We have had a front and center view of trauma in action. Fear, isolation, financial stress and chaos related to the pandemic. World over, this trauma has brought to the fore conversations about mental health on a broader scale. Other impactful and difficult conversations in our country are occurring around politics, systemic racism, and social inequities. We, as psychiatrists, are distinctively positioned to engage these issues as they impact the human communities we serve. We have the opportunity to play a role in healing and recovery in the months and years to come.

Recent news about COVID19 vaccination has allowed many to start to envision an end to the pandemic, finding reserve energy to continue showing up and supporting patients and colleagues. In this newsletter, we bring to you information regarding Arizona’s vaccination plan so you can take this step to protect your and your family’s health. Our physician leaders have been engaged with Az Medical Association, Az Psychological Association, AZ Council for Human Service Providers, and other organizations to provide education and advocate for mental health support for fellow physicians and communities.

Parity efforts have maintained their priority and our immediate past President Dr. Don Fowls has been appointed to DIFI’s Mental Health Parity Advisory Committee for that initiative. This is a huge honor. Congratulations Dr. Fowls! We have also stayed busy planning and developing valuable educational initiatives around involuntary commitment, opiate use disorder, and risk management that we hope to share with you in early 2021.

As an organization, we remain committed to our future. We welcome all members to be involved in the organization to connect, learn, and share their expertise. I especially invite our Resident-Fellow members to engage by attending a meeting, participating in a committee, or applying for an APA or APA Foundation fellowship.

Someday, we will look back on 2020 as an year that changed us. At this juncture, we have the ability to influence that future perspective by consciously reflecting on the story we form about this year, this trauma. Our uniquely human ability to reflect can serve as a source of rumination or a path to rehabilitation. As individuals, families, organizations and countries, we get to choose our path of transformation. Let’s choose it intentionally.

Thanks to our exhibitors for supporting the 2020 Annual Meeting and the ongoing programs and outreach of the Society! Thank you for taking a moment to acknowledge them for that support. Congratulations to Dr. Lee Ann Kelley, Dr.Traci Wherry, Dr. Veronica Murphy, Dr. Eugene Wolff, and Dr. H. Jim Schulte, our exhibitor drawing winners.

Gold Exhibitor 2020 and 2020-2021 Corporate Sponsor

Silver Exhibitor 2020 and 2020-2021 Corporate Sponsor

Silver Exhibitor 2020 and 2020-2021 Corporate Sponsor

2020 Annual Meeting Exhibitors

Thank you to those members who completed the risk management education survey. We are honored to bring to our members risk management education identified by your needs feedback. The live webinars will include "What Would You Do?" and uses real-life scenarios based on actual calls to risk management helplines. One example being: “My patient just told me that he committed a recent robbery. What should I do?” Another example is: “The police have arrived at my office with a search warrant for the records of several patients. What should I do?” The other live webinar topic will be Supervisory, Collaborative and Consultative Relationships (Risk Management: Overcoming Barriers to Implementation in Psychiatry), which will review the three traditional split treatment roles in psychiatry: supervisory, consultative, and collaborative and address the risks associated with each role, the importance of understanding the state and federal laws and regulations pertaining to the formation of doctor-patient relationships, providing consultations and acting in the role of a supervisor, and risk management strategies to overcome barriers with each role. The risk management webinars will be held live virtual on dates to be set in February and March of 2021. Watch for flyers to sign-up starting in January of 2021. In addition to supporting your educational needs, completing one or more of these webinars may make you eligible for a discount on your risk management coverage.

Voluntary treatment for any medical condition is always preferable. However, because of the nature of mental illness, involuntary treatment and hospitalization is necessary in certain circumstances, especially if the illness has impacted that person’s ability to identify their own need for treatment.

Court-ordered evaluation or court-ordered treatment (assisted outpatient treatment) is a complicated topic in which the medical and legal communities each play a role. In order for a psychiatrist practicing in Arizona to effectively protect the patient and others at a time when he or she may not be capable of appropriate decision-making, having the knowledge of Arizona law and its processes necessary to interpret the appropriate course of action and apply the same is essential.

Assisted outpatient treatment (AOT) has been shown to reduce hospitalization, arrest and incarceration, homelessness and violent acts associated with mental illness. Due to strict legal criteria, AOT participants typically represent far less than .05% of a state’s population. Yet, on any given day, they are the people most at risk to be in a hospital, ER, on the streets or behind bars.

Attendees will be instructed on the structure and content of Arizona laws regarding court-ordered evaluations and court-ordered treatment, as well as how to navigate the process in Arizona.

Health care providers are under unbelievable stress during this time--working long hours and relentless shifts while balancing personal safety with the health of patients. For many, COVID-19 brings a unique set of stressors: powerlessness to a disease course with no curative treatment, the isolation of patients from their family support, and an increasing concern of availability of resources. For others, COVID-19 has disrupted the routine care of their patients and worsened access to care or led to preventable adverse health outcomes.

We would encourage all providers to take their own pulse, as well as that of their colleagues, for the coming weeks and months. The physician suicide rate is approximately double that of the general population, and if rates of burnout and depression rise among physicians following the pandemic, we fear a corresponding rise in physician suicides.

Following the death by suicide of emergency medicine physician Lorna Breen in April, the reluctance of physicians to seek mental health treatment was in the spotlight. Physicians cite concerns of confidentiality, fear of discrimination in licensing and lack of time as significant barriers to receiving mental health support.

Out of stressors do come solutions and following examples of other nationwide efforts for a physician support system, the Arizona Medical Association (ArMA) has established a free, confidential peer-to-peer network which has been supported and shared by the Arizona Medical Board. Trained physicians are available as supports through The Virtual Doctors’ Lounge (MDlounge.org) (flyer enclosed). It is available to all licensed physicians, regardless of ArMA membership or affiliation. Note the availability of a similar program for Arizona nurses, The Wellbeing Initiative (aznurse.org/page/WellBeingIndividuals), as well as the more broadly available crisis support initiative, Resilient Arizona (resilientarizona.org), which is offered to all Arizonans.

Last, the Arizona Psychiatric Society continues to work with the Arizona Medical Board in an effort to design a “Frequently Asked Questions” section regarding what is a reportable mental health issue for licensing or renewal as this is a commonly expressed concern. We emphasize that the peer-to-peer network above, The Virtual Doctors’ Lounge, is not a resource which one would constitute a reportable encounter, and even routine psychiatric care (i.e., care for depression, anxiety) does not typically require reporting.

ArMA continues to be a trusted resource for all things COVID. On December 11, the FDA announced that the Pfizer-BioNTech COVID-19 vaccine received Emergency Use Authorization (EUA) for patients ages 16 and older. The Arizona Department of Health Services and AZ County Public Health Departments have been diligently working on a comprehensive plan for vaccine distribution. All Arizona counties have been encouraged to allocate vaccine according to the guidance provided by both the CDC's Advisory Council on Immunization Practices (ACIP) and the Arizona Department of Health Services Vaccine and Antiviral Prioritization Advisory Committee (VAPAC). As such, it is anticipated that the AZ healthcare community will be the first to be vaccinated in our state. As Arizona physicians are encouraged to receive the vaccine, CLICK HERE for detailed information on vaccine distribution for several counties. As ArMA receives information from other counties, they will provide updates.

As reported last week, because of Arizona’s structure, each county will be managing the vaccine distribution process independently. Due to a limited amount of Pfizer doses expected this week, only Maricopa and Pima Counties will begin vaccinating. It is anticipated that the Moderna vaccine will be approved this week, and all other counties will receive a vaccine for distribution beginning next week.

Resources regarding the COVID-19 vaccine have been compiled and made available to the public for you to share with patients and their families, your staff, and your peers at https://www.azmed.org/page/COVID19Vaccine

If you are interested in becoming a member of the Arizona Medical Association, you can join online; or if you would like to learn more about member benefits, contact the ArMA Membership Team, (602)347-6914.

Applications are due January 31, 2021. APPLY HERE.

1. Visit www.psychiatry.org/fellowships and apply.psychiatry.org

7:00-8:00 pm EST

8:00-9:00 pm EST

Meeting ID: 919 1335 2292

Passcode: APPLY

Please feel free to share this information with your members and networks. Questions can be sent to [email protected].

The Arizona Psychiatric Society was represented at the APA November Assembly by Drs. Gretchen Alexander and Jason Curry. Dr. Jasleen Chhatwal was also in attendance in her role as ECP Board of Trustee Representative, representing Arizona and ECP members as a whole. CLICK HERE to read the full written report from Dr. Alexander, some of the highlights of which are:

Fall Assembly meetings were well attended and dynamic. Reference Committee meetings were held the evenings of October 19^th-21^st with the full Assembly meeting November 7^th-8^th. Reference Committee chairs noted that turnout for virtual reference committee meetings was generally improved over attendance at previous years’ in-person meetings. The reports and action papers are detailed in the provided Report. The most engaged discussion centered around the New Business.

• Proposed Position Statement on Concerns About Use of the Term “Excited Delirium” and Appropriate Medical Management I Out-of-Hospital Contexts. This addresses concerns about the use of ketamine in the field by EMS to assist law enforcement officers with detaining uncooperative suspects. The American College of Emergency Physicians has recognized the diagnosis of “excited delirium” since 2009 as describing a state of uncontrollable agitation, generally related to intoxication. These individuals sometimes die in police custody and POC are said to be overrepresented in this group, leading to concerns that the diagnosis is being used to cover up deaths due to excessive force by police. Additionally there is a trend for LEOs to call in EMS and have ketamine administered inappropriately to help subdue detainees, using the justification that they are exhibiting “agitated delirium.” The APA has a previous position paper expressing concern that this is not a recognized diagnosis in DSM-5. Assembly voted to approve the position statement.

• Assembly voted to formally request that the BOT release to the Assembly the consultant’s report which followed their board governance retreat this Fall.

• Discussion of purchase of new APA headquarters in Washington, DC and current APA budget deficit.

The APA Assembly Notes comped by Dr. James Polo are also available by CLICKING HERE.

Take the Well-Being Self Assessment 2.0. APA is seeking to learn more about well-being and burnout among psychiatrists in general and among minority and underrepresented psychiatrists.

November 2020 Update: During the November 2020 Town Hall, Dr. Michele Reid, member of the APA Board of Trustees and Structural Racism Task Force member, presented an update on the work of the Task Force. CLICK HERE to access links to read the report and watch her update on a timestamped video link.

FREE COVID-19 Clinician CME from the Arizona Medical Association in collaboration with Rockpointe Education, "Eliminating Racial Disparities: What Can You Do?" CLICK HERE for more information and to register for this activity.

The inaugural meeting of the Mental Health Parity Advisory Committee ("MHPAC") was held on Monday, December 14, 2020. CLICK HERE for a recap of the Committee introductions and level setting for the work of the Committee in the year head. Congratulations to Dr. Don Fowls (photo to the left) on his appointment to serve on the MHPAC and for his continued contribution of leadership and service to the goal of bringing the community together, across roles and organizations, to support the intentions of the parity laws and to maximize the access to care in our State.

It will be most impactful to the work of the MHPAC to have examples of where parity needs better oversight. Please submit your examples of any potential denials of coverage or requests for review that are beyond the scope of what would be required for med-surge coverage to Teri or contact Dr. Fowls regarding the same. The MHPAC meetings are open to the public, and your comment and participation are also welcome there. The next meeting will be held on Friday, January 15, 2021 at Noon. If you are interested in receiving notices of the MHPAC meetings, please contact Teri.

In May 2020, the ONC released its Final Rule for 21st Century Cures. An overview of the Rule, its complete text, and various Fact Sheets can be accessed here.

On December 7, 2020, APA, and the College of Healthcare Information Management Executives (CHIME) hosted a webinar to provide an overview of, and to discuss, the content of the ONC's Final Rule on Interoperability and Information Blocking. During the webinar, the ONC answered questions about how psychiatrists can best comply with this rule. That recording can be accessed here.

The last few months have seen significant movement across a broad array of issues. For the latest APA Advocacy update on APA-led activities, executive branch, congressional, and state activities, CLICK HERE.

Want to receive APA advocacy updates directly? CLICK HERE to subscribe for Advocacy Alerts and Updates from the APA.

A collaborative initiative from APA, American Society of Addiction Medicine (ASAM), Friends Research Institute (FRI), and the National Institute on Drug Abuse (NIDA), AMNet is seeking addiction medicine providers from a range of practices to participate in a practice-based research network. The network is focused on measuring and improving patient outcomes through the collection of data in PsychPRO - APA's CMS-Qualified Clinical Data Registry. AMNet will be able to serve as a platform for future research studies.

Below is a link to a 5-minute survey to describe your practice and check your eligibility for AmNET. A nationwide response to the survey will help us learn more about the diverse characteristics of practices and their patients. We would like to hear from you regardless of whether you wish to join.

At the end of the survey you can indicate your interest in joining AMNet or request additional information.

Benefits of Joining AMNet:

Please do not hesitate to contact us at [email protected] if you have any questions.

The Nominating Committee invites members to submit their interest in serving as an executive officer of the Society for 2021-2022 (one-year terms with opportunity to advance on the leadership ladder to President-Elect and then President), as a Co-RFM Representative (representing your psychiatric residency program), or as an Arizona APA Assembly Representative (two-year term of service with quarterly meeting travel required). In addition, all Committees or Work Groups are open to members to join.

Help us learn more about your interest and vision in contributing to the Society by completing the interest form on or before February 1, 2021.

Our thanks to Dr. Rahn Bailey and Dr. Sandra DeJong for sharing their election profiles for consideration by Arizona members in advance of voting in the APA 2021 elections for APA Secretary. Candidates for additional APA elected offices participated in an online forum with the APA Assembly in November. CLICK HERE to view video of those remarks from candidates for the President-Elect, Secretary, Early Career Psychiatrist (ECP) Trustee, and Minority/Underrepresented Representative (MUR) Trustee, and a Q&A session. Voting Begins on January 4, 2021, and tends February 1 at 11:59 p.m. E.S.T. Cast your Vote on or before February 1, 2021!

At the recent Annual Meeting Awards Session, we observed a moment of silence for members deceased in 2019-2020. We are respectfully updating that list to include Dr. Steven Galper. If you know of a member that should be acknowledged that is not on this listing, please contact Teri. We honor these psychiatric physicians for the important difference they made to psychiatry, their patients, and our community: