ASAP's Role Recognized

APA Boosts Advocacy Efforts In Courts, State Houses

APA Makes Presence Felt At Recent AMA Meeting

Advancing diversity, equity and inclusion (DEI) are key priorities for the American Academy of Child and Adolescent Psychiatry (AACAP). AACAP was founded in 1953. The mission of the AACAP includes promoting the healthy development of all children, adolescents, and families through advocacy, education, and research. AACAP's Presidential Initiative of CAPture Belonging's goal was to prioritize diversity, equity, inclusion and belonging to create transformational and sustainable changes in the organization and child and adolescent psychiatry. The presidential initiative's strategy had three pillars: advancing diversity, equity, inclusion, and belonging (DEIB) in all program and services, creating a pipeline for diverse child and adolescent psychiatrists, and monitoring DEIB activities and progress. A presidential task force was created and charged with implementing a 2-year action plan and strategy. A 5-point action plan prioritized: awareness, advocacy, workforce and professional development, national partnerships, and sustainability. Focusing on DEIB for any organization enriches the work, community and success that can be achieved. AACAP is proud to have committed to this DEIB path and has already experienced success through continuous membership growth, membership engagement, and record attendance at annual meetings and volunteer involvement. These accomplishments can only enhance AACAP's ability to serve the mission of promoting the healthy development of all children, adolescents, and families through advocacy, education, and research.

In April, after a Texas ruling banning abortion pills, the American Academy of Child and Adolescent Psychiatry (AACAP) warned that access to reproductive health care, including safe and legal abortion, is essential to the physical, emotional, and psychological health of individuals and families. AACAP, along with all other health care organizations, noted that research shows that continues to show that restrictive abortion laws can lead to increased psychological distress and negative mental health outcomes, such as depression, anxiety, and post‐traumatic stress disorder. “We firmly believe that reproductive health care decisions should be made by individuals in consultation with their healthcare providers, without interference from the government or other third parties,” the AACAP states. “Banning abortion pills restricts access to safe and legal abortion, potentially putting individuals at risk of unsafe and illegal procedures.” In the April 12 statement, the AACAP also called on “healthcare providers to continue to provide compassionate, evidence‐based care to individuals seeking abortion services, and to advocate for policies that support reproductive health care access and equity.” The Supreme Court later gave some reassurance that this ban would not hold, but in fact, many states have already banned abortion in various ways and forms.

Brain Abnormalities Found in Girls With Conduct Disorder

Back to table of contents Previous article Next article Legal NewsFull AccessAPA Calls for Halt to Executions Of Mentally Incompetent ConvictsAaron LevinAaron LevinPublished Online:20 Jan 2006https://doi.org/10.1176/pn.41.2.0013aMentally impaired defendants and prisoners convicted of capital crimes but later found to be mentally incompetent should not be executed or sentenced to death, according to two position statements approved by the APA Board of Trustees at its December 2005 meeting.Death row prisoners who lack the capacity to make rational decisions about pursuit of postconviction appeals, to assist legal counsel during those proceedings, or to appreciate the meaning or purpose of their impending execution should not be executed, said the first statement.Just how many prisoners meet any of the above criteria is unknown, said Paul Appelbaum, M.D., chair of APA's Council on Psychiatry and Law and a former APA president. A defendant in a capital case would have to have been competent to stand trial, convicted but not found not guilty by reason of insanity, and found mentally incompetent only after being sentenced to death. However, that is not as unlikely as it sounds, said Appelbaum, a professor of psychiatry at Columbia University and a leading forensic psychiatrist."Many people pass through all those screens and have the death penalty imposed and only then are recognized as having serious mental illnesses," he said in an interview. "Formal findings of incompetence at some point in the process are not all that common, especially with regard to competence to be executed. But a larger percentage of persons on death row appear to have significant mental disorders. It may be a failing of the current system that findings of incompetence are as uncommon as they are."Full Participation NeededThe Supreme Court has said that mentally competent prisoners may choose to forego appeals of the death penalty and that action is not in itself evidence of incompetence (Gilmore v. Utah, 429 U.S. 1012[1977]). Since a prisoner's full participation is needed to assure fair resolution of postconviction claims, he or she must be competent to assist counsel in those proceedings. Current procedure allows a third party, a "next friend," to pursue appeals or other proceedings on behalf of an incompetent prisoner. The new statement advocates that such a person step in when the prisoner has a mental disability or disorder "that significantly impairs his or her capacity to make a rational decision.""Any impediment to thorough collateral review undermines the integrity of the review process and therefore of the death penalty itself," according to the American Bar Association (ABA). "The possibility, however slim, that incompetent individuals may not be able to assist counsel in reconstructing a viable factual or legal claim requires that executions be barred under these circumstances."Current ABA standards say that court proceedings must stop and no execution take place if prisoners lack the capacity to assist their lawyers. Such cessation would become permanent if a judge finds that the prisoner is unlikely to return to competence in the "foreseeable" future. In those cases, according to the APA statement, the death sentence should be automatically reduced to a lesser punishment.The third point in the APA statement requires that a prisoner must not only understand the nature and purpose of the punishment but also why it is being imposed: "Offenders should have more than a shallow understanding of why they are being executed."APA's position advocates commuting to life imprisonment the death sentences of persons found incompetent to be executed. That step would obviate the ethical dilemma arising when courts order such prisoners to be treated to restore competence and permit execution."Treatment for the purpose of restoring competence to be executed is unethical," said Appelbaum, although the Supreme Court has not found a constitutional obstacle to treatment in such circumstances. APA has not formally endorsed commutation to a life sentence in such cases, but both APA and the AMA in amicus briefs have sought to avoid an ethically impossible choice between execution and untreated psychosis. Commutation would permit treatment of a severely psychotic prisoner without raising this ethical conflict, said Appelbaum.Other Impairments Should Be WeighedThe Board also authorized a second statement urging courts to reject the death penalty for additional categories of defendants with significantly impaired mental capacity."Defendants should not be executed or sentenced to death if, at the time of the offense, they had significant limitations in both their intellectual functioning and adaptive behavior, as expressed in conceptual, social, and practical adaptive skills, resulting from mental retardation, dementia, or a traumatic brain injury," said the statement.If adopted by the judicial system, the statement would extend the Supreme Court's 2002 judgment in Atkins v. Virginia, ruling out the death penalty for mentally retarded individuals, to two other disorders involving equivalent levels of impairment.Adopting the current statements marks another step in coordinating APA views on death penalty issues with other mental health and legal organizations. APA cooperates with the ABA, American Psychological Association, and National Alliance on Mental Illness in finding common ground on application of the death penalty to people with mental illness."Our hope is that if four of the major groups in the U.S. that are concerned with law and mental health align their views, it will carry substantial weight, not so much with the courts, but with legislatures who can enact these policies into law," said Appelbaum.The position statements will be accessible shortly at<www.psych.org/public_info/libr_publ/position.cfm>.▪ ISSUES NewArchived

The Solicitor General Unbound: Amicus Curiae Activism and Deference in the Supreme Court

Ongi etorri! ¡Nuestra bienvenida! Our welcome! Es un placer darle la bienvenida al 60º Congreso de AEPNYA (Asociación Española de Psiquiatría del Niño y el Adolescente), que tendrá lugar en Donostia / San Sebastián. En esta ocasión especial, el evento constituye una iniciativa compartida con la AACAP (Asociación Americana de Psiquiatría Infantil y Adolescente) de Estados Unidos; siendo la primera vez que esta organización, la mayor del mundo en psiquiatría infantil y adolescente, acude a Europa. Nuestra dos asociaciones gozan de un llamativo paralelismo en su historia del desarrollo: el 60 congreso de AEPNYA ocurre en el mismo año 2016 que la AACAP realizará su 62 reunión anual en la ciudad de Nueva York. ¡Es el momento, en un entorno cada vez más global, de trabajar conjuntamente y fomentar esta fusión cultural!

In the past 8 years, the US Supreme Court has issued landmark opinions in three cases that involved the criminal culpability of juveniles. In the most recent case, in 2012, a ruling prohibited states from mandating life without parole for crimes committed by minors. In these cases, the Court drew on scientific studies of the adolescent brain in concluding that adolescents, by virtue of their inherent psychological and neurobiological immaturity, are not as responsible for their behaviour as adults. This article discusses the Court's rationale in these cases and the role of scientific evidence about adolescent brain development in its decisions. I conclude that the neuroscientific evidence was probably persuasive to the Court not because it revealed something new about the nature of adolescence but precisely because it aligned with common sense and behavioural science.

Population-based surveys estimate that 0.7% of youth (13 to 17 y of age) in the United States identifies as transgender. Transgender youth are at an increased risk of anxiety, depression, and suicide attempts that often require inpatient care. Unfortunately, because of perceived insensitivity to gender identity from their providers, which includes incorrect use of names and/or pronouns, they may delay seeking necessary care. To date, there have been no specific documentation practice guidelines published by the International Association of Child and Adolescent Psychiatry and Allied Professions, American Academy of Child and Adolescent Psychiatry (AACAP), or other professional associations. The main goal of this study was to review documentation practices among multidisciplinary teams caring for hospitalized transgender youth on a child and adolescent inpatient psychiatry unit. Retrospective chart reviews were completed for 44 transgender patients who were hospitalized between 2008 and 2017. The charts were reviewed for consistency in the documentation of name and gender by the multidisciplinary team. Members included child and adolescent staff psychiatrists, residents, fellows, nurses, nurse practitioners, physician assistants, and social workers. Inconsistency was defined as at least 2 members of the team referring to a patient by a different name and/or gender pronoun in separate notes or >2 interchanges of name and/or gender pronoun in a single note. Kappa coefficient was calculated between each team member role to estimate exact agreement statistics. In 43.2% (n=19) of cases, team members did not have a consistent approach to documenting a patient's name and/or gender pronoun and 18% (n=8) of discharge summaries were also inconsistent in this documentation. The greatest agreement in documentation practices was noted between the team and the staff psychiatrist (κ=0.446). Findings from this study suggest that inpatient treatment teams show inconsistency in documentation practices for youth transgender inpatients. Further work is necessary to understand the implications of these findings for patient satisfaction and clinical outcomes.

GME Legislation Includes Funding for Child Psychiatric Hospitals

The Ugandan Supreme Court's decision in Attorney General v Susan Kigula &amp; 417 Others ended a ten year constitutional challenge against capital punishment. The attorney general was appealing the Constitutional Court's declarations that a mandatory death penalty and a delay on death row of more than three years violate Uganda's Constitution. The respondents cross-appealed the Constitutional Court's declarations that the death penalty is constitutional and that hanging is an appropriate and therefore constitutional method of execution. The Supreme Court dismissed both the appeals and cross-appeals. This article summarises the Supreme Court's findings and analyses the court's reasoning. It demonstrates that, while the court's reasoning is generally in line with the interpretations offered by international courts and human rights bodies, the court arguably missed an opportunity to take a bolder approach regarding the relationship between the death penalty and the prohibition on cruel, inhuman and degrading treatment, particularly in light of recent international trends.

The American Academy of Child and Adolescent Psychiatry (AACAP) announced April 12 the release of an expanded Depression Resource Center. This up‐to‐date tool presents resources on depression helpful to parents, youth and clinicians, say AACAP officials. It offers related frequently asked questions, fact sheets, treatment resources, books, apps, videos, websites, articles and more. It also provides information on getting help. It is consumer‐friendly, reorganized based on the user experience and has a fresh design, officials stated. The release of the revamped Depression Resource Center coincides with the current Presidential Initiative on Depression Awareness and Screening in Children and Adolescents of Karen Dineen Wagner, M.D., Ph.D. Wagner's presidential initiative implements a multipronged approach including the rework of the Depression Resource Center, education and collaboration with professional organizations and government agencies. For more information, visit https://www.aacap.org/depressionrc.

Trustees Tackle Wide Range of Controversial Issues

Since Kant, ethics has been synonymous with moral law, grounded in Reason. As Kant’s heirs, we are still grappling with a tension he sought to resolve through his appeal to a rational God, namely, between ethics and politics. “Politics says, ‘Be ye wise as serpents,’” remarks Kant: “Morality adds (as a limiting condition) ‘and guileless as doves’” (1795, 338). For Kant, both the serpent of politics and the dove of ethics are bound by the same moral duty that has its source in the freedom of our sovereign rational will. The perfection of this good will is possible not as individuals but only from the perspective of what Kant calls “Universal History from a Cosmopolitan Point of View,” which it turns out is a view from the cosmos, more specifically, from the perspective of the “dwellers from other planets” whom Kant imagines viewing us from their own place in the universe (1784, n. 2). As we know, Kant insists that the concept of duty cannot be in conflict with doing our duty—or that ought implies can: “It is patently absurd, having granted this concept of duty its authority, to want to say that one nevertheless cannot do it. For in that case this concept would of itself drop out of morals. . . . [H]ence, there can be no conflict of politics as doctrine of right put into practice, with morals, as theoretical doctrine of right” (1795, 338). But what if the reverse were true? What if ought implies cannot? What if our obligations always outstrip our intentions? What if the sovereign will is fundamentally beholden both to other people and to the Other The Plight of Ethics