Stigmatization: Past, Present, and Future · 2014. 2. 5. · As I read annual applications for residency training, I find that about 30% of personal statements identify stigmatization

Issue 135 June 2013

Stigmatization of people with mental illness and substance use disorders, collec-tively referred to as behavioral health disor-ders, remains a significant concern. While we may have come a long way, it remains a prevalent concern among our patients, psy-chiatrists, and those who advocate on be-half of our patients. Stigmatization is deep-ly embedded in our culture and remains within the medical profession, although as many senior members will relate, not as deeply as in the past. As healthcare is re-formed, beginning now at the state level in the Commonwealth of Massachusetts, the issue of stigmatization drives differing opinions of how best to implement Chapter 224. This discussion provides a new oppor-tunity to speak about oft denied, yet preva-lent beliefs that sustain stigmatization. As I read annual applications for residency training, I find that about 30% of personal statements identify stigmatization as a ma-jor obstacle to overcome, either in their personal choice of profession with advice from family and professors to practice “real medicine” or in observed access to care. This access is not only for behavioral healthcare with heavily managed barriers to treatment, including prior authorization, but also for medical disorders for the patients with behavioral health disorders that medi-cal students encounter throughout clinical rotations. Students clearly see that attitudes toward people with psychiatric and

substance use disorders and to those of us who treat them are tainted with stereotypic views of patients and our profession. Em-pathy for those treated differently and the wish to advocate for their needs is one of the many reasons medical students seek a career in psychiatry and supports a caring, empathic psychiatric workforce. To under-stand where we are and where we might be, a review of the past is important both as it relates to stigmatization and different treat-ment of those suffering from behavioral health disorders. The PastThe PastThe PastThe Past While this is not meant be a comprehensive review of the history of stigmatization or the leaders who worked to change these views, I will highlight some of the evolu-tion of the treatment of the mentally ill that sheds light on both the ebb and flow of the role of stigmatization. This review could be done linguistically with terms such as luna-tic, insane, madman, crazed, and possessed that were expunged and resurged many times throughout the ages. One example is the re-branding of the lunatic asylums of the 19th century to the “less” stigmatizing insane asylums; later lunatic was again used until these setting eventually became hospitals for the mentally ill as inmates became patients. The mentally ill have a long suffered dis-crimination, tainted by the stigmatization of

being “different” and “difficult” to treat, often creating fear or at a minimum distance among the masses who sought explanations in nomenclature of the time and culture. The treatments over centuries varied from Hippocrates gentle treatment of rest to purges of demons that involved beat-ings, deprivations, torture, and death by such means as burnings and drowning (e.g., witch hunts). The family was for centuries responsible for the care of the person with the church or state coming in when the family was unable to contain or care for their ill family member. During the 17th century, people with mental illness were more commonly removed from the family care, especially families without financial resources, and housed with the poor and homeless (“vagrants”), people with physi-cal and intellectual disabilities (“idiots”), and those who were deemed to have com-mitted crimes (“criminals”). Many were held in shackles existing in dark dungeons of asylums until the 19th century with the introduction of Moral Treatment designed by Philippe Pinel, the French physician at the Bicêtre Insane Asylum and later, the Salpêtrière(1). However, many people with mental illness, the responsibility of the family, remained prisoners in their own homes, as depicted by the character of Mr. Rochester’s wife in Charlotte Brontë’s 19th century novel, Jane Eyre.

(Continued on page 3)

Stigmatization: Past, Present, and Future

From the President ............................................................... 1

MIT Corner............................................................................. 2

MPS New Members .............................................................. 2

Managed Care Update ......................................................... 5

MPS Classifieds .................................................................... 7

APA News .............................................................................. 8

MPS Calendar ....................................................................... 12

MPS Bulletin—June 2013

Massachusetts Psychiatric Society ♦ 40 Washington Street, Suite 201 ♦ Wellesley, MA 02481-1802

781-237-8100 ♦ Fax: 781-237-7625 ♦ Email: [email protected] ♦ [email protected]

40 Washington Street, Suite 201 Wellesley Hills, MA 02481 Phone: 781-237-8100 Fax: 781-237-7625 www.psychiatric-mps.org

Janet E. Osterman, M.D., M.S. President Gregory G. Harris, MD, MPH President-Elect Alex N. Sabo, M.D. Immediate Past-President Negar Beheshti, M.D. Secretary Bruce Black, M.D. Treasurer Anthony J. Rothschild, M.D. Sr. APA Representative 2011-2014 Gary Chinman, M.D. APA Representative 2013-2016 Manuel Pacheco, M.D. APA Representative 2013-2016 John Palmieri, M.D. APA Representative 2011-2014 Sheldon Benjamin, M.D. 2011—2014 Gwyn Cattell, M.D. 2013-2016 M. Cornelia Cremens, M.D., MPH 2012—2015 Rohn Friedman, M.D. 2012-2015 Mark J. Hauser, M.D. 2011-2014 Arthur Papas, M.D. 2013-2016 Auralyd Padilla, M.D. 2013-2015 Marc A. Whaley, M.D. President Stephen G. Kessler, M.D. President Beverly Sheehan Dupuis Executive Director Mayuri Patel Executive Office and Membership Administrator Julie Kealey Continuing Medical Education Coordinator

I am honored to be the new MIT Representative for the MPS and would like to start by thanking you all for your support. My name is Auralyd (Lala) Padilla, third year adult psychiatry resident at UMASS, Worcester, or “Woostah”. During the past years, I have been exposed to many opportunities that have helped in my personal and professional development. When I heard about the MIT representative position, I got excited about the possibility of learning more about organized psychiatry, the mental health system in Massachusetts, and most importantly, working closely with trainees in other programs in the state. As previously disclosed by previous residents in my position, it is a great responsibility having to write a monthly column. After finding the elec-tion results, ideas started to emerge as I was driving back home, or walking to the clinic and then I realized…. when I will find time to write the column? Although the thought of writing monthly articles sounds somewhat intimidating, being an MIT Representative and having this commitment, will give me the opportunity to pause, sit down, and think about my work, my life and that of my fellow residents on a regular basis. Training life is hectic. Between answering emails, voicemails, completing guardianships, transportation forms, and hopefully getting up to date with the literature, it is difficult to think of anything else. We focus on surviving and get-ting to know ourselves as Psychiatrists, and sometimes we miss what is going on around us. We are immersed in our own “little world” and the “outside” world can appear foreign. That is why having an advocate and someone to reach out to us and keep us up to date with what goes on at APA and it’s branches is invaluable. It has been the mission of previous MIT Representatives to increase resident participation in the MPS. One of the newest initiatives has been resident participation as co-leaders of the different committees. In addition to continuing to encourage resident participation, during my term, I would like to work on improving the communication among residents throughout Massachusetts. I believe

peer support can strengthen our learning experi-ence and foster valuable relationships. During the coming years, I will ask for your feedback as to how this column would be more helpful and appealing. As I learn more about MPS and their previous initiatives, I will continue to think of ways of being of service to my colleagues. Please don’t hesitate to contact me with questions or com-ments at [email protected]. I look forward to serving you for the next two years.

General Member: Elizabeth LaSalvia, MD Marni Joy Chanoff, MD Annette Kawecki, MD Andrea Seek, MD

Steven Auster, MD

Member-In-Training: Nicholas Barnes, MD Shireen F. Cama, MD Scott Yapo, MD Laura Miller, MD Matthew May-Curry, MD Ariana Nesbit, MD Gerard lru Fernando, MD Melissa Park Bui, MD Anya Bernstein, MD Whitney Elise Peters, MD Teresa Vente, MD Andrea Amerio, MD Christos C. Liapis, MD Christopher Baca, MD Jennifer Bianca Howse, MD

Sagar Vijapura, MD

MPS IS PLEASED TO

WELCOME THE FOLLOWING

NEW MEMBERS



www.psychiatry-mps.org 3

In Massachusetts, in early 1833, the Bloomingdale Insane Asylum on a bucolic hill in Worcester opened its door as the first to provide Moral Treatment for people with mental illness whose family could not af-ford the affluent private asylums to relieve them of the need to care for ill family at home. The State Lunatic Asylum (renamed) was expanded during the 1870’s and later became known as Worcester State Hospital.(3) As time evolved, the wards of the then Massachusetts State Hospital system grew to be overcrowded leaving little capacity to care for patients, a situation that became synonymous with the concept and term of institutionalization.(2) The advent of medications for people with serious mental illnesses, the clinical use of chlorpromazine beginning in the mid-1950’s(3) and later lithium(4) fueled the deinstitutionalization movement that culminated in President Kennedy's 1963 Community Mental Health Centers Act. Unfortunately, while deinsti-tutionalization was implemented with sig-nificant reduction of state hospital inpatient beds, the promised community centers to provide treatment was insufficiently funded and thus insufficient to meet the treatment needs of our most vulnerable citizens. Many would argue that the goal was lofty and meant to decrease maltreatment of the mentally ill but that the underfunding created a fertile ground for increased stigmatization as people with serious behavioral illness (e.g., mental illness and/or substance use disorders) swelled the homeless population and the prison cells, once again part of the population of “vagrants” and “criminals.” The PresentThe PresentThe PresentThe Present The fight for parity exemplifies ongoing stigmatization in our current culture. MPS is one of the leaders in this critical fight through many venues. Stigmatization is seen daily by our membership as we strug-gle with restrictions on inpatient and outpa-tient access to treatment, in patients board-ed for days in psychiatric emergency rooms and insufficient psychiatric beds across the Commonwealth due to current payment structures and underfunding of the Depart-ment of Mental Health, and in payment restrictions of CPT codes. Each of these situations is unique to behavioral health and reflects the separation of those with behavioral disorders from “medical” disorders, a sign of ongoing stigmatization.

To understand the concept of parity, we must first visit a brief history of health in-surance and of managed care behavioral health organizations (MBHO) carve-outs. The creation of publicly funded health in-surance (Medicare and Medicaid) in the 1960's transferred the cost of care for many elderly and poor with mental illness to the federal government while private insurance covered family members of workers or families with means continued to pay pri-vately for long-term care in specialized treatment settings. Alcoholism and drug addiction remained a public health issue or a criminal issue funded by states. Health Maintenance Organizations (HMO) as a concept emerged from Kaiser-Permanente’s insurance system and became an official route of health care financing through the Health Maintenance Act of 1973. This model expanded through the 1980’s, especially in Massachusetts, to become a dominant provider competing with the indemnity plans with higher costs and unfettered access to specialty care. The HMO promise was to care for the en-tire patient with a focus on preventative care and easy access to a primary care phy-sician who would manage all health needs of the patient with referral to specialists when necessary. The insurance company perspective was to contain cost, while more idealistic physicians saw HMO’s as a com-mitment to better patient care and quality of life. Mental health costs were increasing. This was a result of a combination of fac-tors that included faulty implementation of deinstitutionalization, addition of treatment for substance use disorders in some states beginning for alcoholism (MS in 1975 but until 1991 in MA) with a gradual expansion to include other substance use disorders, (5) tightening of the public safety net through closure of state mental institutions, and a growing population. A solution to this cost crisis was the development Managed Be-havioral Health Care Organizations (MBHO) Carve-outs to treat what was des-ignated an expensive and difficult to man-age population. Massachusetts was among the leaders in the use of carve-outs for both private and for public health care plans with Massachusetts Medicaid initiating MBHO in fiscal year 1993 under Governor Weld.

While it could be argued that other aspects of medical care are also expensive and dif-ficult to manage (e.g., diabetes mellitus or coronary artery disease), it is not surprising

that the mentally ill and later those with alcohol and drug dependence were separat-ed from the rest of HMO subscribers given the long and accepted practice of marginal-izing this stigmatized population. The 20 year outcome of these cost containment policies has led to fragmentation of behav-ioral health care and medical care for one person suffering from both psychiatric and/or substance use disorders and physical illness. Both primary care physicians and psychiatrists have found the complexity of different rules, routes of access, and care coverage difficult to manage and with rec-ognized redundancies and deficiencies that are not cost effective or effective patient care. Today, Massachusetts is again at the fore-front of change, as Chapter 224 mandates a new healthcare system of integrated care bringing the entire patient’s needs, behav-ioral health and physical health, under the same metaphorical roof in the design of such entities as Accountable Care Organi-zations and Medical Homes. The potential is to take a lead in health care delivery re-form. The goal, as in the past, is to provide effective healthcare with a reduction in the expanding cost of healthcare. This has pro-vided opportunities for MPS leaders to be involved in the discussion through the Be-havioral Health Integration Task Force and the Physician Work Group to advise the Task Force. With many at the Task Force table, the goal of finding a means to thoughtfully integrate has touched upon issues that relate strongly to stigmatization. Voices for those with “lived experi-ence” (e.g., patients and family members) speak of the role of stigmatization in re-ceiving quality medical care with many serious complaints discounted as “anxiety” or “psychosomatic.” This is well-known to psychiatrists who have found themselves as an advocate for patients to receive proper assessment and treatment of a medical con-dition. Privacy of all behavioral health information is strongly supported by some, while others argue that to remain separate and secretive supports stigmatization while inclusion will inform treatment by also changing attitudes and behaviors of primary care providers. This mirrors the change in MA public school systems about 20 years ago to remove students with spe-cial needs from contained classrooms and mainstream them into regular classrooms with necessary supports. One goal was to enhance socialization of students with

(From the President -Continued from page 1)

(Continued on page 4)



MPS Bulletin — June 2013 4

special needs and acceptance of differences by students and teachers of those with differences. While the entire goals have been difficult to achieve for all students, the overall view of students, parents, and teachers is that it has been successful (personal communication). Being hidden from view, isolated and seg-regated has only served to maintain stigma-tization of the mentally ill for centuries suggesting it is time to try another ap-proach. Other means for decreasing stigma-tization include education that MPS engag-es through many venues including the MPS Public Sector Interest Group, the Addiction Interest Group, and the Consultation-Liaison Interest Group. The work of our Legislative team, APA Representatives, and others in our membership has resulted in laws and policies to create parity of care for behavioral health care and equality in payment structures through changes in CPT codes. This work continues. The FutureThe FutureThe FutureThe Future As MPS continues to work on the present tasks to integrate all medical care, to achieve full implementation of parity and equality in payment, and opportunities that portend change give a potential glimpse of the future. Healthcare integration will be achieved; the final entities and their func-tional capacity are difficult to define and will evolve. This integration, whatever its varied implementation, will allow psychia-trists to serve as role models and provide education to reduce stigmatization. We can anticipate that expansion of CPT codes, now in full use in commercial insur-ance, will be implemented in the Medicaid and Medicaid expansion insurance prod-ucts. This is supported by many in the be-havioral health community as MPS partners with groups that can strategically support our mission. This implementation is direct-ly related to Parity, a policy that was de-signed to reduce stigmatization. Parity (or lack of it) touches many lives, providers of all forms of healthcare and those with lived experiences. Parity is currently codified in state and federal law. Its implementation of parity is under current discussion with many groups joining together to deal with these parity issues that adversely affect our patients, such as boarding acutely and criti-cally ill patient in psychiatry emergency rooms. This emergency room crisis reveals

the stigmatization of people with mental illness and co-occurring substance use dis-orders through restricted access to neces-sary healthcare that is not suffered upon those with chest pain who are readily ad-mitted to intensive treatment without treat-ment delays caused a sanctioned and faulty system of prior authorization. Due to the parity laws and the coalition of MPS and other groups shining light on this unac-ceptable situation, it is possible to predict that over time, this will change. The role of MBHO has come under scrutiny as healthcare integration is debated. The Phy-sician Work Group noted that MBHO are barriers to full healthcare integration with this artificial separation of a person’s health needs into dual insurance systems. Howev-er, the potential risk is that once carved in, funds previously dedicated to behavioral health, may be siphoned to treat non-behavioral health disorders demands atten-tion. This issue will remain unresolved in the immediate future, but will undergo con-tinued scrutiny to determine the best reim-bursement system to achieve parity, healthcare integration, and allow for de-stigmatization of those with behavioral health disorders. (6) Privacy of behavioral health care information and the need of all physicians need to know some information will be solved as these new entities with integrated electronic medical records (EMR) are formed. The content of psychotherapy notes, unnecessary for other physicians to know, will remain protected and released only with patient consent; other information such as medications, diagnosis, and treatment plans that are critical to care of the entire patient will likely be accessi-ble to all healthcare providers, unless the patient requests privacy. Costs will not decrease but the growth slope will be slowed. Savings will come not through restrictions to access for those suffering behavioral health disorders but through knowledge. The current expense in the system of redundant services exempli-fied for example with a middle-aged patient with panic disorder admitted nearly daily to different emergency rooms around greater Boston with chest pain with a myriad of EKG’s and enzymes in disparate systems of care; a cardiac condition repeatedly ruled out while the primary disorder re-mains untreated. Another example is the patient who is too psychotic to effectively communicate chest pain whose medical

needs are unmet leading to an extensive myocardial infraction, catapulted into ex-pensive and ongoing care for sequelae and an earlier than necessary death. Early death is an unfortunate truth that currently befalls too many with mental illness. Care coordination will ensure adherence to treatment with follow-up visits kept result-ing in effective treatment of all disorders, resulting in prevention of relapse in all as-pects of care and cost savings. Improved outpatient care will reduce the pressures on emergency and inpatient services with im-proved quality of life and cost savings. In-tegration will reduce stigmatization as pri-mary care providers see more patients like themselves who happen to also have de-pression, PTSD, anxiety, alcohol abuse, or other common behavioral health disorders as the veil of secrecy is removed. Patients will have better overall care with reduction in medication combinations that may lead to complications once the veil is lifted. Predicting the future is fraught with peril and so I give these as hopes for a better future for our profession and our patients, but with no guarantees that any will come in the near or distant future. I can confi-dently predict that MPS will work diligent-ly to follow these potential changes, fighting for those that will benefit our members and patients and against those that will adversely affect all. In the future stigmatization will be reduced, but MPS leadership will need to continue to be vigi-lant for its presence and impact on policies. 1. Daniels, M., et al A Brilliant Madness, Time-

line. Public Broadcasting System http://www.pbs.org/wgbh/amex/nash/timeline/ Accessed 5/18/2013.

2. Meehan, M.C. The State and the Mentally III: A History of Worcester State Hospital in Mas-sachusetts, 1830-1920. JAMA 1966: 198: 1133.

3. Ban, T.A. Fifty years chlorpromazine: a histor-ical perspective. Neuropsychiatr Dis Treat. 2007: 3: 495–500

4. Shorter E. The history of lithium therapy. Bipolar Disord 2009: 11 (Suppl. 2): 4–9.

5. Robinson, GM., et al. Treatment for Mental Illness and Substance Use Disorders. SMASH. 2006. store.samhsa.gov/shin/content//SAM-4228/SMA07-4228-A.pdf. Accessed 5/19/2013

6. Dalzell, D.A. Mental Health: Under ACA, Is It Better To Carve In or to Carve Out? Managed Care. 2012. http://www.managedcaremag.com/archives/1212/1212.mental_health_carve.html. Accessed 5/18/2013.

(Continued from page 3)




Managed Care Committee Gregory G. Harris, MD, MPH, Chair

All are welcome at the Managed Care Committee Meetings, which occur on the third Tuesday of the month (from 7-9 PM; dinner served!) at the MPS offices in Wellesley. Check the

MPS website for details or contact me at [email protected]

Impending GIC changes in mental Impending GIC changes in mental Impending GIC changes in mental Impending GIC changes in mental health coverage:health coverage:health coverage:health coverage: The Group Insurance Commission (GIC) is responsible for health insurance decisions for all state employees as well as many municipal employees and retirees. Histori-cally, GIC offered state employees several insurance choices for “physical health”, but “behavioral health” coverage only through United Behavioral Health (UBH). As of 07/01/2013 most “behavioral health” coverage will be provided by Beacon Health Strategies (BHS). We are concerned about problems with parity and network adequacy in a mandated, singular carved-out insurer, particularly in the BHS network. We also feel that BHS has a restrictive approach to covering psychiatric services mandated by the 2013 CPT coding scheme. MPS has reached out (in conjunc-tion with NAMI and Health Law Advo-cates (HLA)) to the GIC about these con-cerns and hope to meet with members of the Commission shortly. In the meantime, we continue to encourage MPS members to communicate parity and network concerns with their patients and encourage them to voice these concerns directly with their employers, union and the GIC.

Mental Health Parity and CPT Coding Mental Health Parity and CPT Coding Mental Health Parity and CPT Coding Mental Health Parity and CPT Coding Changes for 2013:Changes for 2013:Changes for 2013:Changes for 2013: In April, I testified regarding Parity and the new CPT codes on behalf of MPS at the Massachusetts Office of the Attorney Gen-eral. Previously, I had testified on the same issues at the Massachusetts Division of Insurance. We have other meetings with the Massachusetts Legislature and other state and federal regulatory bodies and will report back to MPS members about the results as soon as we are able to do so. Although no specific results are available for reporting, we are encouraged that a va-riety of regulatory agencies of government are interested in hearing our concerns.

We want to again thank all who continue to report problems regarding the new 2013 CPT coding scheme. We are actively using your case reports in our advocacy and ask that you continue to report difficulties to the MPS e-mail address: [email protected] In addition, APA has several active report-ing mechanisms to track and address CPT coding and Mental Health Parity abuses. You should continue to file specific com-plaints through: 1. an online form:

https://www.surveymonkey.com/s/cptparityviolations or

2. via a dedicated e-mail address: cptpar

[email protected] general information can be found at: http://www.psychiatry.org/cptparityabuses APA is beginning to compile a list of parity actions by state at: http://www.psychiatry.org/practice/managing-a-practice/cpt-parity-abuses/apa-cpt-parity-actions

Remember, the CPT & EHR Update CME Program from March 9, 2013 was recorded for those who were unable to attend, and will be available for purchase shortly (with supporting documentation and CME credits!) at http://www.psychiatry-mps.org.

Denials of Service Concerns from APA Denials of Service Concerns from APA Denials of Service Concerns from APA Denials of Service Concerns from APA OHCSF (another repeat from recent OHCSF (another repeat from recent OHCSF (another repeat from recent OHCSF (another repeat from recent columns):columns):columns):columns): APA’s Office of Healthcare Systems and Financing is constantly dealing with insur-ance companies concerning coverage deni-als and advocates with HHS/CMS, private and public payors to expand their grasp of the parity rules in order close the loopholes upon which insurers rely to deny coverage. In doing so it is helpful to have specific examples of situations where patients clear-ly in need of a service have been denied the service by the insurer. We constantly hear that “nobody has complained so there is no problem.” While APA can raise your com-plaints with the agencies and insurance companies, it is much more effective if you make the complaint first and we follow up on it. It would be most helpful if you would make a formal written complaint whenever

there is an insurer who has denied psycho-therapy for a patient and provide a copy of that complaint to APA through the e mail below so that we can follow up with the regulators and the insurance company. Filing a complaint with DOL is easy. The process for filing a complaint against an ERISA plan is located at http://www.dol.gov/ebsa/aboutebsa/main.html under “consumer complaints”. If you do not file a formal complaint, please provide APA with any examples you have where an insurer has denied coverage for psychotherapy for a patient and include in it:

♦ The patient’s diagnosis

♦ The recommended psychotherapy

♦ The insurance company name

♦ The employer through which the cov-erage is provided (if known)

♦ The insurance company’s reason for denial if one is provided. You can substitute a copy of the denial letter with the patient’s name and identifying information redacted if that is easier.

♦ If no reason is given for the denial, please indicate that as well.

♦ Other things that would be of interest include whether the company puts nu-meric caps on the number of visits permitted, pulls a file for review after a given number of sessions is reached, or has refused to pay psychiatrists for the psychotherapy add on in the new CPT codes.

This information should be sent to: [email protected].

Please do not share with us personally

identifying information of the patient.

Thank you, Office of Healthcare Systems and Financing

MPSMPSMPSMPS

Will CelebrateWill CelebrateWill CelebrateWill Celebrate

Our 50th AnniversaryOur 50th AnniversaryOur 50th AnniversaryOur 50th Anniversary

April 2014April 2014April 2014April 2014

Watch for Details!!!Watch for Details!!!Watch for Details!!!Watch for Details!!!



MPS Bulletin – June 2013 6

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Partially furnishedPartially furnishedPartially furnishedPartially furnished, T and handicap accessible office to rent between Central Square and Harvard Square in Cambridge, MA. Shared waiting room is furnished. Rate dependent on amount of time needed.

If interested, please contact [email protected] or call 617-797-7598

North Shore / Hamilton MANorth Shore / Hamilton MANorth Shore / Hamilton MANorth Shore / Hamilton MA Beautiful Furnished Office in quiet area, in private, shared, Psychiatric Suite. All amenities. Kitchen, Waiting room. Conference room. Walk to transportation, restaurants, etc. Easy highway access. Full time or Part time. Call Ken or Jay at 978-468-7880 For Rent:For Rent:For Rent:For Rent: Office hours in the late after-noon, evening, and week-end on Bay State Road just off Kenmore Square. The office is on the first floor of a turn of the century brownstone. The atmosphere is restful and conducive to the work of a psychotherapist or analyst. There is parking the back of the building for the renter, and plenty of park-ing on Bay State Road for patients, except when there are ball games at Fen-way. Please call (617)-353-0120 to Dr. Bob Kenerson to arrange to view the space and discuss the rent.

CHILD/ADULT

PSYCHIATRIST

Director of Psychiatry

Seeking a fulltime or part time

board certified psychiatrist to

join a busy, well-established

mental health practice.

Affiliation with managed care

organizations and an interest

working with children,

adolescents or adults preferred.

If interested, please send

Curriculum Vitae to:

William B. Flynn, Ph.D. Executive Director

MERRIMACK VALLEY COUNSELING ASSOCIATION

39 Simon Street, Unit #2A Nashua, NH 03060 Tel. (603) 888-4347 Fax (603) 577-9157

E-mail: [email protected]




2013 Assembly Member-in-Training

Mentor Award

Benjamin Liptzin, MD received a 2013 As-sembly Member-in-Training (MIT) Mentor Award for his outstanding work as a mentor and advocate for MITs. Congratulations!!

The Board of Trustees of the American Psychiatric Association announced the se-lection of Saul Levin, MD, MPA as the APA’s next Chief Executive Officer and Medical Director following the retirement of James H. Scully, Jr. MD, who has led the APA for the past twelve years. Dr. Scully informed the Board in December 2011 that he planned to retire from APA after 12 years of service when his contract expired in 2013. “Jay has been a tremen-dous asset to APA, leading the Association though the development and publication of DSM 5, enactment of the Mental Health Parity and Addiction Equity Act in 2008, significant improvement in APA’s continu-ing medical education program, and the reorganization of APA and the American Psychiatric Foundation. Jay leaves the APA in a much better position than he found it and his impact will be long-lasting. While APA respects Dr. Scully’s decision to retire, we will certainly miss his leadership, enthusiasm and commitment to our members and their patients,” said Dilip Jeste, President of APA. “I have known Saul for over 20 years. He brings extraordinary intelligence, vision and great energy to the challenges ahead for our profession. I look forward to work-ing together with him as we transition to new leadership,” said Dr. Scully. Dr. Levin has had a long history with the APA beginning as a member in 1987. He has served on many APA components and committees, including the APA Delegation to the AMA, the APA PAC Board, the Sci-entific Program Committee, and as a con-sultant to the Finance and Budget Commit-tee. He is also a member of the Maryland Psychiatric Society. Dr. Levin currently serves as the Interim Director of the Dis-trict of Columbia Department of Health, a position he assumed in July 2012. Dr. Lev-in has led efforts on behalf of the District of Columbia to promote access to quality

health care for its residents, including pro-vision of school-based nursing services and implementation of an electronic health in-formation exchange. As Chair of the Dis-trict’s Essential Health Benefits Package subcommittee of the Health Benefit Ex-change Authority, on which he sits, Dr. Levin was influential in insuring that the health services to be provided were com-prehensive and included parity coverage for mental health and substance use ser-vices. He oversaw the merger of the DOH’s Addiction Prevention and Recovery Administration and Department of Mental Health into D.C’s Department of Behavior-al Health. Prior to this appointment, Dr. Levin served as the Senior Deputy Director of the District’s Addiction and Recovery Administration where he worked closely with the U.S. Substance Abuse and Mental Health Services Administration to launch a youth community drug awareness cam-paign. Before his employment with the District of Columbia, Dr. Levin was the Vice Presi-dent for Science, Medicine and Public Health at the American Medical Associa-tion. “Saul’s expertise in electronic health information exchanges and implementation of the Affordable Care Act and meaningful use requirements as well as his commit-ment to mental health parity and proven leadership of large organizations will be extremely important to APA and its members as we adapt to and continue our leader-ship role in health care reform,” said Jeffrey Lieberman, President-Elect of APA. The Board also thanks the

search committee so ably chaired by APA Past President Paul Appelbaum, MD for it outstanding work. “Dr. Scully has served with great distinc-tion and led the APA over the last decade to ensure that research, teaching, and clini-cal care are in the forefront for all psychia-trists as they care for our patients. Jay will be missed and his leadership is an example to all of us. I will miss working with the Mayor, Deputy Mayors, and all my col-leagues at DOH and I am honored and priv-ileged to accept this position in this time of major change in the health care arena, where research, practice, and quality care is center stage in health care reform and men-tal health is such an important part of our public dialogue,” said Dr. Levin. Dr. Levin will join APA in mid-July as CEO-Designate and work closely with Dr. Scully until Dr. Scully retires in the fall of 2013 at which point Dr. Levin will transi-tion to his role as CEO and Medical Direc-tor of APA. According to Dr. Jeste, “We are fortunate to have had such impactful leadership under Jay Scully and look forward to many more years of continued success under Dr. Levin.”

Saul Levin, MD, MPA to be APA’s New CEO and Medical Director

The MPS Executive The MPS Executive The MPS Executive The MPS Executive

Committee, Council and Staff wish you a Committee, Council and Staff wish you a Committee, Council and Staff wish you a Committee, Council and Staff wish you a

safe and happy summer!!safe and happy summer!!safe and happy summer!!safe and happy summer!!

The MPS office will close on The MPS office will close on The MPS office will close on The MPS office will close on

Wednesday, July 3rd at noontime and Wednesday, July 3rd at noontime and Wednesday, July 3rd at noontime and Wednesday, July 3rd at noontime and

will rewill rewill rewill re----open on Monday, July 15th.open on Monday, July 15th.open on Monday, July 15th.open on Monday, July 15th.

Introducing the new DSM-5 Column in the July/August 2013 Issue of the MPS Newsletter

by Gregory G. Harris, MD, MPH, DFAPA, President-Elect MPS and Carlene MacMillan, MD, Child Psychiatrist

Drs. Harris and MacMillan attended APA's “DSM-5 Train the Trainers” session at the 2013 APA Annual Meeting in San Fran-cisco. We are discussing a variety of methods for disseminating information to MPS members and intend to use this new Column in the MPS Newsletter as a vehicle for this. Our intent is to high-light and explore areas of change in the new DSM-5, compared with the previous DSM-IV-TR. We hope to enlist expert guest contributions in specific content areas of the DSM-5. And we will create an archive of materials in the Members Only are of the MPS website that we hope will be a useful future resource.




Adult and Child PsychiatryAdult and Child PsychiatryAdult and Child PsychiatryAdult and Child Psychiatry----Boston, MassachusettsBoston, MassachusettsBoston, MassachusettsBoston, Massachusetts

Harvard Vanguard Medical Associates (http://www.harvardvanguard.org), an eminent and growing multispecialty, ambulatory group practice has full and part-time openings for BC/BE adult and child psychiatrists in our Boston, Braintree, Chelmsford, Concord and Watertown practices. Our psychiatrists work closely with their medical colleagues (internists, pediatricians and gynecologists) in addition to a multidisciplinary team of behavioral health clinicians (psychiatrists, psychologists, social workers and clinical nurse specialists) in a collaborative approach to outpatient psychiatric and behavioral health care. Responsibilities include outpatient psychiatric evaluation, treatment planning and integrated psychiatric treatment, medication management services, partici-pation in a multidisciplinary team, and supervision of clinical nurse specialists and trainees in our behavioral health fellowship program. Experience with Ad-diction Psychiatry is a plus. We are an affiliate of Harvard Medical School where teaching opportunities and an academic appointment are available for the right candidates through the Department of Population Medicine. Our practice features a fully integrated EHR (Epic), excellent practice supports (billing and authorization matters are all taken care of for you), minimal call, after-hours telephonic clinical triage ser-vices, competitive salaries and a comprehensive benefits package including a generous 401(k) plan. Please forward your CV to: Barry Baker, Physician Recruitment, Harvard Vanguard Medical Associates 275 Grove Street, Suite 3-300, Newton, MA, 02466-2275 Fax: 617-559-8255; e-mail: [email protected], Call: 800-222-4606 or 617-559-8275 within Massachusetts. EOE/AA. www.harvardvanguard.org.

CAMBRIDGE: Adult Psychiatry CAMBRIDGE: Adult Psychiatry CAMBRIDGE: Adult Psychiatry CAMBRIDGE: Adult Psychiatry

Position available at Cambridge Health Alliance, Harvard Medical

School. We are seeking a full-time psychiatrist to work in both our

adult outpatient psychiatry and psychiatry transition services. Clini-

cal care is provided through a multidisciplinary team approach with

psychiatrist leadership. Responsibilities include direct clinical care

as well as supervision of trainees and other mental health provid-

ers. Opportunities exist to develop new services and work in flexible

settings. Some hours available in our outpatient addictions service

as a prescriber in a structured Suboxone clinic. The Department of

Psychiatry at Cambridge Health Alliance is an appointing depart-

ment at Harvard Medical School. Our public health commitment to

improving the health of our communities, coupled with a strong

academic tradition, make this an ideal opportunity for candidates

interested in caring for underserved populations in a rich clinical

environment. We have strong adult and child residency training

programs which provide many opportunities for teaching, as well as

innovative programs for medical students. Academic appointment

is anticipated, as determined by the criteria of Harvard Medical

School.

Qualifications: BE/BC, demonstrated commitment to public sector

populations, strong clinical skills, team oriented, problem solver.

Interest and/or experience with dual diagnosis patients a plus.

Cambridge Health Alliance is an Equal Employment Opportunity

employer, and women and minority candidates are strongly encour-

aged to apply. CV & letter to Susan Lewis, Department of Psychia-

try, 1493 Cambridge Street, Cambridge, MA; Fax: 617-665-1204.

Email preferred: [email protected].

Child/Adolescent PsychiatristChild/Adolescent PsychiatristChild/Adolescent PsychiatristChild/Adolescent Psychiatrist Part Time, 16 Hours/WeekPart Time, 16 Hours/WeekPart Time, 16 Hours/WeekPart Time, 16 Hours/Week

The Whitney Academy, Inc., a private JCAHO accredited resi-dential treatment center and special education school for young men, ages 10-22, is seeking candidates for the part time position of Child/Adolescent Psychiatrist. Board Certi-fied/ Eligible in psychiatry and licensed in the Common-wealth of Massachusetts with interest/experience in treating cognitively impaired, mentally ill adolescents, most exhibiting significant symptoms of trauma and sexualized behavior. The role of the Psychiatrist includes overall responsibility for meeting the psychiatric, and psychopharmacology needs of Whitney’s complex population. The Psychiatrist, assisted by 3 RN’s and 3 Nurses Aides, is an active member of the treat-ment teams, working with our licensed therapists, social workers and teachers in the development and implementa-tion of comprehensive treatment plans for up to 36 adoles-cent boys. The position provides an excellent opportunity to work with nationally known experts in the field in a collabora-tive manner and to present at conferences, conduct research and publish. Whitney Academy is a dynamic program com-mitted to clinical excellence serving challenging, complex

patients.

Salary to $124,000.00 depending upon experience.

Excellent Health and Dental Plans.

Please send resume to: George E. Harmon, Executive

Director, [email protected].

BayRidge and Beverly Hospitals, part of Lahey Health

Behavioral Services, have multiple opportunities for

both full time and part time inpatient attending Psychia-

trists, admitting Psychiatrists and night/weekend on-

call Psychiatrists. BayRidge Hospital is a teaching site

for Boston University School of Medicine; there is no

required night call, with a competitive salary and a full

suite of benefit offerings as well as reimbursement for

malpractice insurance as well as CME expenses. The

lucrative night/weekend on-call opportunities can be

tailored to fit your needs, and both on-site and call from

home options are available.

Contact Barry Ginsberg, M.D. Chief and Administrative Director Inpatient Behavioral Health (781) 477-6964 [email protected].




PSYCHIATRISTS

Cambridge Psychiatric Services

PSYCHIATRISTS:

Interested in flexible hours, competitive pay

rates, and a schedule that fits your needs?

Qualified psychiatrists needed to provide overnight, weekend, and holiday moon-lighting coverage at area hospitals, clinics, and other psychiatric facilities. For more information please call Jessica D’Angio at 617-864-7452 or at [email protected] Busy private Busy private Busy private Busy private practice seeks part-time Sub-oxone-licensed physician for the many re-ferrals on our waiting list (my caseload is always full)! Beautiful office space, com-puterized records and scheduling, expert administrative & clinical support. CV with letter of interest to: Jim Recht, MD, 60 Dudley St., Cambridge, MA 02140 or email: [email protected]. Psychiatrist , Dorchester, MA: Psychiatrist , Dorchester, MA: Psychiatrist , Dorchester, MA: Psychiatrist , Dorchester, MA: Full Service Community Health Center is seeking a Psy-chiatrist for 8-16 hours per week providing psychiatric evaluations and treatment. Work with multidisciplinary team provid-ing consultations for diagnostic evaluations and psychopharmacology recommenda-tions. Board certification or eligibility in Psychiatry in MA. Contact: Director of Behavioral Health, Lisa Perrone, LICSW at [email protected] or 617-740-8138.

“Child Psychiatrist “Child Psychiatrist “Child Psychiatrist “Child Psychiatrist needed for private group practice in Metrowest. Growing quickly with strong referral flow. Professional office space. Loads of parking. Great staff. We do all billing. $125.00 per hour. Flat rate. Call 508-246-6493” Taunton State Hospital Taunton State Hospital Taunton State Hospital Taunton State Hospital –––– Temporary Posi-Temporary Posi-Temporary Posi-Temporary Posi-tiontiontiontion————Hospital Practice Psychiatry, PC seeks a psychiatrist for a temporary position in a general adult continuing care psychiatric unit to begin on or after July 1st. Taunton State Hospital (TSH) is a Joint Commission accredited (JCAHO) hospital operated by the Metro Boston Southeast Area of the Massa-chusetts Department of Mental Health (DMH). TSH is a 45 bed continuing care facility providing inpatient services to adults and geriatrics located in Taunton, MA, 45 minutes south of Boston. No night and week-

end coverage and no managed care.

Send resume to [email protected].

Outpatient PsychiatristOutpatient PsychiatristOutpatient PsychiatristOutpatient Psychiatrist

BRIGHAM AND WOMEN’S HOSPITALBRIGHAM AND WOMEN’S HOSPITALBRIGHAM AND WOMEN’S HOSPITALBRIGHAM AND WOMEN’S HOSPITAL

Brigham Psychiatric Specialties, the outpatient service of the vibrant BWH Department of Psychiatry, is expanding, with new practices opening in Chestnut Hill (Fall 2013) and at Faulkner Hospital (early 2014). We need several excellent clinical psychiatrists to join us and staff these practices. Successful candidates will be exceptionally skilled at complex diagnostic assessment, psychopharmacologic management, focused psychotherapy and collaboration with other medical and behavioral health providers. The department has numerous specialty programs, including Women’s Mental Health and Neuropsychiatry, and provides care to a diverse population with high medical co-morbidity. We are a major training site for the Harvard Longwood Residency Training Program. There will be opportuni-ties to participate in teaching and clinical research.

Academic rank at Harvard Medical School will be commensurate with experience, training and achievements.

If interested, please send CV to: Jay Baer, MD, Director of Outpatient Services, Department If interested, please send CV to: Jay Baer, MD, Director of Outpatient Services, Department If interested, please send CV to: Jay Baer, MD, Director of Outpatient Services, Department If interested, please send CV to: Jay Baer, MD, Director of Outpatient Services, Department of Psychiatry, Brigham and Women’s Hospital, 221 Longwood Ave., 4of Psychiatry, Brigham and Women’s Hospital, 221 Longwood Ave., 4of Psychiatry, Brigham and Women’s Hospital, 221 Longwood Ave., 4of Psychiatry, Brigham and Women’s Hospital, 221 Longwood Ave., 4thththth floor, Boston, MA floor, Boston, MA floor, Boston, MA floor, Boston, MA 02115; 02115; 02115; 02115; [email protected]@[email protected]@partners.org

Harvard Medical School and Brigham and Women’s Hospital are Affirmative Action/Equal Opportunity Employers. We strongly encourage applications from women and minorities.

Medical Director, DMH Community Mental Health Center: Brockton Multi

Service Center (BMSC), Brockton and Plymouth, Massachusetts:

Seeking board certified psychiatrist as full-time Medical Director at a Community Mental Health

Center operated by the Massachusetts Department of Mental Health.

Leadership position is responsible for the provision and oversight of clinical and administrative BMSC delivered services which include: outpatient psychiatry, Community Based Flexible Support (CBFS) teams, Emergency Services, Program for Assertive Community Treatment (PACT) teams, and Pharma-cy Services. Clinical services are provided regardless of third party payor status. Variety of duties ranging including clinical supervision, consultation, and administrative leadership. Direct supervision to all Physicians and Psychiatry providers working in BMSC programs. Conducts performance evalua-tions which include periodic reviews to assure clinical competency. Conducts clinical retrospective reviews on high profile/high risk/complex clinical cases. Coordinates the BMSC Community Psychia-try rotation for PGY-3 Harvard South Shore Psychiatry Residents and engages in scholarly and teach-ing activities which predicate an appointment to the Harvard Medical School as adjunct faculty. Provides direct supervision to the BMSC Pharmacist and participates in all pharmacy related initia-tives and activities at the Center. Conducts administrative debriefings for agency emergency events. Serves as the President of the Professional Staff Organization, Chair of the Professional Executive Staff Committee, Chair of the Pharmacy and Therapeutics Committee, and serves on Risk Manage-ment, Infection Control, Leadership, and Medical Records Committees. Is responsible for review of applications from acute care facilities for transfer to state hospital units and participates in the pro-cess of recommending admission. Assures clinical programs are in compliance with Joint Commis-sion Accreditation Standards. Reviews and develops clinically related policies and procedures for the agency. Majority of work takes place in Brockton with less frequent activities in Plymouth. Competi-tive salary, benefits, daytime, flex schedule, no night call. Please respond to Bill Pariseau at

[email protected].

Medical Director, DMH Community Mental Health Center: Brockton Multi Service Center (BMSC),

Brockton and Plymouth, Massachusetts:

Seeking board certified psychiatrist as full-time Medical Director at a Community Mental Health

Center operated by the Massachusetts Department of Mental Health.

Leadership position is responsible for the provision and oversight of clinical and administrative BMSC delivered services which include: outpatient psychiatry, Community Based Flexible Support (CBFS) teams, Emergency Services, Program for Assertive Community Treatment (PACT) teams, and Pharma-cy Services. Variety of duties include but not limited to clinical supervision, consultation, administra-tive leadership. Competitive salary, benefits, daytime, flex schedule, no night call. Available Now.

Please respond to Bill Pariseau at [email protected].




DEPARTMENT OF PSYCHIATRY MASSACHUSETTS GENERAL HOSPITAL

HARVARD MEDICAL SCHOOL

OUTPATIENT ATTENDING POSITION

The MGH Department of Psychiatry is recruiting for an Out-patient Attending in our Primary Care Psychiatry Program. Additional opportunities may exist in other areas, including Urgent Care. Rated among the leading psychiatry depart-ments by US News and World Report, the Department is comprised of a staff of approximately 600 professional ap-pointees committed to excellence in clinical care, teaching, research and community service. Candidates should be: a) board certified/board eligible in Psychiatry with expertise in the care of patients with psychiatric disorders often compli-cated by co-morbid medical illness; b) dedicated to excel-lence in the teaching of psychiatry residents, medical stu-dents and other trainees, to scholarship in psychiatry, and to clinical quality improvement; and c) qualified for an aca-demic appointment at Harvard Medical School at the rank of Instructor or above. Fellowship training in relevant areas such as consult-liaison, addictions, geriatrics, or emergency psychiatry, as well as previous outpatient attending experi-ence are desirable. Interested individuals should apply to Jonathan E. Alpert MD PhD, Associate Chief/Clinical Direc-tor ([email protected]). The Massachusetts General Hos-pital is an affirmative action/equal opportunity employer.

Minorities and women are strongly urged to apply.

Addiction Psychiatrist

BRIGHAM AND WOMEN’S FAULKNER HOSPITAL / HARVARD MEDICAL SCHOOL

Our vibrant Department of Psychiatry is seeking a BC/BE addiction psychiatrist for a faculty position. Brigham and Women’s Faulkner Hospital provides a range of ad-diction treatment services, including a level IV inpatient detoxification unit, intensive outpatient program, and a buprenorphine clinic. Responsibilities include direct patient care in both inpatient and outpatient services, pro-gram development, resident education, and participation in research and quality improvement efforts. Applicants must have an MD, obtain full licensure in MA, and must be qualified to prescribe buprenorphine. Academic rank at Harvard Medical School will be commensurate with experience, training and achievements. Minorities and women are strongly urged to apply If interested, please send CV by to: If interested, please send CV by to: If interested, please send CV by to: If interested, please send CV by to: Joji Suzuki, Director of Addictions Services, Joji Suzuki, Director of Addictions Services, Joji Suzuki, Director of Addictions Services, Joji Suzuki, Director of Addictions Services, Brigham and Women’s Hospital, 75 Francis StreetBrigham and Women’s Hospital, 75 Francis StreetBrigham and Women’s Hospital, 75 Francis StreetBrigham and Women’s Hospital, 75 Francis Street Boston, MA 02115; Boston, MA 02115; Boston, MA 02115; Boston, MA 02115; [email protected]@[email protected]@partners.org Harvard Medical School and Brigham and Women’s Hospital are Affirmative

Action/Equal Opportunity Employers. We strongly encourage applications

from women and minorities.

MPS Calendar of Events

Council June 11, 2013 at 7:00 PM at MPS [email protected]

Sexual Disorders Committee June 12, 2013 at 6:30 PM at MPS [email protected]

Public Sector Committee June 13, 2013 at 7:00 PM at MPS [email protected]

Managed Care June 18, 2013 at 7:00 PM at MPS [email protected]

WMPS—Risk Management— Jim Hilliard, Esq. June 19, 2013 at 6:30 PM at Delaney House,

Holyoke, MA [email protected]

Executive Committee June 25, 2013 at 7:00 PM at MPS [email protected]

Council July 9, 2013 at 7:00 PM at MPS [email protected]

Executive Committee July 23, 2013 at 7:00 PM at MPS [email protected]

Stigmatization: Past, Present, and Future · 2014. 2. 5. · As I read annual applications for residency training, I find that about 30% of personal statements identify stigmatization

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