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.

Wisconsin Health News
June 31, 2024

State Superintendent Jill Underly on Tuesday called for additional investment in school mental health resources in light of asurvey showing students reporting significant challenges. 

Fifty-nine percent of high school students said they experienced at least one mental health challenge during the prior 12 months, according to the survey conducted once every two years. 

More than half reported anxiety, and one in three reported depression. About 21 percent reported non-suicidal self-harm. 

LGBTQ+ and female students reported a disproportionate number of mental health challenges compared to others.

Seventy-nine percent of LGBTQ+  students reported anxiety, while 63 percent reported depression. Forty percent reported considering suicide.

Female students were twice as likely to harm themselves compared to male students. Sixty-seven percent reported anxiety, and 45 percent reported depression. 

“Our kids are in immediate need of our collective help,” Underly said at a Tuesday press conference. 

Data from the survey also show students report less sleep, worsened overall physical health and fewer supports at school and home. Alcohol, tobacco and other drug use declined. 

The data comes from a survey administered in spring 2023 and includes responses from 1,882 Wisconsin students in 42 public, charter and alternative high schools

Regional centers will serve those with mental health and substance use needs

Wisconsin has taken another step forward to help people with mental health and substance use emergencies with the opening of five crisis stabilization centers for adults. Crisis stabilization facilities support people who can't stay in their community safely, but don't need to be hospitalized. Funded by the Department of Health Services (DHS), the centers provide a dedicated location for this level of care for most counties.

"Whether it's been declaring 2023 the Year of Mental Health, securing new investments for school-based mental health and other initiatives, or supporting the launch of the state's 988 Suicide & Crisis Lifeline contact center, we've been working to find solutions to the burgeoning mental health crisis facing our state since 2019," said Gov. Tony Evers. "This includes bolstering our state's crisis care infrastructure so that folks can access the care and support they need when and where they need it—especially in an emergency. While the opening of these new facilities is a tremendous step forward, we know there's far more to do, and we're committed to building on these efforts to ensure every Wisconsinite has access to mental and behavioral health care regardless of their ZIP code."

"The need for services for people experiencing mental health and substance use emergencies has been rising steadily over the past several years," said DHS Secretary-designee Kirsten Johnson. "Our investment in these five crisis stabilization facilities for adults is a commitment to ensuring the right care is available at the right time in the right place for all state residents who need help."

DHS set aside $10 million in 2021 to support the development of five crisis stabilization facilities for adults, with each location serving multiple counties. The funding is part of Wisconsin's share of American Rescue Plan Act (ARPA) funds reserved for mental health and substance use services. Today's announcement represents the work of four providers who each received a share of the funding in 2022 to establish these home-like centers. The services areas are based on partnerships the providers have set up with county agencies providing mental health and substance use services.

Read More

WPA Signed a Letter of support for Wisconsin Opioid Overdose Response Center Funding; View the full letter here. 

The Wisconsin Opioid Overdose Response Center will focus on a systematic effort to build a sustainable and resilient community pharmacy-centric infrastructure that can change the trajectory of the opioid epidemic in communities across Wisconsin. The proposed center has four specific public service goals that focus on education and outreach.

Goal #1 – Establish a pharmacy-focused center at UW-Madison that is capable of developing, implementing, and communicating successful strategies to combat the opioid and fentanyl crisis in Wisconsin.

Goal #2 – Increase patient access to evidence-based treatments for opioid use disorder and opioid overdose through expansion of community pharmacy-based services in Wisconsin.

Goal #3 – Increase the capacity of pharmacies and pharmacists in Wisconsin to access and deploy evidence-based educational materials and programs focused on opioid misuse and overdose risk mitigation strategies.

Goal #4 – Develop new technologies suitable for use by Wisconsin pharmacists and pharmacies to prevent overdose from existing and emerging synthetic opioid molecules.

To achieve these goals, the center will establish a distributed Wisconsin Opioid Overdose Pharmacy Resource Network involving patients, prescribers, veterans, and community leaders from across the state, beginning with partners that include the Wisconsin Psychiatry Association. Working closely with network members, we will leverage our expertise to optimize use of existing tools and develop the next generation of approaches used to combat fentanyl and synthetic opioid overdoses, and to deliver these interventions to citizens across the state through community pharmacies.

Efforts to scale our educational and outreach initiative across multiple sites within an improved resource network will both immediately support community efforts to adopt pharmacy-centric evidence-based interventions that deliver MOUDs to individuals not otherwise being reached, disseminate fentanyl specific prevention and treatment services, and build toward long-term resilience by creating conditions and the infrastructure to enable rapid uptake of new detection and overdose reversal approaches

Senate Bill 145 – the “APRN bill” - has again passed both houses of the legislature without reasonable compromise and STILL LACKING important patient safety standards.

Far beyond licensure, this bill expands scope of practice, codifies it in state statute and eliminates physician collaboration requirements for nurse practitioners, nurse anesthetists, nurse midwives, and clinical nurse specialists in the current law.

Sadly, the bill is still lacking the clinical training and guardrails on independent practice that WPA, the WI Medical Society, and many other physician groups have been fighting to include.

Our last hope to stop this troubling law from being enacted in Wisconsin is another veto by Governor Tony Evers.

This bill disrupts the cooperative and collaborative team-based model of health care that makes Wisconsin a leader in patient care and will result in a systemic shift in patient care and healthcare delivery in Wisconsin.

Your advocacy is needed now! We ask you to contact Governor Tony Evers using this form and ask him to veto SB 145

Urge Governor Evers to Veto SB 145

Written by Kathy Russeth, MD

As a physician deeply invested in organizational ethics and the dynamics of physicians in the workplace, I reflected on the implications of Dr. Neil Berman's article ‘A Reason to Retire?’ (Berman 2023). He takes us through his career and discusses changes in his perspective, defenses, and physician-patient relationships as he approaches the latter stages of his career. The title, posed as a question, provokes an unsettled feeling. Berman seems to suggest, albeit indirectly, that growing empathy might inversely correlate with a physician’s ability to function effectively within the healthcare system, potentially marking a time for transition.

Separating personal growth from changes in the medical field, and considering the former problematic without fully delineating issues with the latter, is problematic. Yes, Dr. Berman touches on these factors, citing “long working hours, increasing administrative burden, and rising caseloads,” but he does not go far enough. When the maintenance of distance from patients is seen as necessary for function or when intellectualization is seen as the way to maintain objectivity, something is wrong with the expectations in medicine.

Physicians can rely on their extensive medical knowledge, diagnostic skills, and evidence-based decision-making even in moments of diminished empathy. However, empathy does not mean “identifying too much” or that the physician must be  “as scared or as overwhelmed” as the patients are at any point. Feeling something real in a moment does not equal losing one’s “cool head;” rather it can provide valuable insight into the patient’s experience.

Empathy aids in finding ways to connect with patients, personalize care, and support treatment adherence. Empathy also helps to facilitate informed consent and shared decision-making, which are essential for best outcomes and true patient satisfaction (Fitzgerald 2018). Furthermore, empathy has the potential to deepen as clinical experience and wisdom accumulate over decades of practice. Rather than viewing the development of empathy as a burden, it should be recognized as a crucial and valuable contribution to the healthcare field.

Loss of the professionals who have grown in empathy and connection represents not just a personal loss for the individual but a broader loss for the field, which benefits greatly from the balance of scientific acumen and compassionate care. Instead of viewing one’s increase in empathy and connection as a signal to exit the profession, this needs to be a signal that expectations within the medical field need to change.

Heavy workloads have long been associated with burnout, emotional exhaustion and loss of empathy (Williams 2020). Increased demands require increased effort and resources, but rarely are those demands met with compensatory opportunities for recuperation. Depersonalization, emotional distancing, and other defenses are coping strategies to conserve resources and deal with exhaustion (DiGuiseppe 2021). However, this is not optimal and should not be looked to as the ideal or the solution. The challenges in managing heavy workloads, with high demands and diminished resources, are not the personal failings of physicians. These are structural and operational issues within healthcare systems that require urgent addressing. 

Healthcare systems have always been challenged, particularly in fitting a humanistic service industry into a business model. The expectations for efficiency in the healthcare system are overt and regularly reinforced. They exploit healthcare employees’ natural tendencies to strive for excellence and do more for their patients and overshadow the humanistic aspects of medical care. This phenomenon, although significantly intensified during the pandemic, was present both before and continues past the acute COVID-19 crisis.

The response by physicians and other healthcare professionals has been to leave medicine (Berg 2023). Whether one chooses to retire early, leave medicine for non-clinical pursuits, take on a more administrative role, or transition to private practice, to manage this distress, the real request is a more sustainable future. Even for those who stay, without effective resources and recuperation, the level of empathic care and ability to sustain employment becomes tenuous at best.

Instead, we need to advocate for a system where empathy and human connection are valued as much as our clinical expertise. Adapting from successful models elsewhere, we can push for reforms that offer more autonomy, control over our work, workload management, and performance metrics that truly reflect quality of care. A sustainable and fulfilling career in medicine is still an achievable goal. However, this requires healthcare structures and systems that prioritize and safeguard the well-being of both patients and healthcare providers. Let us, as dedicated medical professionals, unite in this endeavor to shape a healthcare system that truly reflects our values and commitment to the well-being of all.

Berg, S. The COVID-19 emergency’s over, but 1 in 2 doctors report burnout, AMA, June 23, 2023. Accessed https://www.ama-assn.org/practice-management/physician-health/covid-19-emergency-s-over-1-2-doctors-report-burnout

Berman, N. “A Reason to Retire?” N Engl J Med 2023 Oct; 389:1354-1355. Accessed: https://www.nejm.org/doi/full/10.1056/NEJMp2306534

DiGuiseppe, MD and Perry CJ. The Hierarchy of Defense Mechanisms: Assessing Defensive Functioning With the Defense Mechanisms, Front Psychol. 2021; 12: 718440. Accessed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8555762/

Fitzgerald-Yau N, and Egan J. Defense Styles Mediate the Association Between Empathy and Burnout Among Nurses. J Nero Meant Dis. 2018 Jul;206(7):555-561. Accessed: https://pubmed.ncbi.nlm.nih.gov/29905665/

Williams ES, Rathert C. Buttigieg SC. “The Personal and Professional Consequences of Physician Burnout: A Systematic Review of the Literature”. Med Care Res Rev. 2020 Oct,77(5):371-386. Accessed https://pubmed.ncbi.nlm.nih.gov/31216940/