GAP Circular Letter #666

POST MEETING WINTER 2023

America’s Think Tank for Mental Health

www.ourgap.org

DATES OF FUTURE GAP MEETINGS: 2024 April 4–6 Sonesta Hotel White Plains, New York November 14–16 Sonesta Hotel White Plains, New York

GAP OFFICERS: President Calvin R. Sumner, M.D. docsumner@gmail.com President Elect Robert P. Roca, M.D. rroca2@jhmi.edu Secretary Sy A. Saeed, M.D. saeeds@ecu.edu Treasurer Gail E. Robinson, M.D. gail.robinson@utoronto.ca Past President Lawrence S. Gross, M.D. lgross@usc.edu

CIRCULAR LETTER #666

Message from the President Greetings to all, I can hardly believe that time has passed so quickly since the Fall GAP meeting. I may be biased, but I thought it was a great meeting, and the feedback from many members seems to agree.

Adjusting to a new space is always a challenge, but Frances’ pre-event work with the Sonesta staff resulted in an almost flawless meeting. The hotel space is more limited than we’re used to, and we have some work to do to “right-size” the committee break-out rooms. It was great to see such a large attendance of members, GAP Fellows, and guests, and the energy in the room was remarkable.

The Steering Committee voted in 15 new members, and GAP hosted the attendance of 21 prospective member guests at this meeting. Welcome to our newest members. Let me offer a few words of guidance. GAP continues to be a vital organization with members working together in support of a shared vision of the importance and relevance of the psychiatric perspective for individuals, groups, and society. GAP does not have a “top-down” governance structure like many professional organizations; GAP is of the members, by the members and for the members. GAP is not a virtual organization, and all members are expected to attend two meetings a year, to meet as the Group for the Advancement of Psychiatry, and to work in person with their committees. Of course, there will always be exceptions, but attendance should be the norm. Timely payment of dues is necessary because GAP depends on members’ dues to keep the lights on. And above all else, enjoy and appreciate the collegiality of the organization.

On a more somber note, the joyfulness of the holiday season is tempered with the grim reality of yet another armed conflict in the world with severe consequences for non-combatant civilians. The pervasive nature of information in today’s world means that even individuals not directly involved in conflict are constantly exposed to news and images of armed conflicts around the globe. While this exposure can raise awareness and encourage support for humanitarian efforts, it can also have a significant negative impact on mental health, even for those who are not directly involved in the conflict. Children, adolescents, and those with mental illness are particularly vulnerable to the adverse mental health effects of the traumatic experience of war and violence. The Committee on Disaster, Trauma, and Global Health has issued a proactive statement with a thoughtful perspective for a healing path forward through the crisis that is worth reading and discussing. Here are a couple of excerpts from their statement: “The GAP Committee on Disasters, Trauma and Global Health is deeply attuned to the myriad emotions, including sadness, heartache, and anger, triggered by the ongoing violence, moral injury, and trauma in the Middle East, Gaza, and Israel. We seek to craft a statement that is least likely to provoke reactions, and invite dialogue and suggestions. We condemn all acts of violence, hate, and actions leading to human suffering…We are presenting this high-level overview, based on preventive views, and emphasizing the need

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P.O. B ox 5 7 0 2 1 8 • D allas , Tex as 75 3 5 7- 0 2 1 8 • 9 7 2- 6 13 - 0 9 8 5

AI Plenary Follow Up by Darlene King, MD More than half of U.S. counties lack a single psychiatrist, and more than 150 million people live in federally designated mental health professional shortage areas (defined as more than 30,000 residents per clinician).

Prior to the Covid-19 pandemic, 11% of adults reported symptoms of anxiety or depression. At the height of the pandemic, this percentage jumped to 40%, and now, three years later, the percentage of adults reporting symptoms of anxiety and depression remains high, around 32%.

There is a great need for increased access to mental health care. For clinicians, the demand and need for care must be balanced with documentation, regulatory, administrative tasks, and available time. While many different technologies exist under the umbrella of AI, each with unique concerns, limitations, and questions for further research, Open AI’s Chat GPT has increased awareness by making the technology more user-friendly and accessible than ever before. With the current psychiatric and medical landscape, it makes sense that many are asking—“How do we implement this technology to provide solutions to clinicians and patients?” AI has great potential to increase access to care, help increase efficiency, increase quality of care, and much more. Rapid implementation of AI, though, can be problematic—an example being The National Eating Disorders Association’s chatbot, Tessa, who recommended advice that potentially exacerbated eating disorders.

No matter the type of AI being considered for medical applications, it is essential to consider the limitations, ethical concerns, and potential impact of the technology if we want to enjoy its utility and limit harm.

AI PLENARY FOLLOW-UP WRITTEN BY AI FOR STEVEN HYLER, MD Artificial Intelligence (AI) has emerged as a transformative force in various medical disciplines, including psychiatry. In our brief plenary we covered the current applications of AI in psychiatry, focusing on how these technologies are reshaping diagnostic and therapeutic processes. Given the rapid evolution of AI, understanding its impact on psychiatry is crucial for both current practitioners and future professionals in the field. Machine learning algorithms have revolutionized the way psychiatric disorders are diagnosed and treated. These algorithms can identify patterns and correlations that may elude human clinicians by analyzing large datasets. For instance, machine learning models are increasingly accurate in predicting the onset of depressive episodes based on patient data trends. Natural language processing (NLP) technologies analyze patient speech and written texts, providing insights that aid in diagnosis and treatment. For example, linguistic analysis tools can detect subtle changes in a patient and speech patterns, which may indicate the development or progression of certain psychiatric conditions. As AI continues to evolve, its potential to revolutionize psychiatry grows. Our brief review underscores the importance of continued research and ethical considerations in harnessing AI’s full potential in psychiatry. Emerging trends in AI, like deep learning and predictive analytics, show promise in further enhancing psychiatric care.

Message from the President Continued. to continue to collectively work toward universal adoption and commitment to basic human rights and well-being for all people.”

I encourage all GAP members to read the full text available on the DTGH Committee webpage (https://www. ourgap.org/committees/disasterstrauma-and-global-health).

The Fall GAP meeting marked a significant milestone for the organization with the retirement of David Adler from his position as Chair of the Publications Board. David’s

steady hand at the helm for 27 years guided GAP from the era of only publishing books and monographs to the organization’s current diversified dissemination of committee work products through multiple media channels. David’s successors as Co-chairs of the Publications Board, Matt Erlich and Jacob Appel are well-experienced and ready to take up the baton to continue this group’s important work. For all of GAP, I would like to express our gratitude to David for a job well done.

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In this special season, let us pause to celebrate the everyday moments that have brought us closer and our shared goals to advocate for health and bring comfort to the suffering. Embrace the quiet magic of this season. May it offer you moments of tranquility and joy.

All the best,

Calvin R. Sumner, M.D. President, Group for the Advancement of Psychiatry 2023 Circular Let ter #666

ANNOUNCEMENTS: GAP, the Environment, and You

Public Relations Update

by John Looney, Planning, Marketing and Communications Committee Chair

by John Looney, Planning, Marketing and Communications Committee Chair GAP has a new Climate Committee which is active in educating our profession and the greater world about our climate crisis and its effect on mental health. We also need to ask what GAP itself can do. We have solid evidence from our Publications Committee that our productivity of reports goes up when we meet face-to-face twice yearly. Yet, what can we in GAP do to offset our meeting’s impact on our environment? A number of things: • East Coast members can use the excellent train connections. For example: the Boston, Providence, and New Haven train goes to Stamford, CT, which is 17 miles from the hotel. The Washington DC, Philadelphia, and New York train is also convenient.

• East Coast members not on the train lines can share rides. We will try to put out a directory of where East Coasters live.

• Work with the hotel to use best practices.

• Revise investment portfolio to avoid environmentally harmful companies.

• Offset the carbon cost of travel from the west by increasing the size of our forest.

GAP FOREST AND PLANTING TREES We will plant 5000 trees this year. Members, please contribute to our tree planting fund. Thirty dollars added to your dues will plant and maintain thirty trees. We can promote the tree planting idea to other medical organizations and thereby gain visibility for GAP.

REPORT FROM THE NOMINATING COMMITTEE: An election will be held at the April 2024 Meeting with the following slate presented from the Nominating Committee: President: Robert Roca President-Elect: Sy Saeed Secretary: David Sasso Treasurer: Gail Robinson Board of Directors: Ludmila De Faria, Nubia Lluberes, Scot McAfee, Barbara Schildkrout

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At about the time of our 75th Anniversary, we had clarified the mission of GAP as “America’s Think Tank for Mental Health.” However, we also realized the profession and the public were not aware of what we were thinking in our think tank. Thus we hired Amy Franklin to develop a public relations presence. Our Finance Committee reviewed the cost of about $150 from the annual dues of each member.

Amy reports to the Committee on Planning, Marketing and Communications. That Committee has just recommended that she be hired for another year with a 5% increase. The coming year will give us a fresh appraisal of the cost and benefit of our public relations.

Looking back at Amy’s accomplishments, the most important has resulted from her developing a relationship with Psychology Today. That magazine has now published 30 blogs written by GAP members. The magazine often refers to our blogs as “essential reads”. Jack Drescher and our media committee have also been involved in editing the blogs.

We have also used Amy’s contacts to publish in Women’s Health, Recovery Dialogues & Sober Stories, Everyday Health and others. Amy scans the needs of the media and to make sure GAP members can contribute when appropriate.

Going forward, the plan is to sustain our media outreach, to encourage more GAP members to contribute to media needs, to target other medical and trade organizations, to enhance our website with a media hub, to assess the value of social media to our outreach activities.

Amy and the Committee on Media will continue to develop media training for GAP members.

Please convey to the Chair of the Committee on Planning, Marketing & Communications your thoughts about our public relations efforts: john.looney@duke.edu.

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COMMITTEE REPORTS

COMMITTEES REPORTING:

ADOLESCENCE Members present in person: Dan Becker, Stephan Carleson, Liwei Hua, Aaron Krasner, Jean Wittenberg.

Guest present in person: Mayank Gupta.

Members present on line: Jake Crookall Guest present on line: Natasha Vianna

Adolescence_______________ 4

PROJECTS AND TOPICS DISCUSSED:

Climate___________________ 6

DIAGNOSIS OF PERSONALITY DISORDERS/BORDERLINE PERSONALITY DISORDER IN ADOLESCENCE.

College Student_____________7

Aging_____________________ 5 Arts & Humanities__________ 5 Child Psychiatry____________ 6

Discussion has begun and will be explored and led by Dan Becker and Liwei Hua. No determination of what publication or other action to be taken.

LGBTQ+__________________ 9

Initial document was prepared by Aaron Krasner and was discussed with the committee. Expected products will be a curriculum and teaching modules to be collaborated on with the American Society for Adolescent Psychiatry.

Date not determined.

STIGMA, TEEN PARENTS, THEIR CHILDREN, AND HEALTH EQUITY This is a development arising from our previous work.

b.

Disasters, Trauma, and Global Health___________ 9

DEVELOPING EDUCATIONAL MODULES FOR TRAINING PRIMARY HEALTHCARE PROVIDERS (PHPS) TO TREAT AND SUPPORT MENTAL HEALTH IN ADOLESCENTS

a.

Cultural___________________ 8

A paper on Teen Parents and Obstacles to Health Equity is in preparation (Jean Wittenberg) with a focus on obstacles experienced in interactions with healthcare service providers. Expected date of completion—6 months.

A survey for young parents is being carried out to develop a set of 4–5 questions for primary healthcare providers (PHPs). These will be emailed to a wide range PHPs to stimulate thought about the issue and reflect on their practices. Led by Jean Wittenberg and Natasha Vianna. Potential collaboration with No Teen Shame, American Academy of Pediatrics and Canadian Pediatric Society. Potential collaboration with Dear Abby.

Expected date for distribution to PHPs­— 6 months.

CLIMATE AND ADOLESCENT MENTAL HEALTH The Committee has been exploring ways in which climate change might impact adolescent mental health. We have begun to explore potential collaboration with the Committee on Climate and will continue to discuss potential for this topic.

Military & Veterans__________ 9 Neuropsychiatry____________ 12 Planning, Marketing, & Communications__________ 12 Professionalism & Ethics_____ 12 Psychiatry & Community_____ 12 Psychiatry & Law___________ 13 Psychiatry & Media_________ 15 Psychiatry & Religion________ 14 Psychopathology___________ 16 Psychopharmacology________ 16 Research__________________ 16 Systems Innovation & Transformation___________ 16 Technology & Psychiatry_____ 18 Work & Organization________ 19

SOCIAL ISSUES ARISING FROM IDENTIFICATION AND PRONOUN SELECTION BY 2SLGBTQ STUDENTS Conflicts have arisen between individual child rights, parental rights and political goals regarding non-binary adolescents. We are exploring mental health risks and preparing to write a paper and perhaps a blog on the topic. Possible

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COMMITTEE REPORTS Continued. collaboration with Jack Drescher and the Committee on

a disease concept style (David Sinclair, genetics professor). Mention successful aging despite cognitive decline?)

LGBTQ+, led by Jake Crookall.

THE FUTURE OF GAP.

2.

Ageism

3.

Nutrition/Diet

4.

Sleep (Concepts from “Why We Sleep”

by Matthew Walker?)

5.

Exercise

6.

Mindfulness

AGING

7.

In Attendance: Robert Roca, Susan Lehman, Sehba Krautter, Ebony Dix, Ken Sakauye, Helen Kyomen

Social Connections/Relationships including Family/Caregiving

8.

Wisdom (Concepts from Dr. Jeste’s book?)

9.

Spirituality/Cultural Equity/Diversity

We have included this topic as a standing item on our agenda and will report to the Steering and Executive committees as we clarify our thoughts to facilitate further discussion.

PROJECTS DISCUSSED: APPI Book Ideas discussed with Dr. Laura Roberts: Intended audience: Health professionals.

Research what is already out there regarding publications over the last 5–10 years to position the current project. We can use Google/Amazon.—Dr. Krautter. The format of each chapter should be consistent and symmetrical in terms of structure. Repeated themes.

— Should interventions be discussed as part of each chapter or as a separate chapter? The committee consensus seems to be to discuss interventions in each chapter.

10. Mental Health/Psychiatric Treatment (identified pt and pt’s system, palliative approach, education, psychotherapy (existentialism)) 11. Medical Treatment (patient centered-care, iatrogenic polypharmacy) 12. Legal Issues (NOK, HCP, POA, guardianship) 13. Music/Art/Nature 14. Education/Training Future Generations 15. Implications for Technology/AI: Implementation, Legal/Ethical Issues Timeline: TOC, authors, and proposal by next Zoom meeting on 12/11/23 at 6 pm. Finalize at this meeting. Send to Laura Roberts. Invite authors.

— Help the reader understand the issue — Provide information that will increase the reader’s skill set; segments of dialogue between patient and doctor are especially valued.

Example of chapter structure (see chapter circulated by Dr. Roca for format example):

Ask authors to provide an outline 1.5 months after signing onto the project, and provide a sample chapter (like the one Bob provided).

— Case presentation/vignette with dialogue

Have the book completed by Fall 2024.

— Body of chapter

BOOK #2: POST-PANDEMIC GERIATRIC MENTAL HEALTH CARE (2ND ITERATION OF LESSONS FROM A PANDEMIC)—ESPECIALLY REGARDING CHANGES IN HEALTH CARE DELIVERY SUSTAINED EVEN AFTER THE HEIGHT OF THE PANDEMIC

— Reference list (do not overdo it!)

— Key takeaways — Therapeutics/Recommended reading

BOOK #1: HEALTHY AGING: ENHANCING BRAIN HEALTH AND WELL-BEING INTO OLDER AGE

Current Psychiatry Reports invited manuscripts:

Table of Contents: Does anyone want to author any of these chapters of have suggestions for authors?

1.

Introduction in incognito (i.e., Vignette): Why important? Why it matters? (Addressing aging is

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Dr. Kyomen et al. “Enhancing Brain Health and Well-Being in Older Adults: Innovations in Lifestyle Interventions”— First draft, Dr. Kyomen

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COMMITTEE REPORTS Continued.

Dr. Dix et al. “Ageism in the Mental Health Setting” Photo Essay Project­, Drs. Krautter, Kyomen, and Santos

CHILD PSYCHIATRY

Process: 1. Establish sites (Social balls; tennis club) 2.

Obtain release

3.

Take photo

4.

Interview—“By recording” found to be more efficient on-site per Alzheimer’s Disease Blood Test Pearls and Pitfalls/Pros and Cons Blog—Susan and Ebony

Present: Gabrielle Shapiro, Dorothy Stubbe, Eunice Yuen, Cynthia Pfeffer Fellow attending: Ivy Song Guest: Bud Vana, MD

PROJECTS AND TOPICS DISCUSSED: The committee is working on a journal-length article, “Children’s self-diagnosis by Social Media: What is the Role of Child and Adolescent Psychiatrists.” It will be targeted to the general public and submitted to the Psychology Today blog.

Utilize “Substack”?

Blog posts are up to 1,200 words.

(HEALTHY LIVING/AGING/”EAT WELL AND LIVE LONG”/”WHAT DO PSYCHIATRISTS EAT?”) COOK BOOK

The next topic is “Children’s self-diagnosis by social media: Role to Education future Child Psychiatrists.”

This will be completed in two months and submitted to Academic Psychiatry or JAACAP. This will target practicing psychiatrists, psychiatry residents, and training directors.

Any committee members, maybe ask all GAP members if they have a recipe they want to share. Ask the Finance Committee about using this as a revenue source for GAP. Potluck instead of hotel-cooked dinner?

NEW MEMBERS: Interested: Ken Sakauye, John Beyer Invite: Maria Llorente, Ike Ahmed, Ladson Hinton

The new topic under discussion is “Updates on the diversity of career choices for future psychiatrists.” (AACAP News) to be completed in three months and targeted to psychiatry residents and training directors submitted to AACAP News.

ARTS & HUMANITIES

The focus of work accomplished during the meeting: Recruitment of potential new members; Purpose Statement for GAP Child Committee on the website; Ideas for following GAP products, including a blog, clinical perspective, and training education piece.

Attendees: David Sasso, Chair; Anish Dube, Don Fidler, Andy Lustbader, Ken Weiss We continued work on our video series on the history of psychiatry. We have submitted our new video on 17th and 18th-century history for review by the publications board.

We reviewed our past videos and discovered we have 761 subscribers to our YouTube page; our video on Ancient History has over 11,000 views; the 19th Century has over 34,000 views, and the 20th Century has over 14,000 views.

Those interested can visit our committee website at www. artsgap.org and our YouTube page at www.youtube.com/@ artsandhumanitiesinpsychiatry.

We met with Presidential Guest Dr. Laura Roberts and discussed possibilities for a book-length project on the arts and psychiatry.

Virtual meeting to follow up on 12/07 at 5:30 pm over Zoom. Focus for next meeting: Recruitment of virtual new members; Updates on the projects described above.

CLIMATE Members attending: Elizabeth Haase (remotely), Janet Lewis, Beth Mark (remotely), Caroline Dumont Fellow: Josh Wortzel

We reviewed plans for an article on the use of the arts in therapy and as a therapeutic activity to be co-written by our committee member Don Fidler as a cross-committee project along with current GAP fellow Ivy Song and former GAP fellow Kelsey Wong.

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PLANS FOR BETWEEN MEETING WORK:

Guests: Carson Brown, MD, co-founder Baywell Climate Psychiatry Group (remote), and Alexandra Yoon, MD, Child and Adolescent Fellow, Children’s National Hospital, actively involved in the development of climate psychiatry curriculum study (remotely)

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COMMITTEE REPORTS Continued.

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING: Climate Psychiatry Residency Curriculum Study: We are submitting IRB soon Under discussion: — Book on therapeutic interventions related to climate change—considering an invited proposal from Wiley.

— A qualitative study of adults exposed to a video version of Coco — Climate experiences/attitudes of farmers In preparation: — Paper on Futures Library — Paper on Nature Metaphors PLANS FOR BETWEEN MEETING WORK: All of the above Focus for next meeting: We can use an animator, connections to populations of parents, connections to populations of farmers, and connections to populations of disadvantaged youth.

The clients that mental health clinicians interact with may appreciate that an adult is curious about their on-line activities. Or, they may experience this line of inquiry as an intrusive interrogation. Staff should be aware of the potential intergenerational transference and counter transference reactions this line of inquiry may engender. Despite these clinical pitfalls, mental health clinicians are well advised to familiarize themselves with the digital dimension of the patients’ lives. The paper ends with a number of helpful conversation starters to ask during an interview.

The committee reviewed and edited the draft and submitted it to the Media Committee for feedback.

#2 PSYCHOLOGICAL DEVELOPMENT & IDENTITY FORMATION IN THE AGE OF SOCIAL MEDIA

How many times have you met virtually?

We meet monthly virtually

The Committee on College Students will research the favorable and unfavorable conditions for emotional development and identity formation presented by social media. We intend to develop clinical scenarios highlighting which students are in particular for problematic Internet use.

COLLEGE STUDENT Members attending: Brunhild Kring (chair), Malkah Notman, Alexandra Ackerman, Ludmila de Faria, Francesco Peluso (virtually) Not attending: Lorraine Siggins and Helene Keable Post Fellow Attending: Isobel Rosenthal (virtually for part of the session)

PROJECT TITLES: #1 BLOG POST FOR PSYCHOLOGY TODAY: SOCIAL MEDIA-INFORMED MENTAL HEALTH ASSESSMENT Isobel Rosenthal submitted a draft for a blog post for Psychology Today; the write-up pertains to the challenges mental health staff face during the clinical interview when they engage young adults in a conversation about their engagement with social media. We believe that the social history taken in the context of a mental health evaluation would be incomplete without exploring the patient’s life in person and on line.

For example, there is an opportunity to feel understood by peers, find a community on line for isolated students or students who belong to specific social or identity minorities, stay in touch with family and friends across geographical distances, lack of in-person collective experience, however, specific feeds from social media can become “echo chambers” restricting exposure to different perspectives; the role of psychiatric self-diagnosis inspired

by Internet-based questionnaires and chat rooms (ADHD, autism, gender, anorexia, tics, trauma, My Mental Health), seductive social media algorithms are “hacking” the human mind, creating addictive behavior in vulnerable youth while serving capitalist marketing and mercantile interests.

#3 TELE-PSYCHIATRY FOR COLLEGE STUDENTS: CHALLENGES, OPPORTUNITIES, AND LESSONS LEARNED FROM THE PANDEMIC

The use of social media is ubiquitous and has pros and cons. Young adults enjoy the peer-to-peer interactions and the sense of belonging to on-line committees. However, some young people are vulnerable to the deleterious effects G r o u p f o r t h e A d va n c e m e nt o f P s yc h i at r y

of Internet use; they may fall prey to distraction and sleep deprivation because of the fear of missing out; there can be negative mental health consequences because of the compare and contrast culture and fear of not measuring up; more ominously, youth can become the victim of cyberbullying, sexual and financial exploitation, and gaming and Internet addiction.

Ludmila de Faria, Brunhild Kring, Helene Keable, Meera Menon, Francesco Peluso, Malkah Notman, Alexandra Ackerman

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COMMITTEE REPORTS Continued.

This paper has been published. Journal of Medical Regulation 1 June 2023; 109 (2) 21-28. https//doi. org/10.30770/2572-1852-109.2.21

We are working on several projects: 1.

Kelsey reported on her recent submission of a case to Clinical Psychiatric News. It is now pending review by the periodical.

STATUS: submitted, pending review.

2.

Kenneth discussed a paper that would help clinicians prepare a cultural formulation and clarify what a formulation adds to simple diagnostics, including moving away from reliance on DSM diagnoses as the sole/central aspect of clinical evaluation.

STATUS: Fast track, topic under discussion.

AUDIENCE: Mental health professionals

3.

Sally discussed her plans to work on a product or set of products at the intersection of narrative medicine and cultural psychiatry. The goal is to use narrative medicine approaches to facilitate clinicians’ entry into the life world of the patient, the way culture is embodied in how they think, feel, and live their lives. Products could include a paper and video interviews with cultural psychiatrists (including committee members) about how they understand their work/cultural psychiatry regarding the role of narratives/embodied experience.

STATUS: Fast track, topic under discussion.

AUDIENCE: clinicians, educators, general public

4.

Roberto discussed a paper on ways to incorporate social determinants of mental health and individuals’ lived experiences into the DSM development process, focusing on how service delivery would change if we paid more systematic attention to SDoH in case formulation and care delivery.

STATUS: Fast track, topic under discussion.

AUDIENCE: mental health professionals.

5.

Since the meeting via email, we also discussed a possible collaboration with the GAP Psychopathology committee on the paper in #4 and on another paper on practical ways to identify and record social determinants of health in clinical assessment.

STATUS: Fast track, topic under discussion.

AUDIENCE: mental health professionals.

#4 THE FALLOUT OF THE COVID-19 PANDEMIC ON COLLEGE STUDENTS Brunhild Kring & the GAP College Student Committee This paper has been approved by the GAP Publications Board. The paper is in need of some updates. We intend to submit it to The Journal of Nervous and Mental Disease.

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING: We discussed Paper #1 and edited and revised it. It has been submitted to the Media Committee.

The work on Paper #2 will continue in between GAP meetings via Zoom on 1/17/2024 and 3/20/2024.

Paper #3 has been published.

Paper #4 needs further updates.

PLANS FOR BETWEEN MEETING WORK: Our committee will be meeting monthly via Zoom on 1/17/2024 and 3/20/2024.

FOCUS FOR NEXT MEETING: 1. Welcome our Committee’s GAP Fellows 2.

Update the GAP website

3.

Continue to work on the paper about Psychological Development & Identity Formation in the Age of Social Media

Any ways in which members can be helpful?

Attend scheduled Zoom meetings; reflect on social media’s influence on college students’ development and write assigned paragraphs.

CULTURAL The committee met on Friday and Saturday.

Members attending in person: Francis Lu, Anne Becker, Kenneth Fung, and Roberto Lewis-Fernandez. Kelsey Wong attended as a post-GAP fellowship guest supported by GAP. Sally Huang attended as our current GAP fellow. Ana GomezCarrillo attended as our Ittelson consultant. Sanya Virani was a first-time guest.

In addition, the following members attended virtually for a couple of hours: Neil Aggarwal, Kam Bhui, Mitchell Weiss, and Brandon Kohrt.

We invited Sanya Virani to return as a second-time guest for the next GAP meeting, and she agreed.

We elected Kenneth Fung to join me as co-chair of the committee.

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COMMITTEE REPORTS Continued.

DISASTERS, TRAUMA, AND GLOBAL HEALTH The Committee on Disasters, Trauma, and Global Health is happy to report the submission of the revised textbook manuscript to APPI for Disaster Psychiatry: Readiness, Evaluation, and Treatment, with compliments to GAP’s Publication Board and Leadership for their excellent feedback and support. Our committee spent a good portion of our meeting reviewing our work, welcoming new members, and discussing the implications of the IsraelGaza Conflict. We drafted a statement currently available on our Committee web page https://www.ourgap.org/ committees/disasters-trauma-and-global-health, again with compliments to GAP for supporting our work. We are working on related pieces for GAP’s Psychology Today blog, awaiting final updates from APPI to complete the book, and considering work on radicalization and response to terrorism. We are looking forward to collaborating with other GAP Committees. Please feel free to reach out.

GENDER AND MENTAL HEALTH Present: Gail Robinson, Sophie Grigordias, Nikole BendersHadi, Nkechi Conteh, Kara Brown (zoom), Shelby Powers Guests: Natalie Feldman

LGBTQ+ The LGBTQ+ Committee had an extremely productive November Meeting where we finalized a draft of a journal article that is a product of a three-year collaboration with a team of human rights lawyers at Yale. In this project, we finalized the review of dozens of position statements on conversion therapy by organizations in medicine and mental health. We noted the extent to which these are updated and cited the most current literature and systematic reviews.

The draft has been submitted to the Publication Board, and we hope a prominent journal will accept it. We also welcomed a new member, welcomed back several returning members, and met a new Ittleson Fellow.

MILITARY AND VETERANS Present Members: Robert Koffman, Harold Kudler, Elspeth Ritchie, Guests: Hannah Roggenkamp, Chris Warner 1.

Introductions. Recently retired Army psychiatrist Chris Warner attended as a new Guest of the Committee. Dr. Warner brings 20 years of military and veteran medical experience and leadership, including over ten years experience as a hospital Chief Executive and Chief Medical Officer in deployed/combat environments, community hospitals, and academic medical centers, as well as a senior mental health consultant to national and international level organizations including the Department of Defense, North Atlantic Treaty Organization, and the International Red Cross. He has over sixteen years of academic leadership at multiple universities, through the military, and via representation in national academic organizations, and is an internationally recognized expert on military mental health, post-traumatic stress disorder, and the mental health effects of combat.

2.

F/U on Drs. Ritchie and Kudler’s presentations in Bucharest, Romania at a conference on Crisis and Disaster Management (October 7–8, 2023).

As planned at our April meeting, Drs. Ritchie and Kudler delivered invited presentations drawn from

The committee is working on intermediate-length manuscripts: — What’s In a Name? Archives of Women’s Health — Maternity Lease: JAMA ­— MDMA for PTSD: The Green Journal We are discussing possible podcasts to be completed by April–June 2024. The anticipated audience will be practicing psychiatrists, psychiatry residents, psychologists, other mental health professionals, and the general public.

FOCUS WORK ACCOMPLISHED DURING THE MEETING: ­— Further discussion of the results of the investigation ­— Division of work for writing up papers ­— Highlighting important aspects of the second paper ­— Plans for Between Meeting Work: Continue to write up papers and more information regarding podcasts FOCUS FOR NEXT MEETING: Finishing these papers. ­How many times have you met virtually? Two times Any ways in which members can be helpful? Information regarding podcasts.

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3.

4.

5.

their experience in disaster response in the military, VA, and other settings. Committee members expressed interest in representing GAP at other conferences to share our collective expertise and service as ambassadors for GAP.

help for starting conversations with the Veterans about

F/U on Dr. Schnitzlein’s Memorial Day Blog for GAP. Discussion at our April meeting led to the publication of a GAP blog, which reflected on the whole meaning of Memorial Day. Dr. Schnitzlein was the primary author. The committee acknowledged the assistance of GAP leadership in ensuring publication in time for Memorial Day. Other blogs under consideration include recognition of the contributions and experiences of women in combat, the meaning of Veterans Day, the need to recognize the contributions of service members, veterans, and their families, and the challenges they face (with a possible focus on asking “How DO You Thank Someone for their Service?” while avoiding such questions as “Did you kill anyone, and what was that like?”).

ACTION: Dr. Koffman has volunteered to develop the first draft of the “How DO You Thank Someone for Their Service? Blog. Dr. Ritchie has offered to draft a blog on the contributions and experiences of women in combat.

(as well as the mounting of an awareness campaign

Dr. Schnitzlien’s Natchaug’s 1st Annual Military Mental Health Symposium (December 1, 2023).

Dr. Schnitzlein has led a team of colleagues (many of them ex-military) in developing a symposium entitled “You or Someone You Know: Understanding the Importance of Military Service and Identity” in order to increase military and veteran cultural and clinical competence among clinicians and agencies in and around Norwich, CT. This program is replicable and scalable and, depending on evaluations, may serve as the model for an ongoing Committee project.

ACTION: Dr. Schnitzlein will report to the committee on the outcome of the Natchaug Symposium.

their mental health or substance use and motivating them to seek treatment if it is needed. Funding for this program is now in question. The committee may advocate for continued funding of this unique service about CIC) but will first request and review data and publicly available reports on CIC’s outcomes and overall impact.

ACTION: Dr. Kudler will gather data on CIC for Committee review.

6.

Might there be an opportunity to partner with the DHA and Veterans Health Administration (VHA) in supporting the National Disaster Medical System (NDMS) against the corrosive effects of privatization? Dr. Kudler was a panelist on a November 6th Veterans Health Policy Institute program addressing this issue. DHA and VHA work as partners in times of war and respond to local, regional, and national disasters under the NDMS. However, as these health systems are increasingly privatized, institutional knowledge and structural funding for this mission are progressively eroding. Our committee agreed to reach out to the GAP Disasters, Trauma, and Global Health Committee to consider a joint response aimed at ensuring the nation’s response readiness. This process was begun at the GAP meeting and is ongoing.

ACTION: Drs. Ritchie and Kudler have opened discussions with the leaders of the Disasters, Trauma, and Global Health Committee in hopes of developing joint action on this issue.

7.

Requesting Committee/GAP support for the VA’s Coaching Into Care program (https://www.mirecc. va.gov/coaching/). Coaching Into Care (CIC) is a free VA service for families and friends of Veterans.

Responders assess concerns and provide appropriate resources and referrals. Through 10-to-30-minute calls, psychologists and social workers offer guidance and

G r o u p f o r t h e A d va n c e m e nt o f P s yc h i at r y

Follow-up on the Defense Health Agency (DHA):

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F/U on a video history of military psychiatry in OEF/OIF/OND. While members agree that this is a worthy project, they have voted to “put it to bed” for the foreseeable future given the commitments of time, funding, and production skills necessary to take it forward. In doing so, they noted books, articles, and presentations, which continue to be generated

by Committee members. These aim to ensure that lessons learned since September 11, 2001, are shared and acted upon.

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8.

9.

F/U on Drs. Koffman and Kudler’s International Society for Traumatic Stress Studies (ISTSS) presentation on Psychedelic-Assisted Psychotherapy. Drs. Koffman and Kudler were joined

by Dr. Amy Lehrner, Clinical Director of the Center for Psychedelic Psychotherapy and Trauma Research at the Icahn School of Medicine at Mt. Sinai and the Bronx VA to share recent research findings and clinical issues associated with psychedelic-assisted psychotherapy for PTSD at the recent Annual Meeting of the International Society for Traumatic Stress Studies (ISTSS). This program, which reflects past discussions within the committee, was attended by more than 190 individuals.

Dr. Kudler also presented on this topic at the 2023 meeting of the American Psychoanalytic Association and then provided an invited article on this topic for the Spring/Summer 2023 issue of The American Psychoanalyst. The committee will continue to monitor this project and remains interested in the development of a new GAP Committee on Psychedelic-Assisted Psychotherapy. We are awaiting the publication of a recent VA State of the Art (SOTA) Conference report on this issue, which may help guide future efforts.

ACTION: Dr. Koffman will continue to take the lead on this issue.

Relationship Between APA’s Society of Uniformed Services Psychiatrists (SUSP) and our Committee: Helping military psychiatrists transition to civilian life, careers, and other shared concerns. A number of possible collaborations with SUSP were considered, including Re-booting the Military and Veteran Track at the Annual Meetings of the American Psychiatric Association, Creating CME programs for SUSP members who could be reprised at (APA, ISTSS, and other meetings); Developing a mentorship program for military medical providers transitioning to civilian status; Advocating on issues of concern raised by SUSP members. Conversations with SUSP leadership and rank-and-file members on these and other opportunities are ongoing.

ACTION: Drs. Ritchie and Warner will pursue these ideas with SUSP leadership and report back.

10. F/U on Dr. Kudler’s ISTSS Presentation on Whole Health as primary prevention for psychological trauma, as well as enhanced readiness for military service/deployment. Dr. Kudler reviewed his participation in developing a recent National Academies of Sciences, Engineering, and Medicine G r o u p f o r t h e A d va n c e m e nt o f P s yc h i at r y

(NASEM) report entitled Achieving Whole Health: A New Approach for Veterans and the Nation (https://doi. org/10.17226/26854). The committee discussed Whole Health as a framework for far upstream prevention of military and Veteran suicide and considered the serial use of recently developed measures of well-being to identify vulnerabilities in service members from recruitment through transition to civilian status.

This will remain an ongoing focus for the committee in collaboration with colleagues in APA, VA, and other organizations. Dr. Kudler will chair a panel discussion on this issue at the 2024 Annual Meeting of the American Psychiatric Association. His panel will include the lead authors of the NASEM report with discussion

by Dr. Dilip Jeste, Past President of the APA. ACTION: Dr. Kudler will take the lead on this issue.

11. Determining the value of MH screening for new recruits and all service members as a means of preventing military and Veteran suicide. Military mental health staff are being asked to undertake universal screening of new recruits and all service members for mental health issues as a means of preventing suicide. Unfortunately, the utility of such efforts remains unclear. The committee is considering development of a position paper on this issue.

ACTION: Dr. Warner will develop a brief information paper on this issue for discussion at our April Meeting.

12. The committee’s short- and long-range goals are to ensure that we proceed strategically and effectively, including leadership terms and recruitment of new members. As noted above, the committee already has strong relationships with ISTSS and SUSP. Another potential partner would be the Five Eyes International Collaboration. Five Eyes is a partnership of military and Veteran mental health experts from the Five Eyes nations (the US, the United Kingdom, Canada, Australia, and New Zealand) formed to advance mental health research and treatment for serving military Veterans and their families. We will explore opportunities to collaborate with the Five Eyes group. GAP leadership has subsequently affirmed that psychiatrists from other nations can participate in GAP as guests or members.

ACTION: Dr. Kudler will reach out to Five Eyes leadership to explore opportunities for collaboration.

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NEUROPSYCHIATRY

organizations outside of GAP; our committee makes recommendations directed increasingly toward GAP

Present: Margo Lauterbach, Barbara Schildkrout, Lindsey MacGillivray (virtually) Guests: Muniza Majoka

6.

Develop a membership directory with cities for East Coast members to share rides.

The committee reviewed increased GAP fundraising successes but noted the need to focus on legacy gifts.

We looked at candidates for the Dear Abby Award.

PROJECT TITLE: ETHICAL CONSIDERATIONS ABOUT THE USE OF PRESCRIBED AT-HOME KETAMINE

Laura Roberts was our guest and will be proposed as a new GAP member.

To be completed by February 1 with the first draft in preparation. This will target practicing psychiatrists, psychiatry residents, and training directors. This will be submitted to Biological Psychiatry.

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING: — Our paper on D-Mer (dysphoric Milk ejection reflex) has been praised by reviewers but rejected for publication in the “Harvard Review of Psychiatry.”

It has now been submitted.

— We worked on a paper on the ethical considerations of at-home, prescribed ketamine. We also discussed a paper on FND (functional neurological disease).

Lindsey will write a first draft.

We have met eight times between meetings.

FOCUS FOR NEXT MEETING: — Ketamine Paper, if not yet accepted for publication

PROFESSIONALISM & ETHICS Present: Phil Candilis, Karen Gennar, Michelle Hume, Robert Nesheim, Randy Howe, Jon van Loon, Ted Fallon Guests attending: Madeline Teisberg (former ethics coauthor, presenter with committee members) and Karen Greenberg (former HMS ethics fellow); both interested and supported for membership

PROJECT TITLE: INTEGRATIVE HEALTH FOR UNDER-RESOURCES SETTINGS (3) Data from US use of MAID (3) to be completed by April 2024. This will target practicing psychiatrists, psychiatry residents, training directors, psychologists, and other mental health professionals.

— FND paper — Brainstorming next projects

The committee will submit it to JNMD for publication.

Recommendation appreciated. The Publications Board could be helpful in review and editing.

PLANNING, MARKETING, & COMMUNICATIONS The committee spent considerable time on its new charge of guiding GAP in a pro-environmental direction. Several suggestions will be sent to the Board of Directors:

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING: Re-working of focus of integrative care paper; Specific connection to recent MAID data concerns marginalized groups’ use.

1.

Revise our investment portfolio to exclude companies that harm the environment

Plan for Between Meeting Work: Targeted collaboration among members on specific sections of two papers

2.

Expand the GAP Forest to cover our carbon cost for travel to meetings. We now have ten times what we need, but we will add more and share with other medical organizations

PSYCHIATRY & COMMUNITY

3.

Start an annual tree planting program, planting 5,000 trees the first year

4.

Consult with the management of the new hotel to make sure they are using conservation practices

5.

Consult regularly with GAP’s Climate Committee.

They are working on initiatives for people and

G r o u p f o r t h e A d va n c e m e nt o f P s yc h i at r y

Members attending: Michael Flaum, Jackie Feldman, Curtis Adams, Ann Hackman, Sam Jackson, Steve Leifman, Ken Minkoff, Margie Balfour (video), Matt Goldman (video) Fellow: Alex McClanahan Guests: Dwight Kemp, MD, and Cailtin Stork, MD

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The committee is working on a manuscript with a minimum of 120 pages. Two projects were derived from our work on the Crisis Roadmap. We plan to work on both side by side.

The topics chosen: 1.

Addressing the needs of the most seriously affected individuals with severe mental illness and SUD who are experiencing homelessness: Describing system and service interventions that work.

2.

Building healthy and resilient communities in the face of persistent and longstanding trauma and violence.

The projects are anticipated to be completed in 2–3 years and will target practicing psychiatrists, psychiatry residents, training directors, psychologists, other mental health professionals, and the general public.

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING: — Recruitment of potential new members — Purpose statement for the committee on the website

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING: Discussed publicity/marketing for the site. Visited by GAP member Tobias Wasser of the Administration & Leadership Committee for guidance based on a project he is coordinating for AAPL. Agreed that Jacob M. Appel will field email to the website and triage to individual authors for replies as needed. Thanked Jackie Landess for her amazing work as co-chair and agreed that Susan Hatters-Friedman would join Jacob M. Appel as co-chair for the next project, an endeavor related to bias in forensics, the form of which is still to be determined.

PLANS FOR BETWEEN MEETING WORK: Edit and submit the final sections for review and have them uploaded.

FOCUS FOR NEXT MEETING: The next meeting (Spring 2024) will focus on the details of our next project on bias and assigning work to individual committee members.

— Discussed outline and initial assignments for each project and identified each project’s lead.

PLANS FOR BETWEEN MEETINGS WORK: Virtual meeting to follow up on 12/8 at noon EST. Continue monthly meetings. Initial assignments are due in January.

How many times have you met since April 2023: Six. FOCUS FOR NEXT MEETING: Continue identifying resources and developing assignments for each project.

PSYCHIATRY & LAW Members attending: Jacob M. Appel, Peter Ash, David Cash, Susan Hatters-Friedman, Rick Frierson, Deborah GiorgiGuarnieri (phone), Beesh Jain, Jacqueline Landess, Rick Martinez, Phillip Resnick, Renee Sorrentino

PROJECT TITLE: THE CLINICIAN’S ONLINE GUIDE TO PSYCHIATRY & LAW Web-based resource. Anticipated date of completion: December 2023/January 2024.

STATUS: Nearly complete. Website prototype is up and running: www.psychlawgap.com.

Several sections must still be approved by the publications board and submitted to the president for final approval.

ANTICIPATED AUDIENCE: Practicing psychiatrists, Psychiatry residents, other Mental Health Professions G r o u p f o r t h e A d va n c e m e nt o f P s yc h i at r y

PSYCHIATRY & MEDIA Members attending: Carol Bernstein, Jack Drescher, Jeffrey Freedman, Jessi Gold Fellow: Maya Torain Guests: Amy Franklin, PR and members of the Blog Subcommittee: Barbara Schildkrout, Thomas Franklin (Zoom), Joseph Merlino (Zoom), and Laura Roberts (APPI Editor in Chief and Presidential Guest)

PROJECT TITLE: COMMUNICATING ABOUT COMPLEX SUBJECTS IN HIGHLY POLARIZED POLITICAL ENVIRONMENTS—TOPIC UNDER DISCUSSION It is targeted at all—uncertain at this time.

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING: Drs. Drescher and Gail Saltz (who could not attend this meeting) offered media training for GAP members in September with the assistance of Amy Franklin.

Over 20 members registered, and most showed up. A training recording is available for interested members contacting Ms. Franklin.

Challenges with facilitating difficult conversations due to factors such as the emotional charge of an issue, today’s rapid speed of communication, the rapid spread of miscommunication, and a lack of knowledge of an issue’s history and context; the pressure to respond quickly

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COMMITTEE REPORTS Continued. before thinking through one’s responses in public settings (sometimes leading to the cancellation of a speaker); the challenges of maintaining a middle ground on politicized issues; and the difficulties bringing opposing views to the same table. The question was raised if psychiatrists are better apt to comment/provide guidance.

The committee discussed changes in an APA publication with its Editor in Chief, Dr. Laura Roberts, who attended the meeting as a Presidential guest.

The committee discussed expanding membership. Dr. Lorenzo Norris resigned from GAP. The group discussed Outreach to possible new members who are doing media work, particularly those engaged in social media work.

The committee discussed the possibility of seeking funding for a GAP Fellowship to support an early career psychiatrist interested in using existing social media skills to publicize GAP and its products. There was some conversation about the ethics of designating such a task for younger members.

Earlier in the week, prior to this meeting, Dr. Drescher had a Zoom meeting with Dr. Looney of the Committee Planning, Marketing, and Communications and Ted Gayer, Ph.D., former Executive Vice President of the Brookings Institute, and presently President of another think tank, the Niskanen Center. Dr. Gayer may come to the Spring Meeting either as an Ittleson Consultant or a Presidential Guest to further elaborate and educate GAP about the function of modern think tanks.

The committee reviewed the GAP Blog on Psychology Today. The blog can be considered a success as 22 of the 30 published since September 2022 were designated “essential reads” by Psychology Today editors and placed on the first page of their website. To date, there are over 95k views of the 30 blogs. Drs. Jacob Appel, Joe Merlino, and Barbara Schildkrout have joined the blog subcommittee.

There was a discussion of how to go forward with the modern branding of GAP despite some internal resistances expressed at this meeting, primarily framed in economic terms. The committee understands the position of those who say, “We cannot afford to do this,” but feels very strongly that in the modern era, we cannot afford not to do this (forgive the double negative).

PLANS FOR BETWEEN MEETING WORK: None at present. The committee will likely schedule a Zoom meeting to follow up on some of the issues raised at the fall meeting.

How many times have you met virtually? Many times FOCUS FOR NEXT MEETING: New members; possibly doing another media training for GAP members.

G r o u p f o r t h e A d va n c e m e nt o f P s yc h i at r y

Any ways in which members can be helpful?

Suggesting possible funders for GAP’s publish Outreach would be helpful if any members are aware of such individuals or organizations.

PSYCHIATRY & RELIGION Members Attending: Keith Meador MD, Joseph Merlino MD (virtual), Jenifer Nields MD (virtual), Michael Norko MD, MAR (chair), James Phillips MD (virtual), David Saunders MD, PhD, Andrew Stone MD Guest Attending: Margaret Bishop-Baier MD (virtual)

PROJECT INFORMATION: #1 FAITH COMMUNITIES AND THE WELL-BEING OF LGBT YOUTH (White Paper on the importance of faith communities in efforts to reduce suicide and other adverse mental health outcomes for LGBT youth.)

PROJECT LEADER: Dr. Norko The booklet remains available for free download on the GAP home page. Hard copies of the version on the GAP website are also available from Dr. Norko.

Work accomplished during the meeting: Reviewed the status of the project. Dr. Norko updated the resources and data in Spring 2023 and sent them to the designer to be professionally set up. Dr. Norko obtained a generous grant from the APA Foundation (APAF) of $2,500 to pay for the re-design and printing of 1,000 hard copies. The APAF is also willing to help promote the Toolkit with their faith partners once it is completed. The planned toolkit was also reviewed. It will include a facilitator guide, a short introductory video (15–20 minutes), a flyer, a fact sheet, and Q&A suggestions.

PLANS FOR BETWEEN-MEETING WORK: Dr. Norko will begin working on the toolkit after the New Year.

#2 DEAR ABBY, RELIGION-SPIRITUALITY AND MENTAL HEALTH SURVEY PROJECT LEADERS: Drs. Saunders, Norko, Meador FAST TRACK: journal articles POTENTIAL JOURNALS: J Sci Study Religion, J Rel & Health, and JNMD

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COMMITTEE REPORTS Continued.

ANTICIPATED AUDIENCE: practicing psychiatrists, psychiatry residents, training directors, psychologists, and other MHPs.

WORK ACCOMPLISHED DURING THE MEETING: Reviewed suggestions for editing and re-framing.

Discussed further plans for the manuscript.

Any ways in which the Publications Board might be helpful: Not at this time.

PLANS FOR BETWEEN MEETING WORK: Dr. Nields to make further revisions, then share with editors at Psychodynamic Psychotherapy.

WORK ACCOMPLISHED DURING THE MEETING: Reviewed the current status of the project. The NIH grant proposal was not accepted. Dr. Saunders applied again for the NIH grant in August 2023; he will receive news in March 2024. For now, we will focus on two papers that do not require additional funding: 1.

2.

Description of people who identify as spiritual but not religious (SBNR) but also say they are affiliated with a religious tradition in terms of religious practice and beliefs; Religion-spirituality and mental health, comparing respondents who identify as religious but not spiritual, SBNR, religious and spiritual, and neither religious nor spiritual. Other possible include spiritual-religious practice during COVID and LGBTQ+ and mental health/religion-spirituality.

PLANS FOR BETWEEN MEETING WORK: Draft the first paper in the Spring of 2024.

#3 BIOGRAPHICAL ESSAYS ON MENTAL HEALTH ATTRIBUTES OF MAJOR RELIGIOUS FIGURES PROJECT LEADER: Dr. Phillips POTENTIAL JOURNALS: The “Un-diagnosing St. Joan” manuscript was published ahead of print by JNMD on April 5, 2023.

WORK ACCOMPLISHED DURING THE MEETING: Reviewed the status of the project. JNMD received a “Letter to the Editor” regarding this publication. Drs. Phillips and Norko replied. Letters will be printed at some future date.

PLANS FOR BETWEEN-MEETING WORK: Dr. Phillips’s next plan is to begin work on a biographical essay on Nelson Mandela.

WORK ACCOMPLISHED DURING THE MEETING: The group was invited again to provide feedback to Dr. Stone on the posted version of his article on this topic.

PLANS FOR BETWEEN-MEETING WORK: The Group will provide feedback to Dr. Stone. Dr. Stone to do further research to expand the article.

#6 “LIVING IN FEAR” PROJECT LEADER: Dr. Majeed FAST TRACK: Originally written as an OpEd piece about anti-Muslim attitudes/behaviors/violence ANTICIPATED AUDIENCE: general POTENTIAL JOURNALS: Psychology Today blog.

WORK ACCOMPLISHED DURING THE MEETING: Discussed this project at length. Recent events in the Middle East make it difficult to propose the current manuscript. The plan evolved into a new idea for a blog discussing our society’s need to be able to talk to one another about complex subjects: Dr. Stone and Dr. Merlino will join the project.

PLANS FOR BETWEEN-MEETING WORK: Draft the blog for the Psychology Today blog and submit it to Jack Drescher.

#4 PASTORAL INTERVENTION IN DYNAMICALLY-ORIENTED THERAPY

#7 HOMELESSNESS, MENTAL ILLNESS, AND PSYCHIATRIC ADVANCE DIRECTIVES

PROJECT LEADER: Dr. Nields FAST TRACK: A moving description of the challenges a patient from years ago faced.

PROJECT LEADER: Dr. Merlino

POTENTIAL JOURNALS: Psychodynamic Psychotherapy

G r o u p f o r t h e A d va n c e m e nt o f P s yc h i at r y

PROJECT LEADER: Dr. Stone FAST TRACK: An analysis of whether there are merits to diagnosing King Saul.

POTENTIAL JOURNALS: TBD Any ways in which the Publications Board might be helpful: Not at this time

Any ways the Publications Board might be helpful: Submitted to Board 4/14/23 and feedback reviewed and incorporated in further revision.

FAST TRACK: series of journal articles

Any ways the Publications Board might be helpful: The manuscript was submitted to the Publication Board 4/25/23 and feedback was received about restructuring.

#5 KING SAUL AND PTSD

This was published in Psychology Today’s blog on 9/20/23.

It can be found in “Why We Can’t Help Many of the Mentally Ill—The Importance of psychiatric advance directives.”

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PSYCHOPHARMACOLOGY

WORK ACCOMPLISHED DURING THE MEETING: Reviewed the successful completion of this project.

David Mintz joined us for his first visit. We will be putting him up for membership, but this was only his first visit as a guest.

PLANS FOR NEXT MEETING: We will meet by Zoom on January 27, 2024.

The committee has an invited paper we are writing on the role of B12 in psychiatric practice. Our Fellow, Kevin Kennedy, is very interested in the topic, as was the entire committee.

PSYCHOPATHOLOGY Present: Adler, Berlant, Brunette, Dixon, Edwards, Erlich, First, Siris (virtually) and Talley Fellow attending: Marcos Moreno (virtual) Guests: Enrico Castillo and Nicole Kozloff 1.

2.

3.

RESEARCH

The Committee is working on two projects now that both our manuscripts have been accepted for peer review publication, and we will be developing each as well as a blog (What all providers should ask about electronic and social media use—PS; and How do we understand the phenomenon of increasing mental distress among young adults and what can we do about it—JNMD) We are developing a Survey Monkey of GAP members: Health research that reflects the Experiences of providers working in real-world settings are essential to effectively developing, implementing, and evaluating evidence-based practices (EBP’s). Despite the challenges in using EBP in mental health, there is little research on challenges and opportunities to effectively engage clinicians in mental health research, with most literature focused on primary care or internal medicine.

We propose to survey both health and mental health providers, exploring their experiences, barriers, and potential solutions to engaging in research. The findings will inform strategies to improve provider engagement in research.

Whither DSM-IV Axis IV and its importance in addressing social determinants of health.

ANTICIPATED DATE OF COMPLETION: During 2024.

The manuscript will be submitted to the Journal of Nervous and Mental Diseases and Psychiatric Services.

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING: This was a brainstorming meeting on a new topic with two new guests that led us to develop the first draft of a Survey Monkey on the importance of real bi-directionality between researchers and those in the community with whom they wish to implement research. We continued our work on “whither DSM-IV’s Axis 4.

The next meeting will be scheduled via Zoom to continue working on our projects.

Attending: John Beahrs, Claudette Beahrs, Stu Copans, Gordon Harper, Sean Lynch, Mariam Rahmani, Alan Swann Unable to attend: Doug Kramer (Chair) We discussed a continuing topic, the loss of context in contemporary mental health. Our aim is to finish an extended paper on this topic, for publication.

We started discussing a related topic, namely the limited view of evidence used in most discussions of clinical evidence. This may lead to a publication.

SOCIAL JUSTICE Fall Meeting November 2023 Present: Kenn Ashley, Hugh Cummings, Jane Gagliardi, Alex Harris, Rachel Moster 1.

Committee reviewed feedback from Publications Committee on the Demographic Survey. Plan to continue with the survey, make some revisions, resubmit to Publications.

2.

Discussed ongoing project to review GAP Products for inclusion of concepts of social justice

3.

Discussed ongoing plan to increase committee membership

4.

Reviewed idea of presentation to the membership

SYSTEMS INNOVATION & TRANSFORMATION Members present: Wes Sowers, Deepika Sastry, Jules Ranz, Nubia Lluberes, Bruce Fage, Mardoche Sidor, Hunter McQuistion, and Graham Ellis.

Via Zoom: Michelle Joy, Ken Thompson

COMMITTEE PROCESS a.

Communication—We agreed to continue two Zoom meetings between biannual meetings. We discussed using the LinkedIn SIT group vs. emails for communication.

b.

Update Website—New graphics, membership. Deepika (?)

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COMMITTEE REPORTS Continued. c.

Statement of Purpose for Website—Hunter developed an initial draft, which Deepika edited and distributed.

We will review the statement via email and send a version to Frances along with the committee report.

SEEKING VALUE BOOK PROMOTION a.

Sales Report—The book has not had significant sales.

We discussed alternative approaches to disseminating information in the book.

b.

Viewpoint Column in Psychiatric Services —Wes is working on this. The piece encountered a harsh reviewer but should be accepted.

c.

GAP Blog Posts—Wes and Sosunmolu have published blogs, and Mardoche has one pending. Deepika will submit one on History & Quality. Graham (guest) volunteered to do a “Summary blog” on a selected chapter, and Mardoche will do one on End-of-life care.

d.

e.

Podcast opportunities—explore existing Podcasts, ask to be Guests rather than starting from scratch (APA has one, AACP has one, and can also post Videos on LinkedIn) Outreach to non-psychiatric target audience— LinkedIn—Sunil set up an internal page for SIT, Deepika posted about the book Seeking Value, and tagged committee members to re-post through broad promotion. Wes will speak to AAPI (publisher) about promoting the book on their social media platforms.

Should this be a book about the more significant issue of a broken Mental Health “system” or connecting the dots of which workforce is one piece? We noted that these bigger issues were the purpose of our Seeking Value book, and the workforce is part of that picture.

Wes noted that workforce fits best in the second tier of the three tiers of change described in the final chapter of Value: Individual, Professional, then Social/Political.

These changes do not necessarily require a large amount of resources.

We discussed the need for a collaborative/transdisciplinary approach as most work on this topic has tended to be siloed by the guild. We discussed having our initial product be a series of blogs rather than a book. Julie suggested a format that allows for updates like Wikipedia, given that books become obsolete only shortly after printing.

We discussed producing a series of Monographs as an alternative to a book. Using case studies to demonstrate what is currently working and what is not could be helpful.

The last part of the meeting was spent elaborating on Section III of our Workforce Book proposal and describing why we have an “Obsolete Model.”

WORKFORCE We had a wide-ranging discussion of workforce issues and how we might proceed in creating a product around these issues. We brought up the importance of thinking about this differently than is commonly done. This requires taking a transdisciplinary approach. Julie discussed IMT (Integrated Mobile Teams) in New York City.

A) Production Deficits: Supply and capacity constraints B) Guild Orientation/Protection: Territorial currently will require a culture change C) Rigid Role Definitions: criteria for licensure, scope of practice, regulatory matters “Hierarchy of Merit” D) Inflexible Funding Arrangements: pay based on codes, which only certain professionals can use to bill

This led to a broader discussion about the individual elements of Workforce vs. Systemic issues.

E) Wasted Resources: fragmentation, the patient has to tell a story repeatedly, underutilization of community resources, too many administrators, using expensive meds when cheaper ones are just as effective (in many cases)

Ken Thompson pointed out that “it’s not about the services but who’s providing them”, e.g. Primary Care prescribes the majority of antidepressants and 50% of antipsychotics.

F) Training orientation: needs to be interdisciplinary, more controversial: should there be standardized training for NPs and PAs as there is for Physicians?

TRAINING We are NOT trained to collaborate in the clinical setting (as we do on inpatient units). Will training change? Deepika proposed a broad “Provider school” where there would be no guild distinctions. This might be the end product of moving toward a team-based approach to collaborate and reduce burnout and moral distress, which is prevalent in healthcare.

G r o u p f o r t h e A d va n c e m e nt o f P s yc h i at r y

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Why are there so many middlemen? Because the system is complex.

Why is it so complex? Because it is profit-driven (see Berwick’s JAMA article “Salve Lucrum”)

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COMMITTEE REPORTS Continued.

TECHNOLOGY & PSYCHIATRY

• Active participation in committee’s work- thinking, writing, research.

Members/Guests attending: Victor Buwalda, Alexis Chavez, Mark D’Agostino, Sandra DeJong, Anita Everett, Darlene King, Rob Kolodner, John Luo, Aida Mihajlovic, William Narrows, Manish Sapra, Ujjwal Ramtekkar, Sy Saeed, Andrea Waddell

• Paying GAP dues, travel, and hotel expenses for meetings (meals and drinks are included).

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING: This was our first in-person meeting. Prior to this meeting, the group had met once virtually on August 16, 2023.

Welcome and introductions. Those in attendance described their background and how it related to health technologies. Sy described how the decision to form this new GAP committee came about. He described how new committees are created to address new, important, cuttingedge issues, to refresh psychiatric thought, and to create products that serve both the field of psychiatry and the nation. He reemphasized the following information from our August 16th virtual meeting: GAP and its mission. For over 75 years, GAP has been a think tank for addressing complex issues affecting psychiatrists, other mental healthcare professionals, and the country as a whole, as they strive to change and provide the most effective form of care for patients. GAP has done this by: • Bringing together top psychiatrists across all disciplines • Offering an objective, critical perspective on current issues facing psychiatry

Name of the Committee: The “placeholder” name of the committee has been Committee on Telepsychiatry, Health Technologies, and e-Behavioral Health. The first item on the agenda was to discuss and finalize a name for the new committee. Various options were discussed, including Telepsychiatry, Health Technologies, and e-Behavioral Health; Technology, Informatics, M-health, and E-Health (TIME); Digital Psychiatry; Digital Therapeutics; Technology and Mental Health; Technology in Psychiatry (TIP); and Technology and Psychiatry (TAP). We decided to use a name that was not too long and covered the broader areas under health technologies. We decided on the new name— Committee on Technology and Psychiatry (TAP).

Charge of the Committee: We discussed the charge of the committee, using the charge defined in the initial proposal that led to the formation of this new committee. We agreed on the following revised charge: “The charge of the GAPs Committee on Technology and Psychiatry (TAP) is to facilitate the creation and dissemination of knowledge in the field of health technologies, including specific domains like Informatics, Telehealth, Data Analytics, Augmented Intelligence (AI), Social Media, etc. The work of this committee will include areas such as:

• Developing smart analyses and recommendations • Shaping psychiatric thinking, clinical practice, and mental health programs • Advocating for necessary changes in the psychiatric field • Inspiring the next generation of leading psychiatric thinkers, GAP’s mission is carried out through the work of its committees. These committees address timely questions facing American psychiatry.

Because psychiatry is a multifaceted medical specialty encompassing the biopsychosocial paradigm, committees consider issues ranging from psychopharmacology to the ethical and moral issues inherent in the practice of a field fraught with technical and human pitfalls. There are currently 32 committees.

What GAP members commit to do: • Joining GAP after going through a rigorous acceptance process as a member colleague.

• Make every effort to attend the two yearly meetings in White Plains, NY (Spring and Fall).

G r o u p f o r t h e A d va n c e m e nt o f P s yc h i at r y

• Models of care in telepsychiatry and evidence base for use of videoconferencing and other technologies in mental health care • Telepsychiatry as a solution to problems in access, quality, and value • Telehealth modalities (synchronous, asynchronous, remote patient monitoring, and mHealth) • Use of AI. • Integrating technology into clinical practice • Telesupervision and training in telepsychiatry • Social media, apps, VR, and digital therapeutics • Ethical, legal, regulatory, and other risk management considerations • Transparency and accountability in developing and deploying technological solutions to providing care.

• Interoperability, privacy, and security

(continued...)

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COMMITTEE REPORTS Continued.

• Health records and other health information technologies

7.

Input from clinicians into designing new tools to ensure it is a good product from a clinical integrity standpoint.

• Technology use to address population health.

8.

Will the traditional research method survive in times of AI?

9.

AI in psychiatry

• Business case for using technology.

The goals of this work will include advancing the body of knowledge through the synthesis and distillation of the key issues in clinical applications of health technologies; strengthening the evidence base; education, and knowledge dissemination; and creation of innovative ideas that can clarify critical issues for the public and leaders in organized psychiatry.

Domains in Health Technologies that the committee will cover:

We also generated the following list of potential topics: 1.

Overview of the field to describe what is out there and what evidence supports its use. (Update APA article on Digital Health 101).

2.

What are the knowledge gaps where we can make the most difference?

3.

What type of guidance can we provide, general principles, about evaluating available tools?

4.

Guidelines for consumers to protect them from harm (breach of privacy, etc.) when using technologybased tools.

5.

Clinical training in evidence-based technology use.

6.

Creating a web portal with a repository of information that is “clinic ready.”

7.

“Pain points” in the use of technology, e.g., how do we integrate it into clinical practice, longitudinal engagement of patients, integrating real-time data from a daily diary, etc., into clinical practice.

8.

How to encourage/foster/shape direction {setting an agenda}? Strategic road map.

9.

How to keep humanity at the heart of this and reiterating it.

• Evidence-Base • Clinical Care Across Life Span • Education and Training • Ethics and Professionalism • Population Health • Equitable Care • Regulatory and Compliance • Research and Innovation • Value, Affordability, Quality, Implementation, Digital Mental Health Engagement, and other Administrative/Leadership areas relevant to the use of technology” We also discussed how we could communicate across committees, as well as how we could collaborate with APA and others active in this area.

10. Integrating with primary care.

TOPICS FOR POTENTIAL PROJECTS: We had a robust discussion about our future projects (topic, content, and where we send it for publication), with the broader goals being creating new knowledge that covers innovation, refinement of what is already known, and new knowledge via synthesis of components already known.

Short List: 1.

Current state analysis.

2.

Index of resources (?Psych Times/News).

3.

Index of resources for the GAP Web site.

4.

Current Psychiatry: Review of APPs on wellness

5.

A paper on “Cutting Edge” technology: what guard rails need to be there to protect patients. Write about the “trough of disillusionment” after the hype is over.

6.

What do the psychiatrists need that will be helpful for clinical practice? For example, what would a “good EHR” look like?

G r o u p f o r t h e A d va n c e m e nt o f P s yc h i at r y

11. When should technology tools be used instead of seeking care?

12. How do we ensure that the standard of care is met when using technology-based care?

13. Can GAP have its own blog? What would be the benefit of oversending it to other channels?

WORK & ORGANIZATIONS The committee on work and organizations completed our purpose statement for the GAP website. We are currently working on two blogs for Psychiatric Psychology Today.

The first is on how to support distressed coworkers, and the second highlights the emotional benefits that employees get from the workplace.

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