and multidisciplinary substance use treatment.    

Applications are being accepted now for two positions for the 2019-2020 program year.  CLICK HERE for more information on the fellowship and how to apply.  






APA/APAF Fellowship Window Open; Applications Due January 31, 2019  
Click Above for APA / APAF Grid


The 2018 - 2019 recruitment season for APA/APAF Fellowship applications is open. Applications will be accepted through Thursday, January 31, 2019, for any of the eight (8) APA/APAF fellowship programs (APA/APAF Leadership, Child and Adolescent Psychiatry, Diversity Leadership, Jeanne Spurlock Congressional, Public Psychiatry, Psychiatric Research, SAMHSA Minority and SAMHSA Substance Abuse Minority Fellowships).  All fellowships are open to resident fellow members and two (2) are open to early career psychiatrists (Psychiatric Research and Jean Spurlock Congressional).  

CLICK HERE for a grid outlying the value, terms, eligibility, type, and number of fellowships from which to choose to apply.  VISIT https://www.psychiatry.org/residents-medical-students/residents/fellowships  for more information.  
PRACTICE OPPORTUNITY - NEAR TUCSON MEDICAL CENTER

PRIVATE PRACTICE OPPORTUNITY NEAR TUCSON MEDICAL CENTER.  
SPACIOUS OFFICE - GREAT LOCATION.  Share overhead expenses with established psychiatrist and therapist.  Call Shari at 520-795-0309 or Dennis C. Westin MD at 520-777-0580.  

Fellow definition
CONGRATULATING ARIZONA'S NEWEST DISTINGUISHED FELLOWS AND FELLOWS!

The American Psychiatric Association has elected the following Arizona Psychiatric Society members to the status of Distinguished Life Fellow or Distinguished Fellow of the APA, to be honored at the APA Annual Meeting in May of 2019 at the Convocation of Distinguished Fellows: 
 
Edward M. Gentile, DO, MBA, DLFAPA
Richard S. Rhoads, MD, DFAPA

In addition, the following members of the Arizona Psychiatric Society were approved for Fellow status by the APA, and these Fellows will also be honored during the Convocation ceremony in May:
 
Jasleen Chhatwal, MBBS, MD, FAPA
Jason Curry, DO, FAPA
Debbie Ford, MD, FAPA

 
On behalf of the entire membership of the Arizona Psychiatric Society, we congratulate these newest Distinguished Fellows and Fellows of the APA on their distinguished careers and thank them for their continued support and membership in the APA and our Society. We would also like to recognize and thank the many Distinguished Fellow members in the Society who provided letters of support.   

HOW TO APPLY?   Nominations for Distinguished Fellow must be submitted through the District Branch.  If you are interested in more information on the requirements, please visit  https://www.psychiatry.org/join-apa/become-a-fellow  or contact the APS administrative office ( teri@azmed.org , 60 2- 34 7- 69 03 ).    Di st in gu is he d Fellow nominations are due to be submitted to the APA on or before July 1st of each year (for recognition in the APA Annual Meeting in the year following); Fellow applications are due on or before September 1st of each year and that application may be submitted directly by the applying member.      
MORE NEWS ON KRATOM


Stephen P. Herman, MD, LFAPA, DFAACAP
Board Certified:  Pediatrics, Psychiatry, Child & Adolescent Psychiatry, Forensic Psychiatry

In past newsletters, I have written of this controversial herb from Southeast Asia and also reported on several shipments which were contaminated with salmonella. FDA Commissioner Scott Gottlieb, M.D. has issued several warnings about this substance and its purported salutary effects upon medical conditions as varied as opioid addiction and diminished libido.

Kratom is legal in Arizona and readily available from stores and the Internet. Some sources have even been rated on Yelp! In our state, there are no age restrictions for purchasing it.

Recently, FDA scientists have found heavy metals in 26 kratom batches first tested for salmonella. These include nickel and lead, at levels unsafe for humans. With chronic use, the agency noted, people with high levels of nickel could be at risk for lung cancer. Lead poisoning, more familiar to clinicians, can cause hypertension, arthralgias, cognitive impairment, headaches, abdominal pain, miscarriages, stillbirths and prematurity, psychiatric problems and oligospermia.

Dr. Gottlieb released a statement on November 27, 2018, which read in part, "To date , there have been no adequate and well-controlled scientific studies involving the use of kratom as a treatment for opioid use withdrawal or other diseases in humans. Nor have there been studies on how kratom, when combined with other substances, may impact the body, its dangers, potential side effects, or interactions with other drugs."

It is expected that more concerns will arise until researchers study this substance under controlled and acceptable standards. For now, popular opinion, political clout and Internet testimonials will continue to extol its virtues.
 
For your ease of reference, the Spring/Summer Newsletter update  and the original  Winter Newsletter article on Kratom  are made available here.  The Society thanks Dr. Herman for his extra efforts to bring forth this important information to our community.  
STEPPING UP: AN ARIZONA UPDATE ON A NATIONAL INITIATIVE!
REPORT FROM AUGUST 23-24, 2018 MENTAL HEALTH CRIMINAL JUSTICE SUMMIT AND FIFTH ANNUAL DAVID'S HOPE AWARDS DINNER

Davids Hope AZ

Mary Lou Brnck
Executive Director
David's Hope Arizona

Step Up Arizona 2018 was held on August 23-24, 2018. The two day Mental Health Criminal Justice Summit included the fifth annual David's Hope Awards Dinner at which 240 attendees gathered together to honor law enforcement officers who have exemplified outstanding service and leadership in response to individuals experiencing a mental health crisis. Judicial officers and community members who have shown outstanding service and leadership in mental health criminal justice collaboration were also awarded. 

Max Dine Advocacy Award presented to Kathy Bashor
Included among those awards is the Max Dine Advocacy Award, named in memorium after long-time Arizona Psychiatric Society Board Member and dedicated community advocate.  The 2018 recipient of the Max Dine Advocacy Award (included in the photograph below) was Kathy Bashor, Bureau Chief, Office of Individual & Family Affairs, AHCCCS.  Most recently, Ms. Bashor announced her retirement from AHCCCS ( READ MORE HERE).

CLICK HERE for a full listing of those recognized for their outstanding contributions by the 2018 Davids Hope awards and a photograph gallery of the same.  

Please SAVE THE DATE for 2019 for the Fourth Annual Mental Health Criminal Justice Summit, to be held as a single-day event on August 15, 2019.   
PARITY: WHAT IS IT AND HOW CAN IT BE ACHIEVED?
An Overview from The Kennedy Forum

By law, most health plans must cover illnesses of the brain, such as depression or addiction, the same way they cover illnesses of the body, such as diabetes or cancer. Speak up about illegal denials of care! Learn more at www.DontDenyMe.org #DontDenyMe


President George W. Bush signed the Mental Health Parity and Addiction Equity Act into law on October 3, 2008. The Act was sponsored by Congressman Patrick J. Kennedy (D-RI). Parity as a concept is very simple: insurance coverage for mental health and substance use disorder care should be no more restrictive than insurance coverage for any other medical condition. However, the Federal Parity Law is very complex, and implementation of the law can be challenging.
 
Insurers have done a very good job of coming into compliance with some of the more straightforward components of the law, such as making sure copays and visit limits for mental health and addiction care are no more restrictive than they are for other medical care. However, insurers are likely not complying with some of the more complicated components of the law, albeit unintentionally.
 
Many of these trouble spots relate to how insurers design and apply their managed care practices, such as prior authorization requirements, step therapy, and requirements for providers to join an insurer's network. Often, insurers design and apply these managed care techniques in ways that are more restrictive for mental health and substance use disorder treatment than for other medical treatment, which violates the Federal Parity Law and can lead to deaths from suicides, overdoses, and other forms of preventable death.
 
States have primary enforcement authority over insurers that sell health insurance policies in their states. While there is growing interest by state insurance departments to implement the law and increasing willingness by insurers to submit data to regulators demonstrating compliance, there is much uncertainty about how to do so in an efficient manner that meets the tests of the law.  

The Society is part of the national work group looking at building coalition and stakeholder support for measures that will help achieve parity at the state level.  If you are interested in participating in the APS Work Group on Parity, chaired by Dr. Don Fowls, please contact Teri (teri@azmed.org).  
JANSSEN UPDATE
J&J and Janssen Logo
Mental Health Parity: Health Care Policy Alert

Mental health party describes the equal treatment of mental health conditions and substance use disorders (MH/SUDs) compared to medical/surgical benefits by insurance plans.  October of 2018 marked the ten-year anniversary of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).  For a full Mental Health Policy briefing on Mental Health Parity, providing background, the evolution of Federal mental health parity requirements, health plans affected, and what parity means,  CLICK HERE.  

CME AND LOCAL EVENTS:  APA COURSE OF MONTH AND TELEPSYCHIATRY TOOL KIT; OPIOID EDUCATION; NAMI AZ 1-26-2019 ANNUAL MTG; UofA INTEGRATIVE MENTAL HEALTH CONFERENCE, SFO 4-15 to 4-17-2019

APA FREE COURSE FOR DECEMBER
Each month APA makes available a free CME course exclusive to members only through its Learning Center. December's course is Functional Neurological Symptom Disorders.  This presentation discusses developments in neuropsychiatry and effective strategies in the diagnosis of functional neurological symptom disorder (conversion disorder) for the general psychiatrist.  Presented by Sepideh N. Bajestan, MD, PhD, of Stanford University.  

TELEPSYCHIATRY TOOL-KIT
The APA and the American Telemedicine Association (ATA) recently released "Best Practices in Videoconferencing-Based Mental Health," a guide for mental health providers who want to begin using interactive videoconferencing to offer services to their patients.  This guide is the latest telepsychiatry resource to the APA's Telepsychiatry Tool-Kit.  The guide broadly considers administrative, technical, and clinical considerations of videoconferencing-based telemental health practice.  

SATISFY YOUR NEW OPIOID EDUCATION REQUIREMENTS

ARIZONA OPIOID PRESCRIBING GUIDELINES CME
Free Online Opioid Education for Arizona clinicians that meets the three-hour CME requirements for continued licensing that took effect on April 26, 2018 is made available by the University of Arizona College of Medicine - Tucson.  Topics include:  Introduction to Safe Prescribing of Opioids for Pain Management, Managing Opioid Misuse Disorder in Pregnancy and Neonatal Care, or Opioid Issues in Youth Pain Management for Orthopedic Injuries (1.0 hour each), or Safe and Effective Opioid Prescribing While Managing Acute and Chronic Pain (3.0 hour).


JANUARY 20, 2018 OPIOID USE DISORDER WORKSHOP SATISFIES ANNUAL REQUIREMENT
If you attended the Arizona Psychiatric Society Opioid Use Disorder Treatment Essentials Workshop on January 20, 2018, the continuing medical education provided at the Workshop can be used to satisfy the opioid education requirements for licensure in Arizona, provided you attended at least 3.0 hours of the workshop.  Society planning efforts are underway to bring an additional opioid training to our members, which is planned to be made available online for the benefit of our members located throughout the State of Arizona.

NAMI Az logo updated banner
The NAMI Arizona Board of Directors invites you to attend and participate in the 2019 Annual Meeting, "Breaking the Silence - Ending the Stigma - Saving Lives," scheduled for Saturday, January 26, 2019 at the Ability360 Conference Center, 5025 East Washington Street, Phoenix, Arizona  85034, from 9:30 am to 3:00 pm.  


INTEGRATIVE MENTAL HEALTH CONFERENCE - APRIL 15 TO 17, 2019, SAN FRANCISCO, CA
April 15-17, 2019
Hilton SF Union Square
San Francisco, CA
Registration is now open! 
Visit imhc.arizona.edu   to get in on special early bird rates!
Patients are increasingly looking for mental health care options that go beyond medications and conventional therapy, turning to alternative and complimentary medicine. And with good reason. Scientific evidence for the effectiveness of integrative treatment modalities continues to expand and includes research on nutrition, dietary supplements, mind-body interventions, spiritual counseling, adequate sleep, positive psychology, and psychedelics, in addition to conventional treatments.
The Integrative Mental Health Conference will offer a great chance for healthcare professionals to learn integrative care techniques and network with like-minded physicians, psychologists, nurses, social workers, counselors, and therapists.
CME REPORT FROM ISEN ANNUAL MEETING
The 28th International Society of ECT & Neurostimulation Annual Meeting:  May 6, 2018

Brian Espinoza, MD, FAPA
Interventional Psychiatry
APS CME Contributing Editor

This year we had members from 21 different countries in the audience. This was my tenth year in attendance, and the morning was spent with presentations on indications for ECT other than depression, and review of a study on ECT related mortality. The afternoon was spent in Breakout Sessions and Abstract Presentations.  

CLICK HERE to review or print out the full overview of educational symposium, awards, and presentations from the ISEN Annual Meeting.    

Dr. Espinoza is an APS Member and an Interventional Psychiatrist specializing in Electroconvulsive Therapy (ECT), IV Ketamine for Depression, Pharmacogenomic Testing, Enhanced Medication Management, and Pharmaceutical Research.