We are proud to share that the WPA recently received an APA Component Activities Leadership Fellowship (CALF) grant, which allowed us to hire a law firm to draft an amicus curiae (“friend of the court”) brief in the pending Wisconsin Supreme Court case State v. JDB.

Our brief supported the position that psychiatrists should not be required to testify to a new, higher legal standard for the involuntary medication of patients who are deemed incompetent to proceed in court. This position aligns with current medical and legal practice, ensuring that psychiatric testimony remains grounded in accepted standards of care.

You can read our amicus brief—along with other briefs in this case—on the Wisconsin Supreme Court and Court of Appeals Case Access (WSCCA) Case History.

What’s Next?

Oral arguments for State v. JDB will take place on September 8 at 9:45 a.m. and will be streamed live on Wisconsin Eye. We encourage our members and the public to tune in to see this important issue discussed before the Court.

Written by: Haji Camara, MD; PAD Subcommittee Co-Chair

The Psychiatric Advance Directive Subcommittee of WPA’s Legislative Committee has been working diligently toward introducing Psychiatric Advance Directive (PAD) legislation in Wisconsin. After developing a framework and working closely with our lobbyists, in June we received our first draft bill from the Wisconsin Legislative Reference Bureau. Since then, we have provided clarifications and feedback and are awaiting the next draft.

In Wisconsin, individuals with serious mental illnesses often face repeated hospitalizations or crises without a formal mechanism to ensure their treatment wishes are followed. Without a recognized and enforceable PAD law, providers and families are left navigating uncertainty—sometimes resulting in treatment that patients find distressing or that undermines trust in the mental health system.

What is a PAD? While most people are familiar with medical advance directives—which outline preferences for end-of-life or serious medical care—PADs serve a similar role for mental health treatment. Both empower individuals to make their wishes known in advance, but PADs are specifically designed to address the unique decisions that arise during a mental health crisis, such as preferred medications, hospitalization options, and de-escalation strategies. Just as medical advance directives have become a standard tool for honoring patient autonomy in physical health care, PADs offer the same protection and clarity in psychiatric care.

PADs are already recognized in dozens of U.S. states, giving individuals a clear, legally enforceable way to shape their mental health care in advance. Wisconsin, however, remains one of the states without comprehensive PAD legislation—leaving patients, families, and providers without the legal clarity and protections that are commonplace elsewhere. Passing PAD legislation would bring Wisconsin in line with national best practices and ensure our residents have access to the same rights and safeguards available across most of the country.

The APA affirms that Psychiatric Advance Directives preserve autonomy, respect treatment preferences during crises, and smooth coordination between patients and providers. A 2009 APA–approved resource outlines that PADs, much like medical advance directives, bridge periods when a person’s decision-making capacity is impaired and ensure that care aligns with patient values. The APA also promotes tools—like the My Mental Health Crisis Plan app—developed with SMI Adviser (a SAMHSA-supported initiative) to make PAD creation accessible and practical.

SAMHSA calls PADs a cornerstone of recovery-oriented care. In its 2024 Practical Guide to Psychiatric Advance Directives, SAMHSA emphasizes that PADs:

• Empower individuals to guide their treatment even during incapacitation.
• Strengthen crisis planning and reduce the likelihood of coercive interventions.
• Support equity by giving all patients, regardless of setting, a clear voice in their care.

Both APA and SAMHSA acknowledge that while PADs are widely recognized in most states, their integration into routine practice remains limited—often because providers lack familiarity with them or they are hard to access in emergencies. That’s why SAMHSA stresses public education, training, and accessible registries—features built into the WPA’s draft legislation.

The current draft bill would create, for the first time in Wisconsin law, a formal, enforceable PAD framework that:

• Defines and authorizes PADs – Establishes a legally recognized document where individuals can specify treatment preferences, including medication choices, hospital admission preferences, use of electroconvulsive therapy, de-escalation techniques, and preferred contacts during treatment. 
• Allows appointment of a mental health care agent – Provides the option to designate a specific person to make mental health care decisions, with clear rules on priority if there are conflicting directives. 
• Sets capacity and revocation standards – Requires capacity determinations by two qualified clinicians (or by court order) and outlines when and how a PAD can be revoked, with safeguards for individuals experiencing episodic mental illness.
• Requires provider compliance – Directs health care providers and facilities to follow PAD instructions unless doing so is unlawful, infeasible, or contrary to prevailing medical standards, and mandates documentation of any noncompliance.
• Establishes a statewide Advance Directive registry – Creates a secure system where individuals can store and share their AD and/or PAD with authorized providers and agents.
• Promotes awareness and education – Requires the Department of Health Services to launch a public education campaign, provide training to health care professionals, and ensure PAD information is offered to patients during intake.

We are encouraged by the support we’ve received from legislators on both sides of the aisle, advocacy organizations, and fellow mental health professionals. This momentum underscores the shared belief that Wisconsin needs a clear, compassionate, and legally sound process for honoring psychiatric advance directives.

Enacting psychiatric advance directives into Wisconsin law would be a landmark step in-line with patient-centered mental health care. This legislation ensures that treatment decisions honor the individual’s voice, strengthens collaboration between patients, families, and providers, and establishes a clear legal framework for delivering care during psychiatric crises. By passing this bill, Wisconsin can join other states in affirming that dignity, autonomy, and recovery remain at the heart of our mental health system.

Gov. Tony Evers signed into law a slew of healthcare bills Friday, including one that will allow some nurses to practice independently of doctors. 

He vetoed legislation that would define direct primary care arrangements and allow gig economy companies to offer portable benefit accounts. 

The nursing law caps a 10-year push to create a pathway for advanced practice nurses to work independently of doctors. Evers vetoed the legislation twice before signing a bipartisan compromise bill that requires four years of experience before independent practice, restrictions on providing pain management and title protections for physicians.

“Nurses play a critical role in our healthcare workforce,” Evers said Friday. “I’m proud of our work to expand opportunities for nurses to not only grow their career but create a system that allows for more advanced practitioners here in Wisconsin.” 

Wisconsin had more than 9,100 advanced practice nurses last year, about 10 percent of the nursing workforce. Wisconsin Nurses Association Executive Director Gina Dennik-Champion said that the law will boost healthcare access for rural communities and those facing health disparities.

“It has been a long journey to achieving consensus and we are pleased with the outcome,” she said. 

We’re proud to recognize Dr. Ryan Emhoff for his participation in Wisconsin Doctor Day, the state’s premier physician advocacy event. Dr. Emhoff contributed to the day’s success by presenting on the topic of Psychiatric Advanced Directives, highlighting their role in supporting patient autonomy and improving mental health care outcomes.

His expertise and engagement underscore the importance of physician involvement in shaping health policy. Thank you, Dr. Emhoff, for your leadership and commitment to advocacy in Wisconsin!

Wisconsin Health News
May 27, 2025

Two counties received state grants to improve law enforcement’s response to mental health crises through telehealth, according to a recent report from the Department of Health Services. 

A 2024 law allowed counties to apply for a share of $2 million in one-time state funding to create programs connecting law enforcement officers assisting individuals in mental health crises with behavioral health professionals.

DHS received one application last summer. Staff encouraged more to apply, netting one additional submission. 

“Several counties indicated to DHS staff that they already established relationships and processes between their county crisis programs and law enforcement partners, leading to a lack of interest in this pilot program funding opportunity,” the report noted. 

Dane and Racine counties received grants running from Oct. 1, 2024 through June 30, 2025. Because of the short grant period and the pilot nature, both are focusing on program creation, design, equipment purchasing and electronic system implementation. 

Dane received $230,794, while Racine received $250,437. Those figures include a 25 percent match each county had to meet, which they’re doing through personnel salary and staff time. 

Both are ordering equipment and establishing program policies and procedures.

Written by: Tony Thrasher, DO, MBA, CPE, DFAPA
Re: Opinion letter pursuant to recent Focused Practice Designation in EBH

In February 2025, the American Board of Medical Specialties (ABMS) Board of Directors approved the request from the American Board of Emergency Medicine (ABEM) to recognize expertise in Emergency Behavioral Health (EBH) through a Focused Practice Designation (FPD).

This endeavor was the result of ABEM and the ABPN (American Board of Psychiatry and Neurology) collaborating on this initiative to offer this FPD to interested emergency physicians and psychiatrists!  An Emergency Behavioral Health Task Force was established to bring forward this opportunity, and it had robust participation from ABEM, ABPN, AAEP (American Association for Emergency Psychiatry), and ABFP.

This project has a fascinating history tied to the AAEP and their longitudinal interest in pursuing certification and/or fellowship in the specialty overlap between psychiatry and emergency medicine.  This came to a tipping point when the AAEP was tasked by a formal action statement from the APA Assembly to investigate all possible options in this educational enhancement.

That journey led AAEP leaders to speak to a multitude of psychiatric stakeholders (APA, ACLP, ABPN, AADPRT, NAMI, etc…) about possible options prior to combining forces with our emergency medicine colleagues.  This led to synergy and the creation of a formal task force that would aim for said certification that would be chaired by ABEM with significant inputs from ABPN and AAEP.  After deliberation on the above, the decision was made to examine a Focused Practice Designation (FPD) as opposed to a traditional fellowship.

While the field of psychiatry has not utilized FPDs in the past, our EM colleagues were familiar with it as they’ve used it on such items such as ultrasound specification.  Immediate advantages to the FPD include the ability to include multiple specialties (both psychiatry and emergency medicine have clear interest in this) as well as the ability to recognize physicians at different stages in their career.

Another unique feature of this FPD is the fact that fund of knowledge will not be evaluated by a traditional examination.  In fact, expertise in this FPD will now be assessed through a portfolio approach (also being developed by our ABEM task force).  The portfolio truly manifests the myriad of ways in which physicians demonstrate their professional skill set.  In fact, during the initial presentation to the ABMS subcommittee known as COCERT (the Committee on Certification), their expert panelists noted their extensive interest in not only the portfolio approach but also that this effort includes multiple medical specialties working in tandem.

So, when looking at how this can positively affect those we care for, we are having impact at two levels.  We are supporting the psychiatrists that have dedicated their career to this challenging milieu….while also making sure that psychiatric subject matter experts can train emergency medicine physicians who are markedly likely to see these emergencies regardless of where they practice nationwide!

The ABEM is starting the actual process/details as we speak, and the expectation is that physicians may start applying by 2026.  From a practical standpoint, there will be many advantages to having the FPD in terms of recognition, tenure, professional advancement, compensation, and competitive differentiation when looking at desirable positions.

Respectfully submitted……..

Tony Thrasher, DO, MBA, CPE, DFAPA

Past President – American Association for Emergency Psychiatry

Immediate Past President – Wisconsin Psychiatric Association

Medical Director – Milwaukee County Crisis Services

tony.thrasher@milwaukeeecountywi.gov

Resources:

https://www.abem.org/news/new-emergency-behavioral-health-focused-practice-designation-approved-for-abem/

https://www.prnewswire.com/news-releases/new-emergency-behavioral-health-focused-practice-designation-approved-for-american-board-of-emergency-medicine-302387719.html

https://www.beckersbehavioralhealth.com/behavioral-health-news/emergency-behavioral-medicine-granted-focused-practice-designation.html 

Washington, D.C. (March 17, 2025)-The reported personnel cuts to the Substance Abuse and Mental Health Services Administration (SAMHSA) will inevitably lead to cutting programs and services that so many people with mental health and substance use disorders depend on. We are currently in a mental health and substance use crisis. SAMHSA's critical mission to "lead public health and service delivery efforts that promote mental health, prevent substance misuse and provide treatment and supports while ensuring access and better outcomes for all Americans" is more important now than ever.  

SAMHSA's programs have contributed to the advances our nation has made in fighting the mental health and addiction crises. Its impact across the nation is widespread and crucial. Among other vital services, it provides education to the public on mental health, supports thousands of clinics with training in best practices, produces annual surveys with essential data points, and helps develop the future mental health workforce. In addition, it runs the national 988 Suicide & Crisis Lifeline, which took more than 14.5 million calls, texts, and chats in its first two years.

While the exact SAMHSA programs impacted are yet to be determined, many of these programs are lifesaving for our patients. Mental health has always been a bipartisan issue and must remain that way. Before taking any executive actions that will affect our nation's mental health, the American Psychiatric Association calls on the Administration and Congressional leadership to work with us and our partner organizations to thoughtfully pursue the best path forward to ensure people with mental health and substance use disorder do not lose services they desperately need.

American Psychiatric Association
The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 39,200 physician members specializing in the diagnosis, treatment, prevention and research of mental illnesses. APA's vision is to ensure access to quality psychiatric diagnosis and treatment. For more information, please visit http://www.psychiatry.org/.

WASHINGTON, D.C., March 6, 2025 - Among the first lines of the mission of the American Psychiatric Association (APA) is to "promote universal and equitable access to the highest quality care for all people affected by mental disorders, including substance use disorders."

As the leading American psychiatric organization and the nation's oldest medical society, APA is committed to promoting mental health care for all, regardless of race, ethnicity, age, gender identity, sexual orientation, national or regional origin, religious orientation and/or disability status. This commitment includes educating and advocating for the rights of everyone with mental health and substance use disorders and training the next generation of psychiatrists to provide patient-centric and culturally relevant care.

The country is facing a mental health crisis, with high rates of anxiety and depression across all age groups. Unfortunately, a disproportionate burden of mental health and substance use disorders is experienced by some in our population, including ethnoracially minoritized groups, individuals with lower socioeconomic status, the elderly, and those living in rural areas. These more vulnerable populations experience mental health inequities that result in poorer health outcomes. It is, therefore, crucial that APA continue to promote the rights and best interests of all patients, particularly those most vulnerable.

APA will continue its medical leadership to strive for equitable mental health care and to provide the best possible treatment to all patients. It will continue to seek to prepare psychiatrists to address differences in mental health outcomes in the clinical setting, ultimately leading to improved patient well-being, reduced health care costs, and a fairer system for everyone, regardless of their ethnoracial, social or economic background.

 

American Psychiatric Association
The American Psychiatric Association, founded in 1844, is the oldest medical association in the country. The APA is also the largest psychiatric association in the world with more than 39,200 physician members specializing in the diagnosis, treatment, prevention and research of mental illnesses. APA's vision is to ensure access to quality psychiatric diagnosis and treatment. For more information, please visit www.psychiatry.org.

Read this release on Psych.org

Written by Haji Camara, MD

The American Psychiatric Association (APA) held its 2024 State Advocacy Conference on September 21-22 in Washington, D.C., convening psychiatrists, policymakers, and mental health advocates to address critical issues shaping the future of psychiatric care. Among the participants were over 50 residents and fellows—a record-setting turnout for the event—who joined seasoned professionals in exploring innovative strategies for advocacy. Key topics included expanding the psychiatric workforce, addressing the contentious issue of scope of practice, and leveraging advocacy as a transformative tool to influence mental health policy at the state level.

A central theme of the conference was the power of storytelling in advocacy. Holly Amaya, co-founder of Story Imprinting, delivered an engaging workshop on how compelling, authentic narratives can humanize complex policy issues, fostering connection and understanding among legislators and stakeholders. Participants actively practiced crafting stories that highlighted the real-life impact of mental health legislation, learning how to amplify their voices in legislative arenas. The emphasis on storytelling underscored its potential to cut through political noise, turning abstract issues into urgent calls for action.

Jeff Dufour, Editor-in-Chief of National Journal, provided a dynamic analysis of the 2024 political landscape, offering insights into election forecasts and their implications for psychiatry and mental health policy. His presentation equipped attendees with a clearer understanding of how upcoming political shifts could shape legislative priorities, helping psychiatrists anticipate and prepare for advocacy challenges and opportunities.

Organized by the APA’s Department of Government Relations, the conference aimed to empower attendees with practical tools and strategies for effective advocacy. From interactive sessions to networking opportunities, participants left with actionable insights and a renewed commitment to advancing the field of psychiatry through policy reform.

Wisconsin psychiatrists are encouraged to integrate these strategies into their local advocacy efforts. By cultivating relationships with state legislators, leveraging storytelling to influence policy, and advocating for critical issues such as increased access to mental health care and workforce development, psychiatrists in Wisconsin can continue to drive meaningful change. The conference served as a powerful reminder of the collective impact of organized advocacy and the role every psychiatrist can play in shaping a more equitable mental health care system.

Written by: Kathy Russeth, MD

Advocacy isn’t limited to large-scale efforts; it often begins with recognizing a gap and taking a step to address it.

At the WPA annual conference last year, I was invited to speak on a topic related to advocacy. Having recently read Sexual Citizens: A Landmark Study of Sex, Power, and Assault on Campus by Jennifer Hirsch and Shamus Khan, I was inspired to address a pressing issue: the complexities of sexual relationships. The book challenges traditional narratives about consent and assault, reframing how we think about young people’s sexual relationships and the systemic factors contributing to assault on college campuses. Recognizing the vital role psychiatrists and mental health professionals play in pushing for cultural shifts in schools, universities, and communities to prevent sexual violence, I chose to focus my talk on this topic.

In exploring the issue further, I recognized—like many others—that education, particularly early and school-based education, is a pivotal intervention. Education is the cornerstone for addressing issues such as sexual violence and public health disparities. It shapes young people’s understanding of consent, boundaries, and sexual citizenship, equipping them long before they encounter situations where these concepts are critical.

Many prominent medical and public health organizations, including the American Medical Association (AMA), the American College of Obstetrics and Gynecologists (ACOG), the American Academy of Child and Adolescent Psychiatry (AACAP), the American Academy of Family Physicians (AAFP), the Wisconsin Medical Society (WMS), the American Academy of Pediatrics (AAP), health education organizations, and the CDC, all agree on the necessity of comprehensive, inclusive sexual health education.

At the time of my presentation, the American Psychiatric Association (APA)—a key organization influencing mental health care—had not yet released a formal position on this critical issue. Recognizing an opportunity to contribute to this evolving conversation, I reached out to WPA assembly representatives Dr. Laurel Bessey and Dr. Justin Schoen, who connected me with the APA’s Council on Children, Adolescents, and their Families. The Council acted quickly, forming a workgroup to explore the topic, and a formal position statement was developed and approved by the APA assembly in November.

Having policy in place with our professional organizations is one important way to ensure they represent psychiatrists and support what we know to be best for our patients. Even when there is no immediate action, having a formal position enables organizations like the APA to advocate effectively when relevant legislation, public health initiatives, or practice guidelines arise. Policies provide a foundation for progress and sustained advocacy.

The APA may have already been considering this issue, but local engagement helped amplify momentum and drive swift, impactful action. This experience underscores the value of connecting local and national organizations to address shared priorities and drive systemic change.

Another exciting outcome of this talk was a request to organize a full conference on the topic of Sexual Well-being and the Practicing Psychiatrist, now scheduled for March 13-15, 2025, at the Edgewater in Madison, WI. Register Here. This conference addresses a vital but often overlooked area of mental health: the intersection of sexual health and psychiatric care. It is an opportunity for professionals to gain practical tools and engage in meaningful dialogue about integrating sexual well-being into clinical practice. The enthusiasm among psychiatrists and other mental health professionals for addressing this topic has been extraordinary.

This experience reinforced for me how individual efforts, combined with collaboration, can lead to meaningful change. I encourage you to reflect on areas where your expertise and advocacy can address gaps or strengthen existing initiatives. I also invite you to join us at this exciting conference to learn, network, and contribute to advancing sexual health as a critical component of mental health care.