At its three-day meeting in Washington, D.C., last month, the Assembly voted to endorse five position statements touching on a variety of critical patient care issues including discriminatory disability insurance, publication of findings from clinical trials, the use of atypical antipsychotic drugs, who oversees the care of psychiatric inpatients, and mentally ill people in jails and prisons.

Three of the statements have already won endorsement from the Board of Trustees and will thus now become official APA policy.

While APA has long opposed disability insurance policies that restrict benefit payments when a worker is disabled by a mental rather than physical disorder and has filed court briefs upholding this principle, Assembly members thought it important for APA to adopt an official position on the issue.

The statement they endorsed, which passed with no opposition, decries disability policies that have discriminatory payment caps and time limits. If such restrictions are part of disability insurance policies, the statement says, they should be based on functional-impairment levels and apply equally to mental and physical causes of disability.

The statement also emphasizes, "Improving worker satisfaction and health, practicing early illness and injury management, and providing return-to-work programs are nondiscriminatory ways to appropriately focus on disability and achieve a more responsive rather than a restrictive focus for employers and workers."

On another action related to psychiatric disabilities, the Assembly voted to ask the American Association of Social Psychiatry to recommend a series of rights that federal or state governments should guarantee to psychiatrically disabled individuals to ensure that they have access to all facets of society. The proposal likened the changes that governments must mandate to provide full integration of psychiatrically disabled persons to steps taken over the last decade or so to alter the country’s sidewalks "to allow the wheelchair bound to have maximum freedom in our society."

The Position Statement on the Publication of Findings From Clinical Trials is designed to guide psychiatrists and other researchers who participate in studies where a pharmaceutical company or other sponsor may impose limitations on the extent to which research findings can be published. The statement would put APA on record as maintaining that "all researchers should have the freedom to publish all findings from clinical trials in which they participate regardless of the outcome of the trials."

When data are relevant to medications, whether new or already approved, these findings have "direct implications for the care and treatment of all persons with mental illness. . . . When negative findings on approved drugs are suppressed, there is a real potential for patients to be exposed to ineffective and potentially harmful treatments."

The statement calls on research investigators to refuse to sign agreements "that have clauses that prevent them from publishing both positive and negative results or from collaborating with other investigators to pool data across sites in multicenter trials."

The statement also says that APA "urges investigators to include consideration of the opportunities for disseminating research findings in the process of informed consent. Consent forms should not discuss helping to improve the care of others as a benefit of research participation unless there is a commitment to publish negative as well as positive findings."

A third position statement that won Assembly backing states that "the new generation of antipsychotic medications (except clozapine) needs to be made available as first-line treatments for appropriate individuals throughout all systems of care," including correctional systems. It notes as well that patients with treatment-refractory illnesses should have access to clozapine.

With no dissent, the Assembly also endorsed a position statement emphasizing the critical importance of having psychiatrists be in charge of the care of patients who are hospitalized for mental illness treatment. The statement explains that since "psychiatric illness is a disorder of brain function with cognitive, emotional, and behavioral manifestations, . . .the diagnosis and treatment of patients with psychiatric illnesses require physicians trained in the medical specialty of psychiatry."

It also indicates that optimal patient care requires that a psychiatrist must conduct admissions and discharge evaluations or supervise other physicians responsible for these elements of the hospitalization process. "Failure to provide such care by a psychiatrist will adversely impact and jeopardize the health and safety of patients with psychiatric illness," according to the position statement.

In addition to the four APA position statements, the Assembly voted to support a fifth position statement that is to serve as a resource document rather than be on a track to make it official APA policy. The representatives endorsed a position statement on the mentally ill in jails and prisons that is an official statement of the American Association of Community Psychiatrists (AACP), many of whose members work daily with mentally ill person behind bars. AACP is one of the psychiatric organizations that send a liaison representative to the APA Assembly.

The statement decries the lack of access to care facing prisoners with mental illnesses and dual diagnoses and calls on government officials to "create alternatives to incarceration for as many nonviolent mentally ill offenders as possible." It emphasizes that "special priority should be given to youthful offenders, who should be diverted into noncorrectional settings where their mental health and substance use problems and their educational and vocational needs can be addressed."

The statement also calls for increased advocacy to fight abuses of prisoners and ensure that correctional services "meet appropriate standards for mental health and dual diagnosis services to prisoners."