GAP CL#668

2024 November 14–16

2025

April 25-26

November 6-8

2026

April 16-18

November 12-14

2027

April 8-10

November 11-13

2028

April 6-8

November 9-11

All meetings scheduled at the Sonesta Hotel White Plains, New York

America’s Think Tank for Mental Health

www.ourgap.org

MESSAGE FROM THE PRESIDENT Spring and All

How do you assess the vitality of an organization like GAP? That question is on my mind as I think back on our 154th meeting earlier this spring.

One measure is financial. As Treasurer Gail Robinson discusses on page 3, GAP is fundamentally strong financially; our reserves are higher than ever. However, over 70% are restricted to fund fellowships and are not available to fund operations. As shown in the table on page 2, we currently have a budgeted deficit in operations. The challenge in the next year will be to create a balanced budget that will ensure GAP’s financial health into the years ahead. See Gail’s letter for an invitation to help us come up with the best remedies.

What are other measures of vitality? GAP was created in 1946 by a small group of psychiatrists interested in making a big difference—a band of thinkers and doers intent on impact. Over the years, the organization has counted among its members many of our field’s most prominent, productive, and influential members. They met twice a year to think, debate, and create; and to nurture the relationships that made the work personally gratifying and, therefore, sustainable over decades. There was the work itself, and there were the relationships that made the work possible.

GAP OFFICERS:

President

Robert P. Roca, M.D. rroca2@jhmi.edu

President Elect

Sy A. Saeed, M.D. saeeds@ecu.edu

Secretary David A. Sasso, M.D. david.sasso@gmail.com

Treasurer

Gail E. Robinson, M.D. gail.robinson@utoronto.ca

Past President

Calvin R. Sumner, M.D. docsumner@gmail.com

Creativity and comradery. Those are GAP traditions that I think are two good measures of vitality. How are we doing? As demonstrated by our spring meeting, we are doing very well.

Comradery. The committees make GAP go. They are formed by people who share an interest (often a passion) and—crucially—enjoy each other’s company and want to work together. While shared interests may explain why committees come together initially, comradery keeps them together. It’s a major reason that meeting attendance is so robust and that GAP membership is growing. Present at the meeting were 120 members, 23 committee guests, and 13 Fellows. Eighteen committee guests were inducted as new members at the end of the meeting. There has been a proposal—originating with the fellows themselves—to increase the total number of fellows from 14 to 18 (the number of endowed fellowship positions). GAP wouldn’t grow like this if the collegial chemistry weren’t healthy and strong.

Creativity. At the Spring meeting, we heard that the second edition of “Disaster Psychiatry: Readiness, Evaluation and Treatment” has been accepted for publication. We also learned of the recent activity of the Publications Board, including a review of five chapters of a book by the Committee on Psychiatry and the Law; three peer-reviewed articles for academic journals, including two invited articles; and two pieces for Psychiatric Times by the Psychotherapy Committee. In addition, the Board has reviewed blog posts for the GAP blog hosted by Psychology Today. As of this writing, 20 GAP committees have posted 36 pieces, which have garnered over 120,000 views. This is just a glimpse at what’s going on. Reviewing the following pages shows how busy everyone is and gives us a preview of what’s coming down the line. Projects range from blog posts and peer-reviewed articles to YouTube videos, books, and even a photo essay.

(continued on page 2...)

Message from the President Continued.

One different kind of creative project merits mention. At the request of Cal Sumner, a committee chaired by Roberto Lewis-Fernandez drafted a vision statement on diversity, equity, and inclusion for GAP membership. This was approved by the Board at the April meeting and is reproduced immediately after this letter. Thanks to Roberto and his committee for getting us started down this road.

Transition. At the spring meeting, the biannual transition of officers and directors took place. Congratulations to Sy Saeed on moving to PresidentElect, to David Sasso for becoming Secretary, and to Ludmila DeFaria and Scot McAfee for their election to the Board. Our heartfelt thanks go to Wesley Sowers and Katherine Kennedy for their service as they wrap up their Board terms.

Finally, thanks to Cal Sumner for his two years of service as President (not to mention his eight preceding years as Treasurer). From my conversations with him, I have a sense of the time and effort—much of it behind the scenes—he put into making GAP work. And some remarkable things happened on his watch:

1. We emerged intact and vibrant from the pandemic.

2. We saw an increase in the number of funded fellowships and the size of our reserves.

3. We launched our foray into the popular blogosphere.

4. We had a retreat during which a large proportion of the members spent a few additional hours together to reflect on who we are and where we should be going as an organization. That’s a very nice resume.

One other thing about Cal’s tenure should be noted. As you may know, GAP presidents sign off all materials reviewed by the Publications Board before they are deemed approved. I heard that Larry Gross introduced a new level of diligence to this signoff process during his presidency,

and I understand that Cal raised the bar even higher. David Adler told me he’d be a tough act to follow. So, in admiration for Cal’s care and diligence, so emblematic of his presidency, I offer this modest Haiku for Cal:

So conscientious

Earnest, careful, committed He read every word

In conclusion, a real poem. This letter is entitled Spring and All. As you may know, that is not an original title but borrows from a work of the same title by physician-poet William Carlos Williams. It mixes what looks like verse with what looks like prose. Here is the first verse-like section, often printed as a stand-alone piece:

Spring and All

(by the road to the contagious hospital)

By the road to the contagious hospital under the surge of the blue mottled clouds driven from the northeast–a cold wind. Beyond, the waste of broad, muddy fields brown with dried weeds, standing and fallen patches of standing water, the scattering of tall trees

All along the road, the reddish purplish, forked, upstanding, twiggy stuff of bushes and small trees with dead brown leaves under them, leafless vines–

Lifeless in appearance, sluggish dazed spring approaches–

They enter the new world naked, cold, uncertain of all save that they enter. All about them the cold familiar wind–

Now the grass, tomorrow the stiff curl of the wildcarrot leaf

One by one, objects are defined–It quickens: clarity, outline of leaf

But now the stark dignity of entrance–Still, the profound change has come upon then: rooted they grip down and begin to awaken.

Happy Spring

* Includes 1 life member

** 73% restricted for fellowship funding and not available for operations

*** Note that this is a budgeted loss for current calendar year GAP DIVERSITY, RESPECTFUL INCLUSION AND EQUITY VISION STATEMENT

The Group for the Advancement of Psychiatry (GAP) is a think tank of leading psychiatrists whose thoughtful analysis and recommendations serve to advance psychiatry, benefit society, and improve lives. GAP members value their diverse identities and experiences as a means of providing the broadest and deepest insights to advance the organization’s work. GAP is committed to being an equitable, inclusive, and non-discriminatory organization that aims to improve the mental health of all individuals regardless of race, ethnicity, age, sex, gender identity, sexual expression, sexual orientation, socioeconomic status, language, national origin, religious/ spiritual orientation, ability status, geography, or other characteristics. GAP is committed to fostering a respectful and welcoming environment that attracts and retains members from all backgrounds, especially those that have been underrepresented in psychiatry and psychiatric leadership.

From the Treasurer

GAP has a fiscal paradox. On the one hand, we have over $1 million in our investment account—more money than ever. On the other hand, our income and expenses result in a yearly deficit. Wonderful members have been able to solicit donors to cover 18 fellows. These funds, however, cannot be used for operational expenses. We are not in an immediate crisis, but this cannot continue. We are asking our members to think about creatively tackling this problem.

Aside from the restricted Grants for fellows, we have only two sources of income: our membership dues and meeting fees. Our director, Frances Roton Bell, runs a tight budget concerning basic operational expenses. We have two expenses that contribute to this problem:

1. Several years ago, we hired a publicist to make GAP more well-known. Amy Franklin is responsible for such things as our blog posts which have received considerable attention. Her participation cost is $35,000 a year.

2. The main expense is our meetings. GAP is an unusual organization

Gail E. Robinson, MD, Treasurer

because we charge a membership fee that primarily includes the price of attending two meetings per year. Our membership fees have not been raised since 2016. Even though they may seem very high, the fact that they have stayed the same over the years, despite inflation, means that you have been paying less every year. To partially cover the expense of the meetings, we instituted a meeting fee of $150. However, each member’s proportion of the meeting expenses amounts to over $500 a meeting.

“SOLUTIONS” THAT WON’T WORK

1. At our last GAP retreat, we confirmed the importance of two meetings a year. When COVID restricted us to Zoom meetings, our productivity fell dramatically.

2. It is not a simple matter to reduce meeting expenses. I heard some suggestions regarding cutting the food or alcohol expenses. Hotels set a figure that we need to r each for them to host our group. That figure includes the number of rooms and the food and

ANNOUNCEMENTS

PLANNING, MARKETING & COMMUNICATIONS COMMITTEE

Jonathan Metzl from Vanderbilt has accepted the April 2025 Dear Abby award with pleasure. Doctor Metzl is the Frederick B. Rentschler II Professor of Sociology and Psychiatry and the director of the Department of Medicine, Health, and Society at Vanderbilt University; and the award-winning author of Dying of Whiteness and six other books, he hails from Kansas City, Missouri, and lives in Nashville, Tennessee.

JACK DRESCHER, MD

I wanted to thank the 30 or so GAP members who attended the media training this past Saturday for their active participation in the workshop.

I also want to thank Amy Franklin, our GAP publicist, for organizing the event and Gail Saltz for sharing her

beverages. If we were to cut the food budget, we would have to increase the costs of your hotel rooms. For the next year, we plan to keep that to $219, which is remarkably low for any good hotel, let alone a hotel so close to New York City.

In the spirit of GAP, we want to involve our members in developing creative ideas to solve this dilemma. Should we charge more for hotel rooms? Should committee guests pay for their meals? Should we raise membership or meeting fees? Can we find a funder to cover our operations costs? (Has anyone come into a healthy inheritance or has a wealthy friend who might be interested in contributing?) Could we get a donation to cover the cost of the Friday night dinner and have it named in that person’s honor? Do we have a “product” we could sell that would earn more income?

We welcome and will consider any suggestions you may have. Thank you for supporting this wonderful organization.

extensive media experience as a psychiatric expert. And thanks to my Media Committee co-chair Carol Bernstein as well for her support and participation

We planned to do mock interviews at that training, but there were so many questions from the group (it was great to see that level of participation) that we did not have time to do any interviews.

We plan to hold another media training—again on the Saturday morning of the GAP meeting in November— so please put it on your calendar.

The subject of the “Goldwater Rule” came up, and I said I would share some of my thoughts on it. These were published in a Psychiatric News column. The link is here.

And for those of you who attended or watched the online video of our first media training (which can be found here), please take a moment to send Amy a brief bio and your area of interest as she continues to compile a list of GAP experts in pitching stories to the media.

Report from the Publications Board

Attending Members and GAP Leadership: Matthew Erlich, MD (Pub Board Co-Chair), Jacob Appel, MD (Pub Board Co-Chair), Pub Board Members: Barbara Schildkrout, MD, Abhishek Jain, MD, Chris McIntosh, MD, David Lopez, MD, Gail Robinson, MD, Shelby Powers, MD; Jack Drescher, MD (Blog Subcommittee Chair), Cal Sumner, MD (GAP President, Current), Robert Roca (GAP President, Incoming)

DISCUSSION/OUTCOMES:

1. Recognizing transitions: new members, departing members, members switching to emeritus, and invitations discussed. Dr. Cal Sumner is a new member.

2. Reviewing the logistics for Pub Board reviews: what the Pub Board reviews, the submission process, revision, approval, etc. Discussion post-meeting that Amy Franklin and/or other GAP representatives will inform the general membership when a manuscript, book, letter, etc., has been published with links to the piece.

3. Discussion on inviting one or more GAP fellows to the Pub Board to focus on blogs.

Jacob Appel, MD, and Matthew Erlich, MD

4. Update on JNMD arrangement after Dr. Talbott’s passing, with the continued agreement of the GAP Pub Board to provide peer review for accepted articles.

5. Discussion of the role of Substack and blog organization with a subcommittee of Jacob Appel, Jack Drescher, and Barbara Schildkrout. Plan for future proposal to GAP BOD

6. Publication Board Work since November 2023 Meeting: 11/28/23: Psychotherapy Committee, Psych News piece.

11/30/23: Law Committee. Five Chapters:

—Substance and Law

—Chapter on Medical Aid in Dying

—Chapter on Breaches of Confidentiality

—Chapter on Overview of Forensic Psychiatry

—Chapter on HIPAA Statutory Regulation

12/1/23 Grant Brenner’s GAP Committee Statement. (Needed revision)

12/15/23 LGBT+ Committee paper, Academic Paper

1/10/24: Social Justice Committee’s Questionnaire

1/25/24: Psychotherapy Committee, Psych News piece

2/29/24: Psychopharm Committee paper, Invited Academic

IN MEMORIAM

David Keith, a longtime member of the Research Committee, passed away peacefully on April 19 surrounded by his family.

He earned an English degree at Macalester College in St. Paul, and a medical degree at the University of Minnesota. He provided medical care to indigenous tribes in Peru before serving as a flight surgeon in the US Air Force. Upon completing his service, Dave began his residency in psychiatry at the University of Wisconsin, followed by a Fellowship in child psychiatry, and joined the faculty. After many happy years in the Midwest, Dave moved his family to Manlius, NY. He joined the Department of Psychiatry at Update Medical University in Syracuse in 1988 and retired in 2017 as Professor Emeritus.

He was regarded as a caring, thoughtful, and effective practitioner who authored four books. One of his most cherished professional accomplishments was mentoring psychiatry residents and becoming a resource for family therapy practitioners worldwide.

A celebration of Dave’s life will occur on Saturday, May 4th.

YOUNG FAMILIES AND STIGMA

We have produced several publications (an article, a blog, and a book) and are now pursuing ways to extend that knowledge into the community to support this vulnerable population.

1. We are writing a paper on a health equity perspective on delivering health promotion support and services to young families (in preparation; anticipated audience primary healthcare providers and policymakers; expected completion 3-6 months).

2. We are planning a meeting with senior officials in relevant ministries in the Ontario provincial government to address policy and funding changes that support young families in fall 2024, in collaboration with the Ontario Association of Young Parents Agencies.

3. We are planning a large email campaign to primary healthcare providers to increase their awareness and recognition of stigma as it appears in their practices.

4. We are considering collaborating with Dear Abby to survey the experiences of stigma in young families and raise awareness of the issue.

DIAGNOSIS OF BORDERLINE PERSONALITY DISORDER IN ADOLESCENTS

We have identified a reluctance for mental health professionals to apply this diagnosis to adolescents when it may be helpful. Thus, BPD seems often to carry a burden of stigma, in fact, more for professionals than for patients. We are questioning whether stigma compromises treatment for adolescents more broadly, i.e., are they seen as difficult patients? We are writing a paper for mental health professionals that is expected to be completed within six months.

HUMAN RIGHTS FOR THE LGBTQ2S+ POPULATION

1. Children’s right to select their pronouns without having schools notify parents. Notifying parents is seen as a stress that may contribute to distress and higher suicide rates in this population. We see this as a dilemma between children’s and parents’ rights that demands a nuanced response. We are discussing a paper for publication and distribution to mental health and educational professionals and policymakers.

2. Education for healthcare providers regarding this population is being threatened. We are discussing a statement of response from our committee.

FIVE LANGUAGES IN PSYCHIATRIC DIAGNOSIS

Diagnosis can be described from multiple perspectives. We are writing a paper describing those other points of view, the advantages of recognizing the different approaches, especially from the patients’ experience, and the disadvantages (continued...)

of using just traditional approaches. Completion is expected in 6–12 months. Distribution to mental health professionals.

CLIMATE AND MENTAL HEALTH

We plan to discuss this with members of the Climate Committee at GAP.

The Committee is meeting monthly by Zoom and has had approximately ten meetings since April 2023.

The Committee is open to suggestions, participation, and relevant information from GAP members and others.

AGING

GAP COMMITTEE ON AGING STATEMENT OF PURPOSE: WHAT ARE WE HERE FOR?

We asked our Fellow Laura van Dyck for her impressions about the work of the GAP Committee on Aging and what information might interest other Fellows. She mentioned that the committee:

• Focuses on positive aging perspectives, lifestyle changes and healthy aging, and positive aging.

• Works on projects that provide scientific information to people in different fields, such as geriatric psychiatrists, general psychiatrists, and the lay public.

• Prepares projects for different venues (such as symposia at national scientific meetings, articles in news outlets (Psychiatric Times), articles in peer-reviewed scientific journals, blogs)

• Collegial and collaborative atmosphere of the committee

• This is a think tank, not a shark tank. This led to a discussion of what it means to be a geriatric psychiatrist; what do you tell a resident to encourage them to pursue geriatric psychiatry fellowship?

• What is unique to geriatric psychiatry? What do we do uniquely? Discussion about “The GAP 65” project from Gene Cohen’s days as Chair ensued.

• Geriatric psychiatrists have an expanded knowledge base, for instance, regarding biomarkers.

• It is gratifying to be a geriatric psychiatrist, even if you see patients of all ages.

• Medical school LCME needs to mandate improved requirements for geriatric psychiatry training in medical school.

INVITED MANUSCRIPT FOR CURRENT PSYCHIATRY REPORTS

The final draft of the manuscript “Enhancing Brain Health and Well-Being in Older Adults: Innovations in Lifestyle Interventions” for Current Psychiatry Reports was sent to the GAP Publications Committee, incorporating their suggestions and recommendations. We received a congratulatory note from the Chair of that committee and verbal sign-off from Dr. Roca, so it is now a bona fide GAP-endorsed publication. I will send you all a copy of the submission to the journal and let you know what the journal editors say.

• The GAP Publications Committee asked that once the manuscript is accepted, they should be notified and provided with a copy to disseminate the work.

• They also asked that the first author collaborate with a GAP Fellow to write a blog about the article’s content.

PHOTO ESSAY PROJECT

Sehba and her husband/professional photographer, Michael S. Krautter ,showed us an inspiring slide show, “Through the Lens of Experience,” with beautiful photos and quotes from older adult subjects of diverse backgrounds and walks of life, with positive aging themes. She presented it at a Steering Committee meeting, and a few people volunteered to participate in the project! Sehba and her husband spent Saturday morning taking their photos and interviewing them. Participants would fill out an informed consent form and answer a questionnaire from which quotes could be taken for the photo essay.

INVITED BOOK PROPOSAL FOR APA PUBLISHING

The book proposal and proposed author list for “Healthy Aging: Enhancing Brain Health and Well-Being” were discussed and worked on. The revisions to these will be sent in a separate email. If there are no further suggestions, we will send them to the editors this coming Monday.

Some important points about the chapters in this book that will make it unique from other works:

• Focus each chapter on HEALTHY brain aging perspectives such as improving/stabilizing health, primary prevention, restoration, prevention of recurrence

• Include comments on DEI in EACH chapter

• Ken has already started writing chapters for the healthy brain aging book; they will need reformatting, but please review for the concepts! Are we on the right track with the approach being taken?

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COMMITTEE REPORTS

2025 AAGP AND 2025 APA PRESENTATIONS

The theme of the 2025 APA is healthy aging, and the APA President during that meeting was GAP member Dr. Viswanathan, who came to our 2024 APA symposium on healthy aging and invited us to present in Los Angeles in 2025.

Would you like to present at these meetings? We have a good thing going…

DO

YOU HAVE IDEAS OF WHAT THE NEXT SYMPOSIUM TOPIC OUGHT TO BE?

Sehba and I were talking at dinner, and here is an excellent idea that Sehba initiated that builds upon our prior talks: What about discussing two competing ideas in the context of exercise, nutrition, sleep, and mindfulness?

So, FOR EXAMPLE, Sehba thought about contrasting aerobic vs. strength training. FOR EXAMPLE, John might contrast one diet vs. another diet or diet in general vs. vitamins. FOR EXAMPLE, Ebony might contrast medications vs. nonpharm sleep interventions.

FOR EXAMPLE, I could contrast mindfulness and socialization.

The title of the symposium could be something like:

The Big Debate: Which Lifestyle Intervention Is Better for a Healthy Brain?

—OR—

The Big Debate: Which Lifestyle Intervention Is Better for the Aging Brain?

—OR—

The Big Debate: Which Lifestyle Intervention Is Better for a Healthy Aging Brain?

—OR—

Something Else

I shared these ideas with Bob, who thought about it and said the conclusion for each talk might be that both are important for healthy brain aging for each section. Probably! But as talks for a symposium, they might still be interesting. He wondered whether we should take topics for the proposed aging brain book and build a new symposium around (a) different topic(s).

We have a Zoom meeting scheduled on April 29 at 6 p.m. to discuss this more, but I wanted to share about this now so we can sleep on it and think about it for now. If you have any ideas that occur to you, please email them to the group so we can consider all options. The deadlines for the proposals for the 2025 meetings will be before the next in-person GAP meeting in November 2024.

KEN’S WEB PAGE

Please visit Sakauyeblog.com to check out the website!

NEW GUESTS/MEMBERS

ARE THERE PEOPLE WE WOULD LIKE TO INVITE AS GUESTS/MEMBERS?

Membership requirements have changed: If a guest attends one meeting and expresses interest in joining, we can present their name for membership!

We have seven members, one fellow, and three guests at this time.

CONSULTANTS/INTERESTING PEOPLE

• If time allows, are there people we would like to invite as consultants/interesting people to talk with to provide knowledge and broaden our thinking? They can come from within or outside of GAP.

• Mardoche Sidor, MD, member of the GAP Committee for System Innovation and Transformation authored a blog post on Psychology Today entitled “Dispelling Dementia Myths.” I reached out to him; he plans to be at the November 2024 GAP meeting.

ANNOUNCEMENTS

2024 APA PRESENTATIONS WITH GAP COMMITTEE ON AGING INVOLVEMENT:

• “Ageism in Healthcare: The Impact on Geriatric Mental Health and Needed Solutions” with Susan Lehman, Ebony Dix, and Laura Van Dyck (all on the GAP Committee on Aging)

• “Substance Use in Older Adults” with Susan Lehman, Art Walaszek, and Sandy Swantek

• “Confronting Stigma and Bias through the Arts: An Interactive Visual Thinking Strategies Session” with Susan Lehman, Margaret Chisolm, Mary Blazek, and Meher Kalkat

• Session 1043 “Enhancing Brain Health and Well-Being in Older Adults: Innovations in Lifestyle Interventions” with Sehba Hussain-Krautter, John Beyer, Ebony Dixon, and Helen Kyomen is scheduled for May 8, 2024, from 8-9:30 a.m.

OTHER ISSUES TO POSSIBLY DISCUSS AT THE NEXT MEETING:

Psychology Today Blog on Alzheimer’s Disease Blood Tests—Pearls and Pitfalls (Pros and Cons)

Nursing Home and Antipsychotic Medications (continued...)

COMMITTEE REPORTS

ARTS & HUMANITIES

Members attending: Weiss (Chair), Sasso, Lustbader, Dube (Co-Chair) virtually, and Collins Lewis visiting from the Addictions Committee.

THE FOLLOWING TOPICS WERE COVERED:

• Completion of most recent video history project. The video of the history of psychiatry from 1600 to 1800 needed music added and some credits for materials used. Drs. Sasso and Fidler, respectively, will handle it. We expect it to be published on artsgap.org soon and be accessible through GAP’s Committee page.

• Dr. Steven Sharfstein presented his personal history in psychiatry to a GAP group. We considered asking him to reprise it for a video as an example of a diverse and meaningful career path.

• The Committee was aware that the Fellowship Committee will match new Fellows with Committees for 2025–2027. Arts & Humanities would like a fellow. We will make Lorraine Lothwell aware.

• Dr. Fidler recalled that, at our last meeting, we had planned to write an article, like a blog, on applications of the arts in therapy with now-former Fellow Kelsey Wong and current Fellow Ivy Song. Dr. Fidler circulated a draft of his section and contacted Drs. Wong and Song about their participation. A secondary thought was to consider publishing similar content in the APA’s Journal of Psychotherapy.

• Looking at GAP’s website and our committee page, we noted that our About Our Committee paragraph needed to be refreshed and that the photograph was incomplete. We rewrote the paragraph and sent it on for publication on our page.

• We have continued to publish the Committee’s work products on artsgap.org, for which we self-funded the posting. We thought it could add interest to the page to have individual Committee members, at their discretion, add photos and biographical information to assist readers in understanding our connections to arts and humanities.

• In addition to reviewing the content of our hosting site, we reviewed the viewing statistics (cumulative). The side had 900 subscribers, with 75,000 views over 10,000 hours. The most viewed was our first video, Nineteenth Century, with 40,000 views. We want to encourage training directors nationally to use the videos for residents and others. A connection with AADPRT was brought up to publicize our work.

• Regarding blogs, in addition to one mentioned on applications of arts, we could submit one on the video project itself, which would draw people to our site.

CLIMATE

Members attending: Janet Lewis, Elizabeth Haase (virtual), Beth Mark, CarolineDumont

Fellow: Joshua Wortzel

Guests: Emily Schutzenhofer, Alexandra Yoon

PROJECT INFORMATION:

Parents’ needs—Assessing the needs of parents related to climate change with focus groups to develop useful materials was discussed, and a literature search was initiated.

FUTURE PAPERS:

Reviewed two draft papers on “Future Thinking” – one psychodynamic paper potentially for Psychodynamic Psychiatry, and one general psychiatry article potentially for Psychiatric Times. Both are in subsequent drafts.

Risk assessment tool for heat vulnerability—discussed and beginning literature search.

Coco’s Fire: Changing Climate Anxiety into Climate Action Extending the published children’s book we helped develop into a video version—the initial draft of the video was reviewed, and its uses were discussed.

A one-hour Climate Curriculum for psychiatric residents has been developed and will be launched for study after IRB.

Blog about Climate Dialectics was discussed

The Committee meets monthly via Zoom.

COLLEGE STUDENT

Members attending: Brunhild Kring, Ludmila De Faria, Not attending: Lorraine Siggins, Helene Keable, Malkah Notman, Alexandra Ackerman

Post Fellow Guest: Isobel Rosenthal

Guests attending: Ryan Flanagan, Raj Patel

AGENDA:

1. Meet and greet: integration of guests and feedback about clinical experiences pertaining to issues presented by the current student cohort.

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COMMITTEE REPORTS

2. Review of recent publication: Isobel Rosenthal and The GAP College Student Committee successfully published a Spanish translation. To the best of our knowledge, this is the first GAP blog post that was translated into Spanish by the publisher – a testimony to the relevance of the article

3. Brainstorming about proposals for a new paper: The Committee members were most interested in writing about the issue of social media misuse among college students.

PROJECT TITLE:

HIGHLIGHTING THE BENEFITS AND MITIGATING THE RISKS OF SOCIAL MEDIA USE AMONG COLLEGE STUDENTS

1. Develop treatment strategies to mitigate social media misuse among college students.

2. Plan and develop three subtopics for submission in a blog post series. Eventually, the Committee will develop this into a more scholarly paper.

Topic 1: How to apply DBT principles to mitigate the harmful effects of social media. Members: Ryan Flanagan, Ludmila De Faria, and Isobel Rosenthal

Topic 2: Motivational interviewing for social media use. Member: Brunhild Kring

Topic 3: Social Media Use v. Misuse. Member: Raj Patel

To be submitted to Psychology Today. The Publications Board could help with reviewing and editing.

FOCUS OF WORK ACCOMPLISHED:

We workshopped the three blog posts as outlined above.

PLANS FOR BETWEEN MEETING WORK:

Highlighting the Benefits and Mitigating the Risks of Social Media Use Among College Students.

ARE THERE ANY WAYS MEMBERS CAN BE HELPFUL?

Attend scheduled Zoom meetings; write assigned paragraphs.

CULTURAL

Present: Lu, Fung, Huang, Lewis-Fernandez

Virtual attendance: Aggarwal, Becker, Virani

Fellow: Wong (virtually)

Guest: Susan Daily (from the Child Psychiatry Committee)

Guests virtually: Blake Erickson, Laure Experton

THE

COMMITTEE

IS

WORKING ON THREE PROJECTS:

1. Article, led by Roberto, on how to integrate social determinants into mental health systems. Blake Erickson has joined the team drawing upon his dissertation work on SDoH in psychosis and presentation at the ER.

2. Article, led by Kenneth, on how to guide clinicians in developing a more comprehensive formulation incorporating sociocultural formulation, emphasizing relationships with function processes.

3. Article, led by our GAP Fellow, Sally Huang, on the pedagogic use of narrative medicine to teach cultural competence. She led a brief workshop during the meeting to provide the committee with an experiential introduction to her method to gather feedback. She will also conduct a webinar with the Society for the Study of Psychiatry and Culture to gather further feedback on her method to contribute to her paper.

OTHER UPDATES:

Article, led by previous Fellow Kelsey Wong, is in press with Psychiatric Times.

Francis Lu will be working on the description of the committee for the website.

ANTICIPATED DATE OF COMPLETION:

All are scheduled to be completed this year.

For Articles 1-3, psychiatrists, other MH professionals, residents

For Article 1, also other social scientists WHERE WOULD THE COMMITTEE LIKE THE MANUSCRIPT TO BE PUBLISHED:

Article 1: Possibly Cultural, Medicine and Psychiatry

Article 2-3: Unsure

ANY WAY IN WHICH THE PUBLICATIONS BOARD MIGHT BE HELPFUL: Good reviews

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING: Discussed the articles being worked on.

PLANS FOR BETWEEN MEETING WORK: Work on the articles listed above.

HOW MANY TIMES HAVE YOU MET VIRTUALLY SINCE NOVEMBER 2023: Once

FOCUS FOR NEXT MEETING:

Continue discussion on the above articles.

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COMMITTEE REPORTS

DISASTERS, TRAUMA, AND GLOBAL HEALTH

The committee met and discussed updates from committee members and welcomed new members. We discussed the recent 2nd Edition of Disaster Psychiatry: Readiness, Evaluation and Treatment. We are pleased that the publisher, APPI, has accepted the manuscript. We discussed our group’s initiative to develop blog posts, and reviewed GAP’s blogging guidelines, and renewed the invitation for group members to contribute. We discussed the MARCCD Models for Adaptive Response to Cyclical Disasters updated version https://marccd.info/, which has gained national attention via the Vibrant Emotional Health partnership and is already used for various disaster and crisis trainings. We continued to discuss the complexities of our changing world and how we, individually, through other affiliations and as part of GAP, can continue to find ways to make a difference, including the ongoing recognition of various existential threats to humanity.

FAMILY

In-person attendees: Rama Rao Gogineni, William Sonis, and Rajesh Mehta

Virtual Attendees: Howard Dichter, Narpinder Kaur Malhi, Dhana Ramasamy

AGENDA:

FAMILY COMMITTEE DISCUSSED THE TOPICS BELOW:

1. Blogs from the family committee and in collaboration with other committees

2. Book publication

3. GAP monthly meeting schedule

4. Next, the Fall GAP meeting

5. Get involved with GAP and join the listserv (Upon membership, Frances will add you; if not, please reach out to her)

6. Way to engage/motivate resident/student to learn and practice family therapy—Role Modeling—by conducting interviews/therapy sessions, one-way mirror utilization, supervising, and doing scholarly activities.

BLOGS:

1. ADHD and Families

2. Grandparenting and families

3. LGBTQI+ and families

4. Loneliness and family intervention

5. Addressing delinquency in children through psychosocial determinants perspective

6. Ways to teach/motivate/engage residents and students’ family:

a. Have residents/student construct their genogram

b. Identify and do a self-positive, negative, and neutral cognitive evaluation

c. Do own biopsychosocial formulation on personal challenge/situation

BOOKS AND PAPERS:

Planning to work on converting the blogs into papers: “Child and Family Psychiatry: Integrating Therapy with Children, Youth, and Families,” a GAP approved book accepted by APPI publications, will be edited by Vincenzo Di Nicola, Rama Rao Gogineni, and Suzan Song. Hoping/planning to recruit authors from GAP, AACAP, CACAP, AFP.

MEDIA TRAINING IN PERSON:

Presented by: Amy Franklin, Gail Saltz, and Jack Drescher. Attended by 30 or so GAP members Saturday, April 6. Attendees shared their media experiences, specifics of interview skills, how to practice, and learn talking points, engage in the community, various ways to incorporate media in your practice, and career development. Attended by all three of the Family committee members preset.

Monthly Training sessions held on the third Wednesday of each month, 7–8:15 p.m. are continuing and are very helpful.

GENDER & MENTAL HEALTH

Members attending: Gail Robinson, Nikole Bender-Hadi, Sophie Grigoriadis Fellow: Shelby Powers

The Committee is working on an intermediate-length manuscript.

PROJECT TITLE: FINANCIAL BENEFITS OF PAID MATERNITY LEAVE TO BE COMPLETED JANUARY 2025

This will be targeted at practicing psychiatrists, psychologists, other mental health professionals and the general public.

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COMMITTEE REPORTS

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING:

Completing the first draft PLANS FOR BETWEEN MEETING:

Completion and working on the second draft FOCUS FOR NEXT MEETING: Completion of this project

LGBTQ+

Members attending: William Byne, Marlin Mattson, Chris McIntosh, Stewart Adelson, Tiziano Colibazzi, Joanne Ahola, Omar Fatal, Lorraine Lothwell, Jack Pula, Jack Drescher, Flavio Casoy, David Lopez, Scot McAfee

PROJECT TITLE:

POSITION STATEMENTS AGAINST YOUTH CONVERSION THERAPIES FROM PROFESSIONAL MENTAL HEALTH ORGANIZATIONS: A NARRATIVE REVIEW USING A HEALTH JUSTICE APPROACH,

The Committee is responding to the review process. This statement will target practicing psychiatrists, psychologists/ other mental health professionals, and other medical organizations.

We attempted unsuccessfully to submit it to Lancet Psychiatry. The next attempt will be to JAACAP.

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING:

As usual, this meeting has been extremely enriching and productive. This is a very trying time for the LGBTQ+ community, and we see an increase in transphobic and homophobic laws, rhetoric, and violence. The Committee began its work by checking in with all members present to see how everyone was doing personally and professionally. We discussed the challenging larger social context and the impact on LGBTQ+ mental health, particularly for youth.

The Committee completed our three-year project of writing a journal article reviewing position statements by many professional organizations on conversion therapy. Unfortunately, despite initial interest by Lancet Psychiatry, they dissuaded its submission. We will next attempt JAACAP. We briefly discussed the recently released Cass review in the NHS.

The Committee also started working on a variety of blog posts for Psychology Today, including one exploring the contempt of “Inviting In” as a complement to “Coming Out.”

We attended the Saturday Media Training as a Committee.

PLANS FOR BETWEEN MEETING WORK:

We need to finalize the submission of the manuscript and continue to work on the blog post.

HOW MANY TIMES HAVE YOU MET VIRTUALLY?

Once as a committee. Different members of the committee met more frequently ad hoc.

FOCUS FOR NEXT MEETING:

Continue developing additional blog posts.

MILITARY & VETERANS

Present Members: John Bradley, Harold Kudler (Co-Chair), Elspeth Ritchie (Co-Chair), Carla Schnitzlein

Guests: Shannon Ford, Cassidy O’Neill, Chris Warner

1. Introductions: Dr. Shannon Ford, M.D., Vice Chair for Clinical Operations, Department of Psychiatry, Uniformed Services University of the Health Sciences was welcomed as a guest. Another guest, Ms. Cassidy O’Neill, a fourth-year medical student at the Frank Netter School of Medicine, joined by Zoom to discuss her draft blog.

2. F/U on Natchaug’s 1st Annual Military Mental Health Symposium (December 1, 2023): Dr. Schnitzlein led a team of colleagues (many who are retired military) in developing a symposium entitled “You or Someone You Know: Understanding the Importance of Military Service and Identity” aimed at increasing military and Veteran cultural and clinical competence among health professionals and agencies in and around Norwich, CT (an area with a large military community). The event was carried out on a budget totaling $2,000, and was successful in framing vital information on community resources and attracting the direct (and enthusiastic) participation of U.S. Senator Richard Blumenthal. This program may serve as a model for future ongoing Committee projects.

ACTION: Dr. Schnitzlein and her team are considering plans for future events and were invited to develop a blog that describes their program and encourages other communities to replicate it.

3. Request for Training Resources for Russian Psychotherapists in the Wake of the Recent Mass Shooting in Moscow: Dr. Kudler received a request from Russian psychotherapist Dr. Tatiana Onikova, Director of the International Psychotherapy

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COMMITTEE REPORTS

School, and co-chair of a weekly International Psychotherapy Institute Town Hall in support of mental health professionals who work in conflict areas. Dr. Onikova requested assistance in identifying training resources for psychotherapists now responding to the recent mass shooting of civilians at a Moscow concert hall.

ACTION: The Committee offered a number of publicfacing resources which Dr. Kudler will share with Dr. Onikova.

4. Recent Developments in Access to Care in Military and VA: DoD Signals Re-building its InHouse Capacity while VA Accelerates its Shift to Community Care: COVID revealed limitations in the DoD and VA’s capacity to respond to disasters, and budget realities in both agencies make it impractical to “grow their way out” of these. The advisability of pooling resources within a unified DoD/VA health system was discussed. The importance of integrating community resources with those of DoD and VA into local, regional, and national disaster readiness planning was emphasized. Such plans exist on paper but are rarely discussed or drilled. History teaches that there is a vital need for surge capacity in response to new wars and disasters, but, unfortunately, conventional thinking and political realities mitigate against investment in preventative measures.

ACTION: Dr. Kudler will work on a blog reflecting these issues and calling for action across multiple domains. Drs. Ritchie and Kudler will brief the Disaster Committee on our concerns and pursue a joint initiative to address them.

5. VA’s Rapidly Diminishing Capacity to Support DoD and FEMA in times of War and Disaster: How Might the Committee Advocate for VA’s Fourth Mission? VA’s Fourth Mission is to support DoD and community systems in the event of war or disaster. Unfortunately, with more than one-third of VA’s clinical budget is now spent on Community Care (a rate which is accelerating at an average of 12% per year without caps/guardrails), VA’s in-house capacity is under significant stress, and at least some facilities may face closure. This raises the real possibility that VA may not be able to respond to future crises, leaving both DoD and the community in the lurch.

ACTION: Dr. Kudler is working with the APA Federal Legislative team to advocate for awareness and action. A blog was recommended.

6. VA/DoD Clinical Practice Guideline (CPG) for PTSD: Methodology Questioned: A January 10th “Viewpoint” in JAMA Psychiatry called for revoking the new edition of the DoD/VA CPG for PTSD on the basis that its developers privileged research methodology over clinical utility in developing recommendations. Committee members who have worked on similar CPGs pointed out that if the wrong questions are framed at the outset of the process, the final product is likely to be flawed. Such problems can profoundly affect future practice, teaching, and research funding.

ACTION: The Committee will extend our discussion and develop partners in advocacy. One suggestion was to develop a Letter to the Editor of a prominent medical journal summarizing our concerns and recommending review of the VA/DoD CPG process (and, potentially, other CPG processes) by the National Academy of Medicine (given that the IOM 2011 report, Clinical Practice Guidelines We Can Trust, is widely regarded as having set the standard for CPG development.

7. Psychedelic-Assisted Psychotherapy: Recent Developments: Discussion deferred in Dr. Koffman’s absence, but the Committee continues to monitor this issue and is supportive of Dr. Koffman’s interest in creating a new GAP focus on it.

8. Review of Cassidy O’Neill’s Draft Blog for the Month of the Military Child: The Committee congratulated Ms. O’Neill on her valuable statement on military children and their families.

ACTION: Drs. Schnitzlein and Kudler will work with Ms. O’Neill and then develop a blog in time for publication in April.

9. Recognition of the Contributions and Experiences of Women in Combat: There remains a pressing for attention to a variety of issues affecting military women. These include (but are not limited to) concerns about military sexual trauma, fertility, musculoskeletal injuries, poorly fitting body armor, and access to reproductive services, including abortion.

ACTION: Dr. Ritchie will present an invited talk at the April 2024 APA Meeting on these and related issues in partnership with Dr. Tamara Campbell, Executive Director, VHA Office of Mental Health and Suicide Prevention. These presentations may provide the basis for a GAP blog.

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COMMITTEE REPORTS

10. Relationship Between APA’s Society of Uniformed Services Psychiatrists (SUSP) and Our Committee: Unfortunately, SUSP is not able to sponsor a Fellow for the Committee. We have, however, been successful in recruiting new Committee Members through SUSP connections.

ACTION: Drs. Ritchie and Kudler will develop a strategy to recruit new Committee members (including SUSP members) at the APA meeting.

11. Upcoming APA Session on VA’s Whole Health System as a Model for Primary Prevention of StressRelated Pathology in the Wake of Psychological Trauma/War/Disaster: Dr. Kudler will join Dr. Alex Krist of the National Academy of Medicine and Dr. Dilip Jeste, Past President of APA and the leader of its Taskforce on the Social Determinants of Health in a presentation advancing a VA Whole Health Model that integrates clinical care with social services and places its focus on how the patient, family, and community define health and health goals rather than on what physical and lab examinations reveal about the patient.

ACTION: Dr. Kudler will report back on discussions arising from this presentation.

12. Short- and Long-Range Goals of the Committee to Ensure That We Are Proceeding Strategically and Effectively Including Leadership Terms and Recruitment of New Members: The Committee agreed on growing to a total of 8–10 members and developed a list of DoD, VA, and Veteran candidates to reach out to. We will revise our committee blurb on the GAP website to make it more attractive to potential Fellows. We will also reach out to residency directors within DoD, VA, and other training programs to recommend that they discuss our committee with prospective Fellows.

ACTION: Dr. Ritchie was elected Committee Co-Chair. Dr. Warner expressed interest in becoming a GAP member (and was subsequently approved by the GAP Steering Committee).

NEUROPSYCHIATRY

Members attending: Barbara Schildkrout, Margo Lauterbach, Muniza Anum Majoka

PROJECT TITLE:

DYSPHORIC MILK EJECTION REFLEX

Project is in its second revision/resubmission to the Harvard Review of Psychiatry.

PROJECT TITLE: ETHICAL CONSIDERATIONS WITH PRESCRIBING AT-HOME KETAMINE”

Project is in the first draft and is in the process of being completed.

We are thinking about new topics.

PLANNING MARKETING, & COMMUNICATIONS

Members attending: Looney, Sharfstein, Bonner, Boland, Trivedi, Powsner

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING

• Focus on budget issues

• Discuss public relations

• Discuss fundraising

• Discuss GAP Forest

• Discuss committee membership

The Committee plans to invite Dan McCarthy and Jack Drescher’s cousin as consultants

FOCUS FOR NEXT MEETING

Fundraising, new members, sports medicine committee. The membership could be helpful by suggesting sources for fundraising.

PSYCHIATRY & COMMUNITY

Members attending: Jackie Feldman, Curtis Adams, Ann Hackman, Kin Minkoff, Caitlin Stork, Dwight Kemp, Stephanie Le Melle, Paula Panzer, Sam Jackson (virtual)

Fellow: Alex McClanahan

Guest: Keris Myrick (virtual)

The committee is working on a manuscript with the topic chosen, and a minimum of 120 pages targeted at practicing psychiatrists, psychiatry residents, training directors, psychologists, mental health providers, and the general public.

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING:

Met with Dennis Culhane as a consultant to discuss his work on homelessness, including early intervention with Critical Time Intervention. Reviewed assignments to further develop our statement of work regarding the homelessness issue, and shared assignments describing examples of

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COMMITTEE REPORTS

interventions to promote community healing and prevent (gun) violence.

PLANS FOR BETWEEN MEETING WORK:

Virtual meeting to follow on 5/10 at 12 EST and continue monthly meetings. The Committee has met virtually five times since the November meeting.

FOCUS FOR NEXT MEETING:

Continue identifying resources and developing assignments for each project

PSYCHIATRY & LAW

Members attending: Jacob M. Appel (co-chair), Susan Hatters-Friedman (co-chair), Peter Ash, Richard Frierson, Debbie Giorgi-Guarnieri, Abhishek Jain, Phil Resnick, Renee Sorrentino

Regrets: David Cash (consultant), Jackie Landess, Richard Martinez, Alan Newman, Debra Pinals (contributing)

Ryan Hall will be joining the Committee as a guest in Fall 2024.

PAST PROJECTS:

The Committee’s previous project, The Clinician’s Online Guide to Psychiatry & the Law is now online at https:// psychlawgap.com/ with final edits underway.

CURRENT PROJECT:

The Committee is embarking on a project-likely a series of articles, but possibly a book-focused on bias and worldview. These will likely include using the Delphi method to assess a series of vignettes. Among the types of biases that should be considered are confirmation bias, expert bias, disgust bias, agency bias, etc.

PSYCHIATRY & MEDIA

Members attending: Carol Bernstein (co-chair), Jack Drescher (co-chair), Jeffrey Freedman, Gail Saltz

Fellow: Maya Torain

Guests: Amy Franklin (GAP Publicist), Linda Michaels (Ittleson Consultant to the Psychotherapy Committee, founder of PSIAN (Psychotherapy Action Network) who has extensive experience in marketing, Robert Roca (GAP President), and Lisa Mellman (visiting from the Psychotherapy Committee)

PROJECTS: MEDIA TRAINING FOR GAP MEMBERS AND GAP BLOG ON PSYCHOLOGY TODAY

This is an ongoing project with no expected completion date.

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING:

• Amy Franklin, Drs. Saltz, Bernstein, and Drescher did a media training no Saturday morning which over 30 GAP members attended. Feedback is that the meeting was successful and helpful, and the Committee plans to do another training at the Fall GAP Meeting in November.

• Discussion of GAP Blogs on Psychology Today, which have had over 115k visits

• Discussion of possible GAP podcasts—Dr. Saltz has been doing podcasts for the American Psychoanalysis Association and would be willing to do them for GAP. GAP members would make excellent podcast guests; this would require funding for technical support.

• Possible GAP YouTube channel: the Arts & Humanities Committee had begun this several years ago—again, this would require funding

• Discussion of expanding into social media (#GAPPsychiatry); Amy Franklin could do this if funding were available; possible recruitment of GAP Fellows, who have more social media experience than their elders, to engage in a GAP social media project—to discuss with Dr. Lothwell, Chair of the Fellowship Committee

• Planning for GAP Media Training schedule for this meeting

• Discussion with Dr. Roca about the importance, perhaps the necessity, of continued outreach via modern means other than journal publications; again, funding was discussed

• Discussion with Dr. Michaels about PSAIN’s market research of psychotherapy consumers and her possibly writing a GAP blog on the subject

• An earthquake disrupted the meeting; Dr. Saltz, a regular CNN contributor, contacted CNN immediately and did an interview with them, which was online two hours after the quake—demonstrating the need for relationships with the media.

PLANS FOR BETWEEN MEETING WORK:

Further discussion to prepare for media training in the spring (hopefully mock interviews)

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COMMITTEE REPORTS

FOCUS FOR NEXT MEETING:

—Media training

—Recruiting more GAP members to write blogs —Brainstorming about funding ARE THERE ANY WAYS THE MEMBERSHIP CAN BE HELPFUL?

Yes, it would be helpful if GAP members gave some thought to how to fund GAP’s needed forays into social media (#GAPPsychiatry), podcasts, etc., all of which would require additional funding.

PSYCHIATRY & RELIGION

Members attending: Margaret Bishop-Baier MD, Brian Fallon MD (virtual), Salman Majeed MD (virtual), Keith Meador MD, Joseph Merlino MD (virtual), Jenifer Nields MD (virtual), Michael Norko MD, MAR (chair), James Phillips MD (virtual), David Saunders MD, PhD

Guest: Carol Kessler MD

PROJECT INFORMATION

1. FAITH COMMUNITIES AND THE WELL-BEING OF LGBTQ+ YOUTH (White Paper on the importance of faith communities in efforts to reduce suicide and other negative mental health outcomes for LGBTQ+ youth.) Project leader: Dr. Norko

The 2nd Edition of the booklet is now available for free download on the GAP home page. One thousand copies of the 2nd Edition are now being printed and will be available from the GAP Office and Dr. Norko. The re-design and printing costs for the Second Edition were sponsored by a generous grant from the APA Foundation (APAF) of $2,500.

Work accomplished during the meeting: We reviewed the project’s status. The next step is to create a Toolkit to accompany the booklet, consisting of a facilitator guide, a short introductory video (15-20 minutes), a flyer,a fact sheet, and Q&A suggestions. The APAF is also willing to help promote the Toolkit with their faith partners once it is completed.

Plans for between-meeting work: Now that the redesign is completed, Dr. Norko will begin work on the Toolkit.

2. DEAR ABBY RELIGION-SPIRITUALITY AND MENTAL HEALTH SURVEY Project leaders: Dr. Saunders, Dr. Norko, Dr. Meador

Fast track: journal articles

Potential journals: J Sci Study Religion, J Rel & Health, and JNMD

Anticipated audience: practicing psychiatrists, psychiatry residents, training directors, psychologists, and other MHPs

Ways the Publications Board might be helpful: not yet

Work accomplished during the meeting: Reviewed the status of the project. The second NIH grant proposal was not accepted. For now, we will focus on two papers that do not require additional funding: 1) 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 (Dr. Norko to take the lead); and 2) Religionspirituality and mental health, comparing respondents who identify as religious but not spiritual, SBNR, both religious and spiritual, and neither religious nor spiritual (Dr. Saunders to take the lead). We plan to begin with a qualitative analysis of individuals who identified as SBNR and noted that they belong to an SBNR community. We will explore the free text responses to subjects’ descriptions of those communities and compare mental health outcomes for SBNR subjects who did and did not say they belonged to an SBNR community. Later possible papers include spiritualreligious practice during COVID; and LGBTQ+ and mental health/religion-spirituality. Lily and Fetzer Foundations were discussed as possible sources of grant funding for further quantitative analysis.

Plans for between meeting work: First draft of paper #1 by November; begin review of text responses for paper #2 by June 2024.

3. BIOGRAPHICAL ESSAYS ON MENTAL HEALTH ATTRIBUTES OF MAJOR RELIGIOUS FIGURES: Project leader: Dr. Phillips

Fast track: series of journal articles

Potential journals: The “Un-diagnosing St. Joan” manuscript was published in JNMD in 2023.

Work accomplished during the meeting: Reviewed the status of the project. JNMD received a letter-tothe-editor regarding this publication. Drs. Phillips and Norko replied. Letters will be printed at some future date. Discussed possible approaches to the psychiatry and religion connections in the life of Nelson Mandela.

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COMMITTEE REPORTS

Plans for between-meeting work: Dr. Phillips will pursue the dimensions discussed for a biographical essay on Nelson Mandela.

4. PASTORAL INTERVENTION

IN DYNAMICALLY

ORIENTED THERAPY Project Leader: Dr. Nields

Fast track: A moving description of the challenges a patient from years ago faced.

Potential journals: Psychodynamic Psychotherapy

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

Work accomplished during the meeting: Reviewed feedback from the analytic writing group to which Dr. Nields presented the revised manuscript. Discussed further plans for the manuscript.

Plans for between meeting work: Dr. Nields will make final revisions to the abstract, then share it with editors at Psychodynamic Psychotherapy.

5. KING SAUL AND PTSD Project leader: Dr. Stone

Fast track: An analysis of whether there are merits to diagnosing King Saul.

Potential journals: TBD

Ways the Publications Board might be helpful: not at this time

Work accomplished during the meeting: The group was re-invited to provide feedback to Dr. Stone on the posted version of his article on this topic. He was unable to join this meeting.

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”/“WE HAVE TO TALK”

Project leader: Dr. Majeed, joined by Drs. Stone and Merlino

Fast track: Originally written as an OpEd piece about anti-Muslim attitudes/behaviors/violence

Anticipated audience: general

Potential journals: Psychology Today blog.

Ways the Publications Board might be helpful: Submitted to Board 4/14/21. A revised version, prepared in response to the Gaza war and society’s need to be able to talk to one another about difficult subjects, was submitted to the blog subcommittee in December 2023.

Work accomplished during the meeting: Discussed feedback regarding the blog and how to proceed.

Plans for between-meeting work: Dr. Norko will confer with Dr. Appel regarding the previous blog feedback.

7. PSYCHEDELICS, RELIGIOUS/SPIRITUAL EXPERIENCES, AND MENTAL HEALTH OUTCOMES Psychiatry & Religion Report April 2024–4/9/24 Project leader: Dr. Bishop-Baier

Fast track: journal article

Anticipated audience: practicing psychiatrists, psychiatry residents, training directors, psychologists, and other MHPs

Potential journals: TBD

Ways the Publications Board might be helpful: not at this time.

Work accomplished during the meeting: Dr. BishopBaier discussed her preliminary research and work on the topic. One area of inquiry is whether religious/ spiritual experience is a necessary or common element when beneficial mental health outcomes are the result of the use of psychedelics.

Plans for between-meeting work: Dr. Bishop-Baier will continue her research and report at our next meeting.

8. MENTAL HEALTH OF CLERGY

Project leader: Dr. Merlino

Fast track: journal article

Anticipated audience: practicing psychiatrists, other MHPs, clergy

Potential journals: TBD

Ways the Publications Board might be helpful: not at this time.

Work accomplished during the meeting: Dr. Merlino discussed his bishop’s interest in a survey of the mental health needs of his clergy. We discussed the possibility of creating an anonymous survey in REDCap or Qualtrics to promote more open responses and provided data for a paper.

Plans for between-meeting work: Dr. Merlino will continue his research on the topic and discuss the survey possibilities with his bishop.

PLANS FOR NEXT MEETING:

We plan to meet next by Zoom in July or August; a poll will be sent to committee members.

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COMMITTEE REPORTS

PSYCHOPATHOLOGY

Members attending: Adler (virtual), Berlant, Dixon, Edwards, Erlich, First (virtual), Siris (virtual), Talley Fellow: Marcos Moreno

THE COMMITTEE IS WORKING ON TWO PROJECTS:

1. We have developed a Survey Monkey of GAP members and additional groups and are getting an IRB approval so the results can be published. Health research that reflects the experiences of providers working in realworld settings is essential to the effective development, implementation, and evaluation of evidence-based practices (EBPs). Despite the challenges particular to use EBPs 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.

2. How to Ensure the Inclusion of Social Determinants of Health in Psychiatric Formulation: The Need for a Bi-axial System in the DSM and Common Practice. This long-term project is nearing completion and will be submitted to the Publications Board between meetings.

The projects will target psychiatrists, psychiatric residents, training directors, psychologists, other mental health providers, and the general public.

This is to be submitted to Psychiatric Services.

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING:

The Survey Monkey work awaits approval from an IRB.

The SDOH Biaxial paper is approaching the final stage of submission to the Publications Board between meetings. The Committee will continue to meet via Zoom to continue working on our various projects.

PSYCHOPHARMACOLOGY

Members present: Sumner, Gross, Pine, Baron, Garakani

Virtual attending: Kevin Kennedy, Fellow, Alexander, Talan

Guest: David Mintz

Our guest, David Mintz, was voted into membership on Saturday.

We began work on our new paper, as our psychedelic was accepted for publication. Our new paper is an area of expertise of Mintz, Characteristic of the Provider Effecting Response to Pharmacotherapy.

We are planning a Zoom meeting in July.

PSYCHOTHERAPY

Members attending: (in person) Eve Caligor, Andrew Gerber, Richard Hersh, Kiki Kennedy (chair), Daniel Knoepflmacher, Lisa Mellman, Eric Plakun, Frank Yeomans

Via Zoom: Susan Lazar, Randy Welton

Fellow attending: Samuel Rosenblatt, MD

Guests: In person: Linda Michaels, PsyD: Ittleson Consultant to discuss potential collaboration opportunities with her organization, Psychotherapy Action Network, Jeffrey Katzman, MD, and Margaret Cheng Tuttle, MD

Virtually: Meiram Bendat, JD, PhD: update on Wit v.UBH

FOCUS OF WORK ACCOMPLISHED DURING THE MEETING:

• We welcomed the Ittleson Consultant and two guests, Jeff Katzman and Margaret Tuttle.

• Our Ittleson Consultant, Linda Michaels, PsyD, MBA, the Co-Founder of the Psychotherapy Action Network (PsiAN), described the genesis, mission, and structure of PsiAn, which has many overlaps with our committee. Several members offered ideas for potential collaborations with PsiAN.

• Attorney Meiram Bendat joined our meeting virtually to provide an update on the status of Wit v. UBH and discuss other cases related to psychotherapy practice, mental health parity, and generally accepted standards of care.

• We discussed psychotherapy and the future of psychiatric practice, psychotherapy education initiatives, new approaches to developing psychotherapy supervisors, the need for a better understanding of the value of intermediate levels of care, and ACGME competencies for psychotherapy.

• Members reviewed their various professional psychotherapy projects and activities, with the goal of developing some into GAP work products, as well as discussing the next steps for current GAP projects.

PLANS FOR BETWEEN-MEETING WORK:

• Our joint in-person networking event with the APA Psychotherapy Caucus is scheduled for Tuesday, May 7, from 5:30 to 7:30 p.m.

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COMMITTEE REPORTS

• Two virtual meetings are planned for June 2024 and September 2024

• Identify Blog topic(s) for GAP’s Psychology Today Blog Project.

• Continue to develop psychotherapy-focused op-eds for Psychiatric Times.

HOW MANY TIMES HAVE YOU MET VIRTUALLY?

Twelve times since November 2023, January 2021, April 2021, July 2021, November 2021, February 2022, June 2022, October 2022, January 2023, June 2023, September 2023 and January 2024.

FOCUS FOR NEXT MEETING:

• Review our joint event with the APA Psychotherapy Caucus at the APA Annual Meeting

• Clarify the timeline for three blog topics

• Discuss working with the new section editor for psychotherapy for Psychiatric News

• Discuss the new psychotherapy supervisor education/ training program

RESEARCH

NAME CHANGE: CONTEXTUAL PSYCHIATRY COMMITTEE

Mission Statement: Skilled psychiatrists are well-trained to address the unseen and underattended features of psychiatric illnesses and inform their treatment. The mission of the Contextual Psychiatry Committee is to apply the same skills to the field of Psychiatry itself. We believe that it will be useful to understand the Umwelt of Psychiatry to include the broader context of the patient as a person, including the person’s prenatal, developmental, familial, social, relational, and cultural aspects.

Our committee is working on a book (monograph) on Utilizing the Context of the Patient in Psychiatric Assessment and Treatment. The book will recall the central place of context in the history of Psychiatry, describe the recent loss of context and the costs, list factors contributing to this loss of context, and outline strategies that can help clinicians bring the context back to the clinical discussion. We welcome future GAP Fellows to join us in this endeavor.

SOCIAL JUSTICE

Attendees: Kenn Ashley (chair), Hugh Cummings, Alex Harris, Rachel Moster, German Velez (Guest)

1. Committee to complete the survey—Alex and Rachel will complete the survey and distribute it to committee members for final review before submission to the Publications Committee

2. Committee discussed the concept of Social Justice (used in broad terms, to include DEI)

a. One key concept (German): Recognizing human dignity as a collective

b. Reviewed committee’s statement of purpose bullet points to focus our tasks:

i. Fostering a respectful and welcoming environment that will attract and retain members from all backgrounds, especially those that have been historically underrepresented in psychiatry and psychiatric leadership.

ii. Ensuring that diversity, equity, inclusion (DEI), and social justice infuse the work of all GAP committees.

iii. Reviewing all policies, procedures, and processes at the organizational and committee level to ascertain that structural inequities are identified and addressed.

iv. Fostering an organization-wide process to develop a DEI plan that will have input from the whole membership and serve to educate all members about the critical role of DEI and social justice as essential features of excellence that impact GAP’s ability to meet its mission.

3. Committee discussed the idea of a blog—to consider potential topics.

4. GAP DEI Statement—obtain a written copy of the finalized statement that was presented at the GAP Business Meeting, distribute it to the committee.

a. Kenn to f/u on process, as necessary

5. Committee members will continue to review previous GAP products to assess through the lens of social justice—f/u and find which decades still need to be reviewed.

6. Discussed potential strategies to partner with other GAP committees to allow for future GAP products to include concepts of social justice

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COMMITTEE REPORTS

a. Join publications committee – currently, no committee members are interested in this avenue

b. Offer consultation services to other committees— Kenn made such an offer at the Steering Committee lunch

c. Potential Topics for Collaborations:

i. AI—Technology and Psychiatry Committee: discussed and committee was interested in collaboration Contact: Manish Sapra, MD, MMM, FAPA; msapra@northwell.edu

ii. Climate Change—Climate Change Committee

iii. Education—Committee on Medical Education

1) Lack of diversity in Psychiatry

2) Effect of Supreme Court ruling on Affirmative Action

iv. Rollback of DEI

v. Immigration

vi. Effect of Supreme Court ruling on abortion

vii.Anti-trans legislation

7. Discussed attempts to effect change and how to quantify impact

a. Within GAP, work with members/committees to determine the meaning of equity/social justice and how to incorporate that into their committee work

b. Assess over time if committees have increased concepts of equity/social justice into their work

8. Discussed potential plenary on social justice— committee will develop plans for plenary program

SYSTEMS INNOVATION & TRANSFORMATION

Members present: Wes Sowers, Hunter McQuistion, Donovan Wong, Miriam Tepper (guest) Via Zoom: Deepika Sastry, Bruce Fage, Ken Thompson (guest)

COMMITTEE PROCESS

1. Communication: We have an internal group on LinkedIn for the SIT Committee (set up by Sunil). There has been no activity here thus far; the main mode of communication has been by email. It is not clear that there is an advantage to using this mode.

2. Accountability: The main issue is responsiveness when committee members receive a message. We urge members to respond promptly when they receive a message, but there is no way to enforce this request.

3. Meetings: We will continue to plan for 1–2 meetings b/w biannual GAP meetings in April and November.

SEEKING VALUE BOOK PROMOTION

Sales Report: The book has not had significant sales. We did not go into means of promoting the book further during this meeting but revisited previous plans:

1. Market to Public Psych Fellows

2. Taking Issue Column in Psych Services: Done!

3. GAP Blog Posts: Wes, Sunmolu and Mardoche published blogs. Mardoche’s was on “Dispelling Dementia Myths,” and he may be working on another one on End-of-Life care. Deepika will submit one before the end of this year for her book chapter, History & Quality. Graham (guest) has been working on a “Summary blog” on a selected Value book chapter, but he was not present to report on his progress due to a communication problem.

4. Plan for Blogs on Workforce (see below)

5. No progress on Podcast opportunities?

6. Outreach to non-psychiatric target audience— November 2023: No progress to report

ANTI-RACISM AND SMART (SELF-MONITORING OF ANTI-RACISM) TOOL

Reviewed the Diversity Statement that the GAP Board edited on April 4, 2024. There appears to have been one editing change since the statement was released a year ago, in April 2023. Next step? Apply the SMART tool to each committee.

Wes spoke to Kenn Ashley, head of the Social Justice committee, during lunch. They are currently finalizing the survey and hope to disseminate it to GAP committees. Consider inviting Kenn to our next meeting. Of note is that the Social Justice committee is modeled as a “consultation” committee, open to collaboration, and may help address workforce issues.

WORKFORCE PROJECT

We began by reviewing the discussion of this topic from the last meeting in November 2023, including the “Problem list” we developed from expounding on Section III of

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COMMITTEE REPORTS

Wes’s proposed Book outline for this project, “An Obsolete Model.”

1. Production Deficits: supply” and capacity constraints

2. Guild Orientation/Protection: currently territorial; will require Culture change

3. Rigid Role Definitions: criteria for licensure, scope of practice, regulatory matters “Hierarchy of Merit”

4. Inflexible Funding Arrangements: pay based on Codes, which only certain professionals can use to bill

5. Wasted Resources: fragmentation, redundancy, underutilization of community resources, too much administration, prescribing practices.

6. Training Orientation: professional silos, lacks interdisciplinary interaction, siloed training, limited team experience, lack of uniformity, and central planning.

7. Geographic Disparities

8. No Uniformity in the allocation of potential workforce according to levels of service intensity needs

9. Lack of Diversity in the workforce and related access issues

10. Unattractive Job Expectations, productivity, documentation, burnout

11. Limitations of FFS financing to meet needs

12. Onerous medical electronic records and documentation requirements

13. Inefficiency Elements of a Comprehensive Workforce

• Psychiatrists

• MHNPs

• PAs

• Social Workers

• Master of Education

• Service Coordinators

• Primary Care MDs

• Peer professionals

• Community Outreach MH workers

• Natural and peer supports

• Nutritionists?

What is our Vision for the Workforce? Focus on a Vision of an “idealized” Workforce Model w/unlimited funding:

1. Financing—move away from FFS constraints to more flexible funding/global funding arrangements

a. For example, when a grant ends, so does the program it funds. How can that be changed?

b. Training: think more globally, encourage a transdisciplinary approach

c. Team-based care models

2. Support for community MH well-being and recovery: such as a Peer network that includes Community health workers; Diversity to reflect the population being served

3. Autonomy and flexibility of the Workforce: allow for more time and role flexibility, better work/life balance, reduce administrative burden—help those “in the trenches”

4. Technology: can it reduce administrative burden, e.g., using AI for documentation

5. Prevention: Focus on the “Front end.” How do we prevent people from getting to the Acute care endpoint?

a. Integrated care/collaboration with Primary Care as a point of entry

b. Allow for more interaction among workforce elements

c. Develop prevention elements for the workforce, outreach, and recovery.

6. Incorporate principles relevant across all levels of service, e.g. DEI, Autonomy, Social determinants of Health. meeting basic needs.

7. Match service intensity to need. “One size does not fit all” and allocate appropriate workforce elements.

8. Consider linguistic and cultural barriers while reducing stigma and improving equity and access for underserved populations.

9. Reduced geographical differences and distribution of workforce.

10. Focus on the mission of Community MH/social justice to recruit workforce to CMH.

11. Deepika: SWOT analysis leading to a series of Monographs focused on Solutions, Gen Z approach to work more focused on the mission/employer caring for well-being

12. Role of paraprofessionals: Difference between them and “natural supports” aka “Community Support Network”—the former is paid; the latter is not.

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Focus on Prevention and Health Promotion as a Base for Workforce Development

1. MH Workers in New York City: Miriam provided an overview. (ENGAGE)

a. NYSOMH: adapting community-based model from Mozambique

b. Eight dedicated “Community Wellness Workers” and two supervisors: former Crisis Counselors, Case Managers, etc: administer a Screening tool to determine appropriate LOC

c. IPC (Interpersonal Counseling x 4 weeks), modified Motivational Interviewing and Safety Planning. Training provided, must practice protocols

d. moving from Clinics to Community (shelters, food banks, etc.)

2. Other elements of the Prevention and Community Based Workforce (LOCUS Level 0)

a. Mutual support: 12 Step, Recovery Inc. SMART Recovery, Integrated Community Therapy (ICT), etc.

b. Faith-based organizations and clergy

c. Advocacy and Support Organizations: NAMI, MH Association, peer support networks

d. Online/apps, Hearing Voices network, etc.

e. School-based Support, Screening, and Intervention

f. Law enforcement: CIT Trained

3. Centralized Organization for Community Outreach, Education, Connectivity (Community Support Network)

a. Establish Stable Support for Community Outreach Workers

b. Outreach, education, and engagement specialists

c. Mental Health First Aid, Screening

d. Community workers should be part of the community they serve

ACTIONS: Wes will compose an initial blog-style draft on Workforce vision—Hunter, Deepika, and Miriam to edit. Hunter and Miriam will work on a draft for Community workers/Community support network.

TECHNOLOGY & PSYCHIATRY

Members and Guests Attending: Victor Buwalda, Alexis Chavez, Mark D’Agostino, Anita Everett, Steve Hyler, Darlene King, Rob Kolodner, John Luo, Aida Milhajlovic, Manish Sapra, Ujjwal Rametekkar, Sy Saeed, Anda Waddell

1. Introductions and reflections from members on recent advances/experiences with technology.

2. Discussions involved integrating AI into work processes, addressing privacy concerns, and developing AI-powered tools like chatbots for clinical decision support and psychiatric assessments.

3 AI in Behavioral Health Transformation. Participants shared their work experiences, especially those related to technology. They described upcoming projects within the organizations. The team delved into the potential of artificial intelligence (AI) in improving patient care. The Committee discussed the potential of incorporating AI into healthcare work processes, focusing on improving efficiency, accuracy, and patient engagement. They discussed the challenges of incorporating AI with existing patient EHRs, addressing privacy concerns, and the need for regulation and contracts. The team also explored the potential applications of AI in areas such as mental health, insurance processing, and patient matching and considered the formation of a proposal to demonstrate their work in this field. Lastly, they discussed the importance of publishing in a timely manner to address the evolving landscape. They also discussed tailoring their message to reach their target audience, considering the varying information needs and preferences of technologically savvy and nonsavvy individuals.

4. Developing Chatbot for Psychiatric Assistance: Dr. Hyler discussed his project to develop a chatbot capable of helping clinicians by serving as a decision support system. He sought feedback on the project’s feasibility and potential issues. Dr. Hyler proposed that such a clinical decision support system should be developed by APA and endorsed by its members.

5. Telepsychiatry: The team discussed the challenges and implications of telepsychiatry, including legal and ethical issues and the potential risk of expanding sub-optimal care with the extended reach of telehealth technology.

6. Book proposal: Sy Saeed will lead the committee in developing a book proposal in telepsychiatry, focusing on the use of AI and virtual care for underserved populations.

The Committee discussed the use of technology in healthcare, especially for vulnerable populations, and the concept of audio-only care. The team emphasized

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the importance of maintaining a standard of care, even when using technology for remote consultations.

The Committee discussed potential collaboration with Kenn Ashley from the Social Justice Committee on a project on AI in patient care, particularly for underserved populations. They also explored the challenges and opportunities presented by telepsychiatry, particularly in reaching underserved populations, and the potential benefits of integrating AI for scoring to reduce bias. Lastly, they touched on the resistance to incorporating technology in healthcare, the need for standardized practices, and the potential of technology, like virtual reality and AI, to improve care, especially for vulnerable populations.

7. Effect of Social Media: The team also discussed social media’s impact on mental health, the need for further research in this area, and the possibility of debating its pros and cons.

NEXT STEPS:

1. Sy Saeed will lead the effort in developing a book proposal and sharing the materials before the next meeting.

2. Ujjwal Ramtekkar will explore partnerships with existing publication platforms, such as APA and AACAP, to co-author articles and leverage their existing processes to expedite publication timelines.

3. Ujjwal Ramtekkar will co-author a textbook chapter on the use of telepsychiatry with Sy Saeed.

4. The Committee will work towards developing a framework for categorizing AI applications in psychiatry, with a focus on ambient, predictive, and patient-facing AI to guide the committee’s focus and its decision-making.

5. The Committee considered starting to write blog pieces to share insights on topics relevant to Technology & Psychiatry. The first blog will be on virtual reality. This will be led by Aida Mihajlovic and William Narrow.

6. The Committee will invite someone with experience in FDA regulation for digital therapeutics. Barry Herman’s name was suggested as an expert in this area.

7. Sy Saeed will lead the effort to update the GAP website to reflect the committee’s current focus.

8. Darlene King will share more details with the Committee about the telepsychiatry blog on the APA website, which could be a potential platform for publishing articles related to the Committee’s work.

FOCUS FOR NEXT MEETING:

Develop and refine our website

Pursue blog opportunities

Peer review articles on relevant use cases of technology such as Virtual Reality, Chatbots, and the growth of telepsychiatry companies.

WORK & ORGANIZATIONS

Our committee worked on our purpose statement and description, and some topics for potential articles on what we get from work that we don’t get anywhere else. We are curious about how the workplace can support or undermine good mental health and are interested in exploring this relationship in a rapidly changing world.