Missouri Psychiatry - Missouri Psychiatric Association

Vol 2 No 2 2nd Quarter 2011
Missouri
Psychiatry
Newsletter of the Missouri Psychiatric Association (MPA)
A District Branch of the American Psychiatric Association
Ryall Chosen as MPA’s Next President
By Rebecca DeFilippo MS, MBA
F
or the first time, members of
Missouri Psychiatric Association have
elected officers to serve on the new
statewide organization’s executive council.
Members chose Jo-Ellyn M. Ryall MD as
president, James R. “Bob” Batterson MD
as president-elect, and Moses Tabe
Ambilichu MD as secretary-treasurer.
They will serve one-year terms from May
2011 through May 2012. They will
officially assume office at the close of this
year’s APA annual meeting in Honolulu on
May 18, at which time interim president
Daniel T. Mamah MD, MPE will become
past president. There were no write-in
candidates to the uncontested slate.
Dr. Mamah introduced the three new
officers at the first annual MPA
membership meeting held April 9, in
Kansas City, during the Missouri State
Medical Association annual conference.
The meeting followed a CME luncheon
program on a psychopharmacology update
for primary care sponsored by Western
Missouri Psychiatric Society.
MPA mailed ballots to 504 eligible voting
members March 3, and specified an April
1 postmark date of return. Slightly more
than 23 percent of eligible voters returned
ballots. By comparison, about 25 percent
of eligible voters cast ballots in this year’s
recent APA election for president-elect,
secretary and other positions.
Together, Drs. Ryall, Batterson and Tabe
Ambilichu will work with the MPA
Executive Council to guide the new
statewide association through the merger
process initiated in March 2010 when
members of the state’s three formerly
independent APA district branches voted
to combine operations.
New Officers Cover the State
Distinguished Life Fellow Jo-Ellyn Ryall
has a long history of leadership, advocacy
and active involvement with key roles in
medical membership organizations at the
local, state and national level. When her
term as president of Eastern Missouri
Psychiatric Society ended in 1984, Dr.
Ryall continued on the executive council
as a chair and/or member of several
committees including membership,
bylaws, nominations, and Distinguished
Fellow/Fellow nominations. She also
chaired the APA bylaws committee and
the APA Assembly procedures committee,
served as APA Area 4 Council Deputy
Representative (2001-2006), and chaired
the APA Area 4 Council (2006-2010).
Moses Tabe Ambilichu MD
Continued on page 12
Contents
Jo-Ellyn M. Ryall MD
MPA Newsletter Second Quarter Template.indd 1
James R. “Bob” Batterson MD
Legislative Report.............................2
A Matter of Opinion..........................3
WMPS News, CMPS News..............4
EMPS News......................................5
Deliberate Insulin Underdosing........6
Mental Health First Aid....................7
News from the APA..........................8
Medicaid & State Budgets..............10
Blogging Tips..................................12
Estate Planning Tips........................14
NAMIWalks....................................15
Upcoming Events............................16
4/21/11 9:20:28 AM
Missouri Psychiatry
2nd Quarter 2011
MPA Legislative
Report
By Mo McCullough
T
wo important dates mark the calendar
for the Missouri General Assembly.
May 6 is the deadline when appropriations
bills must be truly agreed and finally
passed and the legislative session ends
May 13 at 6:00 p.m.
My legislative report will reach members
during this critical weeklong period so, as
I write this in early April, I cannot predict
how things will turn out for the citizens
of Missouri. However, I am fairly sure
about several things. First, very few bills
will make it through the entire process
and reach the Governor’s desk. Second,
and more importantly, there will be no
psychologist-prescribing bill in 2011.
RxP is a dead issue in Missouri for the
second year in a row. Nothing is certain in
politics, but an apparent lack of interest by
any legislator to sponsor a bill saw filing
deadlines in both the House and the Senate
pass without measures to expand the scope
of practice for psychologists under the
guise of improving access to care. With
no bill filed, the chance of it coming up
as an amendment, although possible, is
extremely slim.
However, as we know, RxP proponents are
still out there and won’t give up. This year,
they mounted a multi-state effort to grant
psychologists the authority to practice
medicine by introducing bills in Arizona,
Hawaii, Montana, New Jersey, Oregon,
Tennessee, and Utah. They keep pushing
despite little success: at press time, bills
effectively are dead in Arizona, Montana
and Utah. But, as I’ve said, nothing
is certain in politics. The big surprise
occurred when two members of Congress
filed bills to include clinical psychologists
under Medicare’s definition of
“physician.” The battle has now gone
nationwide.
2
MPA Newsletter Second Quarter Template.indd 2-3
In Missouri, MPA supported measures to
require the Department of Mental Health
to develop transition plans for residents
of state facilities for the developmentally
disabled (HB411 and HB421), and add
bath salts or Methylenedioxypyrovalerone
(MDPV) to the list of schedule I
controlled substances (HB551 and
HB572). In addition, we agreed with a bill
to add insurance policies for long-term
disability to those that must adhere to the
state’s mental health parity law (HB1026).
We also opposed bills to permit licensed
professional counselors to diagnose mental
disorders (SB358) and motorcyclists to
ride helmetless (SB28 and HB114).
And then there is the state budget. Suffice
it to say, the final budget won’t be kind to
anyone.
The budget won House approval in early
April before heading to the Senate. In
their budget, the House restored all of the
funding withheld from many vital services
across the state. However, the House did
not restore funds cut from the budgets for
Comprehensive Psychiatric Services and
Alcohol and Drug Abuse services. This
means a significant number of people
living with mental illness and substance
use disorders will experience serious cuts
in service and treatment.
When all is said and done, I’ll report the
outcome in the next issue of Missouri
Psychiatry.
________
Mo McCullough, a registered lobbyist in
Missouri, represents MPA and psychiatric
physicians, their patients and the profession
before the state legislature. He is a frequent
contributor to Missouri Psychiatry.
Missouri Psychiatric Association
1321 Montevale Court
Fenton MO 63026-3016
(636) 343-8555
[email protected]
http://missouri.psych.org
OFFICERS (May 2011-May 2012)
President
Jo-Ellyn M. Ryall, MD
President-Elect
James R. “Bob” Batterson, MD
Secretary/Treasurer
Moses Tabe Ambilichu, MD
APA Representatives
S. Arshad Husain, MD
Garry M. Vickar, MD
Sherman W. Cole, MD (Alternate)
Immediate Past President
Daniel T. Mamah, MD, MPE
COMMITTEES
Bylaws Committee
Chair Open
Ethics Committee
Chair Open
Legislative Committee
James R. “Bob” Batterson, MD, Chair
Membership/Fellowship Committee
Jo-Ellyn M. Ryall, MD, Chair
Members-in-Training Committee
Moses Tabe Ambilichu, MD, Chair
Newsletter
Daniel T. Mamah, MD, MPE, Editor
Program Committee
Chair Open
Public Affairs Committee
Chair Open
CHAPTERS
Central Missouri Psychiatric Society
Umonoibalo Ehimare, MD, President
Hina Syed, Executive Director
Eastern Missouri Psychiatric Society
Susan A. Minchin, MD, PhD, President
Rebecca DeFilippo MS, MBA Executive
Director
Western Missouri Psychiatric Society
Mahmoud M. Wahba, MD, President
Jill Watson, Executive Director
ADMINISTRATION
Rebecca DeFilippo MS, MBA, Executive
Director
Missouri Psychiatry
2nd Quarter 2011
A MATTER OF OPINION
Receptors and Receptivity: Both Important for
Psychiatry
By Armando Favazza MD, MPH
Iattempted
n 1845, Dr. Wilhelm Griesinger
to free German psychiatry from
the speculations of the Romantics by
declaring that mental disease resulted from
a morbid action of the brain. Griesinger,
a noted neurologist and psychiatrist in
Stuttgart, was right, of course, but didn’t
go far enough. The fact is that the brain is
the organ of all experience and not only
madness. But what does this mean? Surely
the brain can create problems of its own
doing but it also can create problems as
it processes stimuli from the body as a
whole as well as from the environment.
Modern psychiatric treatment, until fairly
recently, has focused on changing the
morbid actions of the brain by attempting
to change its processing functions
through the remarkable power of words,
relationships, and expectations. Today,
however, we have new medications and
technologies that may repair processing
mechanisms as well as the brain’s
innate functions. We went through the
psychodynamic and community psychiatry
revolutions and now are in the midst of
the biological revolution. The problem
with revolutions is that, by necessity, they
are overly optimistic. I think it fair to
state that most clinicians who have been
in practice for a while are as impressed
and puzzled by the bioresearch articles
published in the APA green journal and in
the Archives as were clinicians decades
ago who were bombarded by arcane
psychoanalytic findings. It is quite difficult
to distinguish between causal and epiphenomena.
We must be supportive of the current
revolution—surely, many good things will
come from it, but our enthusiasm
should be tempered by the fact that many
“important” findings tend to diminish
over time when attempts are made to
replicate them. This led John Ioannidis, an
international epidemiologist, to write his
now famous paper, “Why most published
research findings are false” (PLoS
Medicine, 2005).
Insurance companies have embraced
the new biopsychiatry and, as reported
in a front-page article in the New York
Times (March 6, 2011), are financially
coercing psychiatrists into “medication
management” as the staple of their
practice. If patients want to talk, send
them to a psychologist. If their lives are
chaotic, send them to a social worker. If
they need a friend, tell them to get a dog.
In truth, a computer could probably do as
good a job as a clinician in many cases
by fitting a patient-generated symptom
check list into an algorithm, prescribing an
appropriate medication, and setting up a
return appointment. But personal
encounters, even if for only fifteen
minutes, hold therapeutic potentials that
should be utilized. I strongly suspect
that I have helped thousands of patients
by listening with undivided attention,
providing good advice, offering hope, and
validating their lives while prescribing
medications. There is room enough
in psychiatry for both attentiveness to
patients’ receptors and receptivity to their
humanness.
__________
Dr. Armando Favazza is an American author
and psychiatrist best known for his studies
of cultural psychiatry, deliberate self-harm,
and religion. His Bodies Under Siege: Selfmutilation in Culture and Psychiatry (1987)
was the first psychiatric book on this topic. He
is an Emeritus Professor in the Department
of Psychiatry at the University of MissouriColumbia, a Distinguished Life Fellow of
the APA, and a member of Central Missouri
Psychiatric Society.
Assembly Elections in May
The elections for Assembly officers will be held at the APA Annual Meeting in
Honolulu, Hawaii, May 14-18.
The Assembly has three officers: Speaker, Speaker-elect, and Recorder. Ann
Sullivan, MD (New York County District Branch), Speaker-elect, will assume the
office of Speaker at the end of the annual meeting.
Scott Benson, MD (Florida Psychiatric Society) and John Gaston, MD (Georgia
Psychiatric Physicians Association) are campaigning for Speaker-elect. Ramaswamy
Viswanathan, MD, DSc (Brooklyn Psychiatric Society) and Melinda Young, MD
(Northern California Psychiatric Society) are vying for the office of Recorder.
Interviews with the candidates are posted on Assembled Writings, an online
publication of notes from the APA Assembly, at http://apamember.wordpress.com/.
An interview with Dr. Benson appeared April 5 and with the Recorder candidates on
April 15.
3
4/21/11 9:20:29 AM
Missouri Psychiatry
2nd Quarter 2011
WMPS News
CMPS News
WMPS Plans Fall Meeting
A fall meeting is in the works for WMPS.
Matt Brown MD will be the featured
speaker. Watch for more details.
New Staff for CMPS
Hina Syed is the new executive director
at CMPS, effective March 5. She replaces
Sherry Cass, who served in the role
for more than nine years and relocated
this spring with her family to Austin,
Texas. Hina has a bachelor’s degree in
accounting. She also is executive assistant
to Dr. S. Arshad Husain at International
Medical and Educational Trust (IMET),
which provides consultation, training
and therapeutic services to national and
international communities. “It brings
together professionals from around the
world to work in partnership for children
in need, especially those suffering
from trauma,” she said. She resides in
Columbia, Mo., with her husband, Dr.
Kaleem Syed, a psychiatrist, and four
children. Contact Hina at 573-289-6495
and [email protected].
New Staff for WMPS
Stacy DeMeyer, Membership and
Education Assistant, is the new contact
for membership and CME events at
WMPS. Ms. DeMeyer has been with
the Society since January. Stacy has an
extensive meeting planning background,
most recently with the American Academy
of Family Physicians. Stacy is a Kansas
City native and resides with her family in
Lee’s Summit, Mo. She and her husband
are active members of Kansas City Disc
Dogs. Contact Stacy at 816-531-8432 and
[email protected].
New Members-in-Training (3)
At University of Missouri-Kansas City:
Muhammad Farhan MD, Olajide
Oguntuase MD, and Silvie Vijayananda
MD
Transfers In (2)
General Member Mary Beegle DO from
North Dakota Psychiatric Society
General Member Warren E. Weston
MD from Ohio Psychiatric Physicians
Association
Advancements (4)
From MIT to General Member: Sarmistha
Bhalla MD, Mitchell Douglass MD, and
Lee Duong MD
To Distinguished Fellow: James Robert
“Bob” Batterson MD
Deaths (1)
Sergey Y. Cheranov MD, 42, of
Overland Park, Kan., died Nov. 20, 2010.
A Member-in-Training at the time of his
death, he was on staff at Western Missouri
Mental Health Center, in Kansas City.
Transfers In (2)
General Member Sarmistha Bhalla MD,
from WMPS
General Member Katarzyna
Derlukiewicz MD from EMPS
Transfers Out (1)
General Member Zoobia Mirza DO,
to Oklahoma Psychiatric Physicians
Association
4
MPA Newsletter Second Quarter Template.indd 4-5
2nd Quarter 2011
EMPS News
The Western Historical Manuscripts
Collection, a joint collection of the
Missouri State Historical Society and the
University of Missouri, will serve as the
official repository of material and papers
related to the life and professional career
of Distinguished Life Fellow Armando
R. Favazza MD, MPH. Dr. Favazza,
the self-described “godfather of studies
of self-harm,” is emeritus professor of
psychiatry at the University of MissouriColumbia and a 42-year member of APA.
“This provides me with both a touch of
immortality as well as the opportunity
to clear out all my files, cabinets, and
albums!” he said. His review of The
Myth of Tantalus: A Scaffolding for an
Existential and Ontological Theory of
Personality by Shlomo Giora Shoham
appeared in Transcultural Psychiatry
(47:184-187, 2010).
Hina Syed
Advancements (3)
From MIT to General Member: Sundara
Rameshwar Reddy Munagala Venkata
MD, Deborah B. Krause DO, and
Jaskaran S. Sandhu MD
Missouri Psychiatry
Armando Favazza MD, MPH
Total Members (as of March 31, 2011):
CMPS: 72
EMPS: 309
WMPS: 112
Total: 493
New Members-in-Training (9)
At St. Louis University: Alexander
E. Graypel MD, PGY-1; Marisa L.
Jennings MD, PGY-1;
Pavan Kundan Madan MD, PGY-1; and
Mihaela Valentina Stoica MD, PGY-1.
At Washington University in St. Louis:
Sushma Chandramouli MD, PGY-4;
Marie Anne Gebara MD, PGY-1;
Brendan O’Connor MD, PGY-1;
Sapna Sareen MD, PGY-2; and
Jason A. Winston MD, PGY-4.
Advancements (16)
The APA Board of Trustees approved four
EMPS General Members for Fellow status
at its December 2010 meeting. The status
change was effective January 1, 2011. The
new Fellows are: Tracy D. Gunter MD,
Narsimha R. Muddasani MD, Radhika
Rao MD, and Duru Sakhrani MD.
APA also honored several EMPS members
May 24, 2010, at the Convocation of
Distinguished Fellows during the Annual
Meeting in New Orleans. The honorees
include:
Life Members: William M. Irvin Sr. MD
and Earl Robert Schultz MD
50-Year Distinguished Life Fellows: Carl
Leon McGahee MD and Moisy Shopper
MD
Life Fellows: Mirza Sadat Ali Baig MD,
Ibe Onuka Ibe MD, and Jerold Jay
Kreisman MD
Fellows: Bun Tee Co MD, Abhilash
K. Desai MD, Linda Sue Horne MD,
Kimberli Etta McCallum MD and
Thomas F. Richardson MD
Transfers In (5)
General Member Imran I. Chishti MD,
St. Louis, from CMPS
General Member Vegas Coleman
MD, Poplar Bluff, Mo., from Indiana
Psychiatric Society
MIT Sang-wahn Koo MD, Poplar Bluff,
Mo., from Oklahoma Psychiatric Society
General Member Alina N. Schneider
MD, Sikeston, Mo., from Washington
State Psychiatric Association
General Member Patrick John Stangeby
MD, St. Louis, from Oklahoma
Psychiatric Society
Transfers Out (6)
MIT E. Taylor Buckingham IV MD,
MPH, to Iowa Psychiatric Society
General Member Katarzyna
Derlukiewicz MD to CMPS
Fellow Abhilash K Desai MD to
Maryland Psychiatric Society
General Member Joao Henrique Ramos
MD to Kentucky Psychiatric Medical
Association
General Member Alison Winesett
Newman MD, to Central California
Psychiatric Society
MIT William J. Newman MD, to Central
California Psychiatric Society
Correction: Missouri Psychiatry (2nd
Quarter 2010) erroneously reported that
General Member Lisa M. Beffa MD had
transferred to EMPS from the Illinois
Psychiatric Society. Dr. Beffa moved
to California and transferred to the San
Diego Psychiatric Society
Deaths (5)
Anna Eleanor Hartnett MD, died Jan.
27, 2011
Stephen L. Post MD, died April 6, 2011
William I. Stryker MD, died Sept. 23,
2010
Pearl Carolyn Lawrence Ulett MD, died
Jan. 5, 2011
Harold D. Wolff MD, died Jan. 9, 2011
Missouri Psychiatry encourages
members to share news about their
professional accomplishments
such as promotions, job changes,
special honors, awards, publications,
presentations, and retirement. We
will publish information in the
earliest possible issue, based on the
order in which it is received and as
space permits. We will not publish
information submitted more than one
year following the event or personal
notices, e.g., engagements, marriages,
births, and adoptions. Good, clear
photos are always welcome.
Submit information by e-mail to:
CMPS: Hina Syed at hinkz786@yahoo.
com
EMPS: Rebecca DeFilippo at
[email protected]
WMPS: Stacy DeMeyer at sdemeyer@
metromedkc.org
Mail to:
Membership Update
Missouri Psychiatric Association
1321 Montevale Court
Fenton, MO 63026
(Please include a daytime phone
number for verification purposes. For
additional information, call 636-3438555.)
OFFICE SPACE FOR RENT
Immediate occupancy at convenient West County location near St. Louis Community
College-Meramec Campus and I-270 at Big Bend Road. Rental includes 11x15 office
in a 2nd floor suite with waiting room and kitchen area. Office has 2 windows w/
blinds. $550/mo rent includes heat, A/C, electricity, and water. Must provide own
phone and computer. Public restrooms on each floor with full elevator service. Free
surface and handicap parking outside 1st and 2nd floor entrances. Lease runs through
Nov 2011, and can be renewed.
Space can be viewed by appointment or during office hours M-T-W 9am-noon or
1:30-5pm. Contact Jo-Ellyn M. Ryall, MD, at 314-909-0121 or e-mail joellyn2@
gmail.com. 12166 Old Big Bend Rd, Suite 210, Kirkwood MO 63122.
5
4/21/11 9:20:30 AM
Missouri Psychiatry
2nd Quarter 2011
Deliberate Insulin Underdosing and Omission
Should Be Included in DSM-V Criteria for
Bulimia Nervosa
By Albert Shaw, M.D., Armando Favazza, M.D., M.P.H.
F
ourteen percent of young women
with insulin-dependent diabetes mellitus
(IDDM) deliberately omit or underdose
their insulin in order to lose weight, as do
50% of women with IDDM and an eating
disorder.1 The first case reports of this
behavior appeared in 1983.2 It is called
“diabulimia” in diabetic textbooks3 and in
the lay media. The Yahoo search engine
reveals over 100,000 hits for diabulimia
including blogs, newspaper/ magazine
articles, and TV shows. The American
Psychiatric Publishing Textbook of
Consultation-Liaison Psychiatry4 and the
text of DSM-IV mention skipping insulin
doses, but neither it nor “diabulimia” is
included in the American Psychiatric
Publishing Textbook of Clinical
Psychiatry5, the Kaplan and Sadock’s
Comprehensive Textbook of Psychiatry,6 or
DSM-IV criteria for bulimia nervosa. We
are unaware of any articles in psychiatric
journals that use the word “diabulimia.”
We report a case of diabulimia in which
the patient underdosed or omitted doses of
insulin by disconnecting her insulin pump.
bulimia nervosa, with disconnection of her
insulin pump counted as the “inappropriate
compensatory behavior” needed for this
diagnosis. We prescribed both low dose
clonazepam to help with her anxiety and
poor sleep and weekly psychotherapy for
bulimia and depression. She responded to
graduated exposure techniques to decrease
her postbinge anxiety and the frequency
of disconnecting her insulin pump. She
learned to challenge cognitive distortions
(e.g., that bingeing was a reward and that
her life was better when she was thinner).
During therapy, she practiced telling her
family and friends about her disorder, and
her guilt, isolation, and anxiety declined
quickly after she shared her “secret”
with them. She stopped disconnecting
her insulin pump although she still has
occasional thoughts of restarting her
diabulimic behavior. Her mood was stable
and euthymic at her 3- and 6-month
follow-up appointments. She has kept her
regular appointments with us and with her
endocrinologist, and her hemoglobin A1c
has steadily improved.
Case Report
An endocrinologist referred a 22-yearold woman with IDDM to our psychiatry
clinic because of her bulimia, anxiety, and
depression. She started bingeing four to
five times a week during her sophomore
year of college. She felt out of control and
decided to disconnect her insulin pump
overnight after bingeing. She reasoned
that omitting insulin would cause the same
weight loss she experienced in high school
before she was diagnosed with IDDM.
Unhooking her pump partially reduced
her anxiety about gaining weight, but
her hemoglobin A1c climbed from 7% to
16%, and guilty and embarrassed by her
behavior, she avoided her family and her
endocrinologist. We diagnosed her with
Comment
We urge the specific inclusion in DSM-V
[sic] of insulin misuse, as occurs in ICD10, among the recurrent inappropriate
compensatory behaviors to prevent
weight gain in bulimia nervosa. DSM-IV
lists only “laxatives, diuretics, enemas,
and other medications.” DSM-V should
use the word “diabulimia” in discussing
insulin omission—by stopping injections,
by underdosing, or by turning off insulin
pumps—in the body of text on bulimia.
Although our patient did not suffer any
serious medical problems, the acute
consequences of diabulimia include
ketoacidosis and death, while chronic
consequences include nephropathy,
neuropathy, and retinopathy.7
6
MPA Newsletter Second Quarter Template.indd 6-7
__________
Albert Shaw, M.D.
Armando Favazza, M.D., M.P.H.
Department of Psychiatry, University Of
Missouri School of Medicine, Columbia,
Missouri
References:
1. Rodin G, Olmsted MP, Rydall AC, et al:
Eating disorders in young women with
type I diabetes mellitus. J Psychosom Res
2002; 53:943–949
2. Hillard JR, Hillard PJA: Bulimia,
anorexia nervosa, and diabetes: deadly
combinations. Psychiatr Clin North Am
1984; 7:367–379
3. Brink S: Insulin therapy and home
monitoring
for type 1 diabetes mellitus, in
Diabetes Mellitus: A Fundamental and
Clinical Text, 3rd ed. Edited by Leroith
D, Taylor SI, Olefsky JM. Philadelphia,
Lippincott Williams & Wilkins, 2003,
pp 498–499
4. Wise M, Rundell J (eds): The American
Psychiatric Publishing Textbook of
ConsultationLiaison Psychiatry, 2nd ed.
Washington, DC, American Psychiatric
Publishing, 2002, pp 477–493
5. Hales R, Yudofsky S (eds): The American
Psychiatric Publishing Textbook of Clinical
Psychiatry, 4th ed. Washington, DC,
American Psychiatric Publishing, 2003,
pp 1001–1021
6. Sadock B, Sadock V (eds): Kaplan and
Sadock’s Comprehensive Textbook of
Psychiatry, 8th ed. Philadelphia, Lippincott
Williams & Wilkins, pp 2002–2021
7. Pickup J, Williams G (eds): Textbook of
Diabetes, vol 2, 3rd ed. Malden, Mass,
Blackwell Scientific Publishing 2003,
p 64.7
__________
Reprinted with permission from the Journal of
Neuropsychiatry and Clinical Neurosciences,
(Copyright © 2010). American Psychiatric
Association.
Missouri Psychiatry
2nd Quarter 2011
Mental Health First Aid: A Key to
Understanding Mental Illness
By Joseph J. Parks MD
T
ragedies at Virginia Tech and, most
recently, in Tucson, emphasize the need
for better understanding of mental illness
and treatment. In the Arizona situation,
many people recognized a problem in the
alleged shooter’s mental state—including
police, classmates, and teachers—yet
the tragedy still unfolded. As a society,
we need to pay more attention to our
mental health and know what steps to take
when we notice a problem in ourselves
or in our neighbors. But the stigma that
surrounds mental health evokes shame to
admit when there is a problem, so many
people are afraid to seek the help they may
desperately need.
It’s easy to tell when someone needs
CPR: they are unresponsive, not breathing
or have no pulse. However, when faced
with a mental health emergency, are we
prepared to recognize it and to intervene in
a crisis?
the University of Melbourne, Australia.
Three entities collaborated to develop the
Mental Health First Aid curriculum for
U.S. audiences, Missouri Department of
Mental Health Office of Transformation,
Maryland Department of Health and
Hygiene, and National Council for
Community Behavioral Healthcare. It was
introduced in Missouri in 2006.
Since its inception, Mental Health First
Aid has shown positive results in Australia and 14 other countries. The 12-hour
training is designed to give the public key
skills to help someone who is developing
a mental health problem or experiencing a
mental health crisis. The evidence behind
the program demonstrates that it builds
mental health literacy by helping the
public identify, understand and respond to
signs of mental illness.
Just as CPR training helps a layperson
with no clinical training assist an
individual following a heart attack, Mental
Health First Aid training helps laypeople
assist someone experiencing a mental
health crisis. In both situations, the goal
is to help support an individual until
appropriate professional help arrives. The
training also can help demystify mental
illness and combat the stigma that keeps
people from seeking help.
Mental Health First Aiders learn a 5-step
strategy that includes assessing risk,
respectfully listening to and supporting
the individual in crisis, and identifying appropriate professional help and other supports. Participants learn about treatment
and self-help strategies, such as helping
someone through a panic attack, engaging
with someone who may be suicidal, or assisting an individual who has overdosed. A
key component of Mental Health First Aid
training is the opportunity to practice the
intervention strategy rather than just learn
about it.
Mental Health First Aid helps lessen the
disparities between physical and mental
illnesses, and does so through a simple
approach to build one’s confidence and
ability to help.
Just like the ABCs in CPR (airway, breathing, circulation), the mnemonic device
“ALGEE” helps participants remember
what to do when confronted with a mental
health crisis:
Mental Health First Aid was created in
Australia in 2001 by Anthony Jorm, a
respected mental health literacy professor,
and Betty Kitchener, a nurse specializing
in health education. The program is based
at the ORYGEN Research Center at
• Assess for risk of suicide and harm
• Listen non-judgmentally
• Give reassurance and information
• Encourage appropriate professional help
• Encourage self-help and other support
strategies
Missouri currently has more than 100
Mental Health First Aid instructors available to teach the 12-hour course. For more
information on locations of instructors,
scheduled classes and details on how to
schedule a class, visit the national website
at www.mentalhealthfirstaid.org.
__________
Among his many roles in mental health administration, academia and medical practice, Dr.
Parks serves as the Chief Clinical Officer for
the Missouri Department of Mental Health in
Jefferson City. He is a Distinguished Research
Professor of Science at the University of
Missouri-St. Louis, director of the Missouri Institute of Mental Health, and a Clinical Assistant Professor of Psychiatry at the University
of Missouri-Columbia Department of Psychiatry. He is a General Member of the APA and a
member of Central Missouri Psychiatric Society. In addition, he is president of the Medical
Director’s Council of the National Association
of State Mental Health Program Directors. He
practices psychiatry at Family Health Center,
a federally funded community health center
established to expand services to uninsured and
underinsured patients in the Columbia area.
He recently served as director of the Division
of Comprehensive Psychiatric Services for the
Missouri Department of Mental Health.
Joseph J. Parks, M.D.
7
4/21/11 9:20:30 AM
Missouri Psychiatry
2nd Quarter 2011
Missouri Psychiatry
2nd Quarter 2011
Continued from page 8
APA Resource: Supporting Early
Career Psychiatrists (ECPs)
The APA and its Assembly Committee on
ECPs provide resources and networking
opportunities to specifically serve
members who are within their first seven
years after training (residency/fellowship).
The “Practice Management for Early
Career Psychiatrists” is a reference guide
that addresses the various issues ECPs
must face. Members can download
this resource via psych.org in the Early
Career Psychiatrists section. The guide
offers a wide range of knowledge from
licensing / board certification and contract
negotiation to implementing electronic
billing and managing patient relationships.
This detailed document not only meets
the needs of residents and ECPs, but the
information it contains may also be helpful
to members who have been in practice for
years.
To enhance the experiences of ECPs
within the APA, the 2011 Annual
Meeting features ECP-focused sessions
and exclusive opportunities for young
psychiatrists to socialize with other ECPs
and engage with APA leadership. Sessions
dedicated to ECPs include What Have
You Done for Me Lately: Identifying
Early Career Psychiatrists ’ Needs and
Resources within the APA, Responding
to the Impact of Suicide on Clinicians,
and an update on psychiatry certification
and its subspecialties from the American
Board of Psychiatry and Neurology. On
Monday, May 16, the ECP Caucus will
host its networking event at the Ala Moana
Hotel (1:30 pm – 2:30 pm) to connect
ECPs with their local DB and national
representatives.
Additional resources supporting members
early in their careers can be accessed on
psych.org in the Early Career Psychiatrists
8
MPA Newsletter Second Quarter Template.indd 8-9
Early Career Psychiatrists section where
links are provided for CME activities,
awards and fellowships among others.
Committee Provides Resources for
Disaster Response
The APA’s Committee on Psychiatric
Dimensions of Disasters continues
to develop timely resources to help
psychiatrists and psychiatric organizations
prepare for and respond to natural
disasters, terrorism threats, and other
traumatic events.
Members may reference the “Disaster
Psychiatry Handbook” for guidelines
on topics like clinical interventions
following a disaster and tips for parents
and caregivers. The “Disaster Psychiatry
Handbook” and relevant materials
including APA Position Statements on
posttraumatic stress disorder (PTSD) and
traumatic brain injury (TBI) are easily
accessed via the Disaster Psychiatry
section of psych.org.
The Let’s Talk Facts brochure series is
another tool for helping patients and their
families understand mental health issues
linked to trauma like PTSD, substance
abuse, and anxiety. APA members get
a 20 percent discount on titles in the
Let’s Talk Facts series, which are sold
in packages of 50. Visit the American
Psychiatric Publishing, Inc. website to
order brochures or visit HealthyMinds.org
for a preview of each brochure.
Listserve, Award Support Women in
Psychiatry
The APAWomen listserve, available to
all women members, enhances dialogue
on issues most significant to female
psychiatrists. The online mentorship
feature encourages members to share their
personal views and advice for balancing
work and family responsibilities. A
popular section lists the latest job postings
as well as announcements of government
and privately sponsored programs for the
advancement of women doctors. The
service supports women in psychiatry and
strives to advance their careers in a field
where women are still a minority. To
join the APAWomen listserve , members
should send their name, email, and
member number to [email protected].
Nominations are now being accepted
for the Alexandra Symonds Award
which recognizes a woman psychiatrist
who has made significant contributions
to promoting women’s health and the
advancement of women. The deadline for
nominations is June 1. Information about
the materials required for nomination is
available online or can be obtained from
Alison Bondurant at abondurant@psych.
org.
College Mental Health Caucus
Scheduled for Hawaii Meeting
A recently released national survey on
the state of mental health for entering
college students revealed that this year’s
freshmen class has the highest stress levels
in the history of the 25 year survey. APA
members with a special interest in college
mental health issues may participate in a
meeting of APA’s College Mental Health
Caucus at the 2011 Annual Meeting next
month.
Continued on page 9
Participants will have the opportunity to
discuss issues, raise concerns, and share
information. The meeting will be held in
the Kona Room of the Sheraton Waikiki
Hotel. Check the Daily Bulletin for date
and time.
HIV Psychiatry Sessions Presented at
APA 2011 Annual Meeting
Residents attending this year’s Annual
Meeting can participate in sessions
and workshops with updates in HIV
Psychiatry. Sessions for residents include
HIV Psychiatry: What Residents Need to
Know on Sunday, May 15 from 12:00 pm
until 3:00 pm and Comprehensive HIV
Psychiatry Update on Monday, May 16
from 12:00 pm until 3:00 pm. The APA
organizes trainings on the neuropsychiatric
and psychological dimensions of HIV
disease through the Office on HIV
Psychiatry. Trainings are tailored to meet
the specific needs of residency training
programs, hospitals, medical groups,
local health care organizations, and APA’s
district branches. For more information
or to schedule a training session, please
contact program staff at [email protected].
APA Launches International MemberGet-A-Member Recruitment Campaign
APA members are encouraged to share
their membership experiences with
friends and colleagues who are practicing
psychiatry around the word. As an added
incentive, those referred psychiatrists who
meet APA requirements for international
membership will have their application
submitted (with the name of the member
who made the referral) for a drawing held
at the 2011 Annual Meeting. The winners
of the drawing may choose, as their prize,
free registration to the 2012 Annual
Meeting or free 2012 APA membership
dues. Please go online for additional
information and requirements.
Foundation Announces Helping Hands
Grant Application Deadline
The American Psychiatric Foundation is
accepting applications for its 2011 Helping
Hands Grant Program until Wednesday,
May 25. The program awards grants
of up to $5,000 to medical schools for
community mental health projects that
are initiated and managed by medical
students. The foundation developed the
Helping Hands Grant Program to engage
more medical students in community
service activities, particularly those
focused on underserved populations;
to raise awareness about mental health
and the importance of recognizing an
illness early; and to build an interest
among medical students in psychiatry and
treating mental illnesses in underserved
communities.
phone, or in consultation with schools
and local organizations that serve the
military community. Efforts are underway
to create a large, national, volunteer
network over the next three years to
address postwar mental health issues
such as post-traumatic stress disorder
(PTSD), traumatic brain injury (TBI), drug
abuse, anxiety, and depression. For more
information on how to volunteer, go to
http://www.giveanhour.org/. A resource
document on more ways to assist returning
military and their families is posted on
psych.org under Military Health in the
Resources column on the left.
___________
Reprinted with permission of the
American Psychiatric Association.
www.psych.org
Some Member
Benefits of MPA
Did you know that as a member of
Missouri Psychiatric Association, you
are entitled to some media benefits?
These include:
1. Free listing of your
advertisement on the MPA
website. MPA members can post their
research studies, job listings, events or
books for 6 months on the MPA website
at http://missouri.psych.org. The listing
can repost again after that period.
Mental Health Professionals Donate
Time to Support Service Members,
Families
The American Psychiatric Association is
an active partner with Give an Hour in
expanding a national network of mental
health professionals who volunteer
their services to better support military
personnel and their families. Clinicians
can donate an hour of their time each week
to provide direct services in person, by
2. Discount on MPA newsletter
advertising. MPA members can place
any size advertisement in the MPA
newsletter, Missouri Psychiatry, for
50% off the regular cost. Event listings
are free for MPA members. Missouri
Psychiatry reaches nearly 600 MPA
members and associated professionals in
Missouri and appears online at the MPA
website.
9
4/21/11 9:20:31 AM
Missouri Psychiatry
2nd Quarter 2011
Medicaid and State Budgets
during the recent recession, leading many
to turn to the Medicaid program to provide
health benefits for themselves and their
families. As a result, Medicaid enrollment
increased by 3.7 million people nationally
between June 2009 and June 2010,
bringing the total number of enrollees
above 50 million for the first time in the
program’s history, according to a survey
by the Kaiser Commission on Medicaid
and the Uninsured.
The most significant cause of the growth
in Medicaid enrollment at the end of
this period was the economic decline.
Individuals lost jobs and suffered lower
incomes. As a result, many became
eligible for public coverage under
Medicaid or the Children‘s Health
Insurance Program (CHIP).
Growth in Medicaid spending generally
inversely tracks the rate of growth in the
economy, rising when the economy falls
and falling when the economy rises. The
current economic recession has been
so deep and extended that the need to
cut state budgets has collided with the
increasing demand for health services
through Medicaid. The state-run health
program for people with low incomes
has eclipsed K-12 education as the most
expensive portion of overall state budgets.
States’ Fiscal Problems Mean Cuts in
Medicaid and Mental Health Programs
Despite the Medicaid program’s success
in holding down per capita cost growth
relative to other segments of the health
care system, states are grappling with
immediate budgetary crises that may
result in significant cuts to the program. In
addition, the enhanced federal Medicaid
matching funds from the American
Recovery and Reinvestment Act (ARRA)
will expire June 30, despite the fact that
most states‘ fiscal situation hasn’t yet
recovered.
10
MPA Newsletter Second Quarter Template.indd 10-11
While the federal money is credited with
preventing even worse financial problems,
deficits were so deep that 39 states cut
Medicaid payments to providers in 2010,
and 20 states reduced benefits, according
to Kaiser.
New gaps totaling $26.7 billion have
opened up in state budgets this fiscal year
and states face another $82.1 billion in
deficits in FY 2012, according to a fiscal
brief released by the National Conference
of State Legislatures. In many cases, the
expiration of ARRA funds was cited as
the reason for the shortfalls. On July 1,
the enhanced federal aid will disappear,
causing an increase of from 25 to 33
percent in each state’s share of Medicaid
costs.
Continued from page 10
Secretary Kathleen Sebelius offered to
help budget-strapped governors find ways
to reduce Medicaid costs, but did not agree
to urgent requests to sharply cut eligibility
for the program, which covers 48 million
poor, disabled and elderly people.
Medicaid and CHIP together cover more
than 35 million children.
In a letter to the nation’s governors,
Secretary Sebelius said the Patient
Protection and Affordable Care Act
(PPACA) allows states with deficits to cut
people as long as they are adults who are
not disabled or pregnant, and they have
incomes above 133 percent of the federal
poverty level ($14,500 for an individual).
Twenty-one states and the District of
Columbia currently offer coverage to such
adults above that income level.
Because of federal eligibility restrictions,
the options for states are largely limited
to cutting benefits that are not federally
required, such as mental health services;
decreasing payments to physicians,
hospitals and nursing homes, and raising
taxes on those providers.
The Secretary said she would work with
states to help them identify ways to lower
Medicaid costs by improving quality,
and suggested one way states could save
money would be to better manage care for
the sickest Medicaid beneficiaries.
In Congress, the Republican House
leadership has promised to roll back
most federal spending to 2008 levels.
That could mean as much as $100 billion
in cuts. The biggest potential target is
Medicaid, which accounts for nearly 43
percent of state spending from federal
funds.
Medicaid Expansion Coming
Under PPACA, Medicaid will expand
significantly in 2014 when 16 million
more people are expected to become
eligible for the program. The federal
government will pick up all costs for the
new enrollees for the first three years. By
2020, states will be required to assume 10
percent of the costs of the expansion.
One proposal under consideration is to
replace the funding structure for Medicaid,
in which the federal government pays at
least 50 percent of the cost, with fixed
federal block grants to states. A report
from the Center on Budget and Policy
Priorities said the block grant plan “would
shift costs and risks to states, low-income
beneficiaries, and health care providers”
and “likely unravel the health reform law,
driving up the number of people who are
uninsured and underinsured.”
There is much uncertainty in predictions
of costs and benefits. In March,
Congressional Republicans released a
report estimating Medicaid expansion
would cost states $118 billion through
2023. In contrast, a Robert Wood Johnson
Foundation report predicted states would
receive $82.3 billion from the federal
government in Medicaid and state
exchange subsidies.
In February, Health and Human Services
2nd Quarter 2011
Medicaid and State Budgets
By Paula Johnson, APA Department of Government Relations
M
illions of Americans lost income
and health benefits as job losses mounted
Missouri Psychiatry
Continued on page 11
In mid-February, Arizona became the
first state to receive approval from the
Administration to drop 250,000 childless
adults from its Medicaid program.
The development of state budgets is a
dynamic and quickly changing process.
Here are snapshots of some proposals and
actions across the country:
Governor Jan Brewer had requested the
waiver to help close a projected $763
million budget shortfall for 2012. The
waiver was needed to exempt the state
from a PPACA provision requiring states
to maintain their level of Medicaid
coverage until 2014.
• California has proposed cutting
Medicaid by $1.7 billion, in part by
limiting beneficiaries to 10 doctor visits
a year and six prescriptions a month.
The change would affect only 10 percent
of Medicaid recipients, according to
the state’s Medicaid director. But many
of them would be among the sickest
beneficiaries. The state also suggests
eliminating an adult day care program that
serves 27,000 people who might otherwise
end up in nursing homes.
State Budgetary Actions
In Minnesota, officials are working in the
opposite direction, expanding Medicaid
eligibility to some 95,000 childless adults
before 2014, largely to win federal dollars
for coverage that was being provided by
the state. Advocates claim the move will
draw about $1.4 billion in federal funds to
the state, and will help create 25,000 jobs.
Opponents say the action is not good longterm policy.
Texas and California are considering
further reductions of as much as 10
percent in payments to providers.
Medicaid reimbursement is already so
low that many physicians refuse to accept
the coverage. Texas briefly considered
withdrawing from Medicaid altogether,
but concluded the loss of federal matching
funds would cost the state money in the
end.
Several states also plan to raise copayments for beneficiaries. And Florida is
considering vast expansions of managed
care plans as well as reducing Medicaid
provider rates by 5 percent in an attempt
to control costs. The state Senate has
proposed cutting optional services such
as mental health funding, dentistry
and optometry for Medicaid patients.
In an effort to encourage primary care
physicians to continue accepting patients
under Medicaid, the Senate is considering
legislation to increase payment rates for
primary care providers, and enact medical
liability reform.
• Illinois announced rollbacks to
proposed cuts for substance abuse
treatment funding. The planned $208
million in substance abuse treatment cuts
were first reduced to $100 million. State
officials now say the cuts will total only
$57 million. The current-year cuts come in
addition to those proposed in the FY 2012
budget, which would eliminate all $55
million that Illinois spends on substance
abuse treatment from the state’s general
revenue fund.
• In mid March, the Kansas House
and Senate rejected a proposal to reduce
funding for community mental health
centers by an additional $25 million over
the governor’s recommended reduction of
$15 million.
• Proposed changes to Ohio’s Medicaid
program are projected to save $1.4
billion. The budget would reduce hospital
reimbursements by $478 million and save
$159 million through lower payments
to managed care companies that oversee
most of the state’s Medicaid beneficiaries.
The budget also would save $243 million
through changes to mental health services,
including implementing a new limit on the
hours of psychiatric treatment, counseling,
and assessment that Medicaid patients
may receive. The budget is now before the
state legislature.
• After signing legislation in early
January to inject $330 million into the
state’s Medicaid program, MassHealth,
to pay bills, Massachusetts proposed a
2012 budget that would cut $16 million
from Department of Mental Health
hospitals and eliminate 165 state inpatient
mental health beds, moving patients to
community-based facilities. In addition,
the budget would reduce funding for stateadministered preventive health services
by $5.9 million. The budget would save
$1 billion through new Medicaid provider
contracts, requiring increased care
coordination and cooperation between
providers.
• Vermont’s proposed budget would
reduce mental health funding by $4.6
million. The budget also would increase
assessments on health care providers
to raise $28 million and end the statesubsidized private insurance program,
transferring the program’s beneficiaries to
the Vermont Health Access Program. The
Vermont Medical Association has objected
to the proposal, arguing the plan would
greatly expand the number of Medicaid
recipients, while only reimbursing
physicians at “44 percent of the cost of
delivering care.”
Supreme Court to Hear Medicaid
Payment Cases
The U.S. Supreme Court has agreed to
hear arguments on three consolidated
California cases that challenge Medicaid
provider payment cuts. The high court said
it would hear one-hour oral arguments on
the three cases, most likely this fall. In all
three cases, providers sued the California
Department of Health Care Services to
stop planned rate cuts that state officials
said were necessary amid a severe budget
crisis.
At issue is whether California and other
financially troubled states have the
flexibility to reduce Medicaid payments
to physicians, hospitals and other medical
providers.
Continued on page 14
11
4/21/11 9:20:31 AM
Missouri Psychiatry
2nd Quarter 2011
Ryall Chosen as MPA’s Next President
Continued from page 1
“This is a good thing, the merger,” Dr.
Ryall, a private practice psychiatrist in St.
Louis, said in a recent interview. “MPA
can achieve a greater presence, a louder
voice within Missouri and among Area
4 and APA, at large, as a unified district
branch.”
President-elect Bob Batterson, a child and
adolescent psychiatrist with Children’s
Mercy Hospitals & Clinics, in Kansas
City, will become president in May
2012. He, too, has been active with
APA at all levels, including serving as
president and secretary-treasurer of
WMPS in the 1990s. He is the APA
Assembly Deputy Representative for
Area 4 and was Assembly deputy rep
for WMPS from 1999 to 2010. He also
is the Area 4 representative for 20112012. He is a member of the board of
directors for MoPPPAC, the MPA political
action committee, and chair of the MPA
legislative committee. He is an associate
professor of pediatrics at the University of
Missouri-Kansas City School of Medicine
and an APA Distinguished Fellow.
Dr. Batterson said a special focus during
his term in office would be to manage
better outreach with rural psychiatrists in
all areas of Missouri. “Our rural members
are not very active with our psychiatric
society and we don’t really do a great job
of communicating with them or really
know how to serve them,” Dr. Batterson
said. “My goal is to work with members
to help MPA develop ways to offer
them more direct service from a state
association.”
Moses Tabe Ambilichu, a fourth year
psychiatry resident at St. Louis University
(SLU) School of Medicine, will begin a
child and adolescent psychiatry fellowship
at the University of Missouri-Columbia
in July. He will transfer his district branch
affiliation to Central Missouri Psychiatric
Society. As incoming secretary-treasurer,
Dr. Tabe will help establish MPA’s
financial stability, including budget
12
MPA Newsletter Second Quarter Template.indd 12-13
development and oversight. Since he first
joined APA in 2008 as a first-year resident,
he has assumed an active role at both
district branch and area council levels. He
served for three years as co-chair of the
EMPS Member-in-Training Committee
and recruited an incoming resident to
represent SLU pending his election to
state office.
He is a strong supporter of APA and
actively promotes membership and
participation to his SLU and soon-tobe UMC colleagues—residents and
faculty alike. He not only attended
several orientation programs for firstyear residents, but helped SLU achieve
membership in the 100 Percent Club, in
which all residents of a school’s psychiatry
training program are members of APA. He
was born in the Republic of Cameroon, a
country of central and western Africa, and
graduated with a medical degree from the
University of Perugia, in Italy. He is fluent
in English, French and Italian.
Member Satisfaction Survey
The MPA 2011 election ballot also
included a brief survey to identify
members’ expectations and opinions about
their level of satisfaction with MPA and
their respective local psychiatric chapter.
The 3-question instrument solicited
comments related to overall satisfaction,
preferred services/benefits, and other
comments or suggestions. Members
provided feedback in the areas of CME,
advocacy, member benefits, resources,
membership recruitment/retention,
concerns, and miscellaneous. For a
complete summary of survey responses,
please contact MPA at 636-343-8555 or
[email protected].
__________
Rebecca DeFilippo is executive director of
Eastern Missouri Psychiatric Society and
Missouri Psychiatric Association. She also
manages MoPPPAC, the Missouri Psychiatric
Physicians Political Action Committee. She is a
frequent contributor to Missouri Psychiatry.
Blogging Tips
Unlike typical medical literature, blogs
contain personal thoughts, are not
subject to peer review, and may not be
intended only for physicians. The risk
of patient privacy violations has become
more apparent with this informal,
widely accessible communication
method. Another risk is the unintended
establishment of a treatment relationship.
Remember, it’s the reader’s perception
that matters, not the intention of the
physician.
Risk Management Advice
1. Patient information must be kept
confidential – and there is more to
de-identifying than merely deleting a
patient’s name.
a. Opinion Q.4.a. in the APA’s
Opinions of the Ethics Committee on
The Principles of Medical Ethics (2009)
addresses the ethical obligation to
disguise individuals and states “[T]he
problem of disguising is not always
easily resolved. Close friends, family
members, or the patients themselves
might see through the disguise. This
could lead to legal liability as well as a
charge of unethical conduct…”
b. Opinion Q.4.b. states “…
presenting case material requires that
patient identity be hidden; if this is not
possible…, then fully informed consent
is required…”
2. Make it clear that no treatment
relationship exists, do not post anything
that could be perceived to be treatment
advice, and clarify that nothing on the
site is intended to be medical advice.
3. Do not assume a post is anonymous.
4. Do not vent about difficult
relationships with patients, cases,
lawsuits, or administrative actions in
which you are involved.
5. Assume that everything you write will
be found by a patient and/or an opposing
side in an administrative or legal action.
__________
Excerpted from “Risks Associated With
Specific Internet Activities” by Professional
Risk Management Services, Inc.
Missouri Psychiatry
2nd Quarter 2011
Four Estate Planning Tips to Consider
By Aaron Vickar
M
y friend Chris Erblich describes
estate planning as a journey instead of
a one-time destination. Chris, a partner
with Husch Blackwell LLP, practices in
the areas of tax and estate planning with
a focus on high net worth individuals. He
recently shared with me some practical
tips about estate planning and I’d like to
pass them on to you.
Review and Update Existing Estate
Planning Documents
It is essential to have in place core
estate planning documents, i.e., living
will and health care power of attorney,
financial durable power of attorney, will
and revocable trust. These documents
should be reviewed every few years.
Laws change, family situations change,
and attitudes toward wealth and charity
change. Estate planning documents also
should change to keep pace.
commonly directs assets to be distributed
outright to children or grandchildren at
a certain age, such as 25 or 30. Outright
distributions to beneficiaries can have
significant drawbacks. Assets distributed
outright to a beneficiary may be exposed
to a beneficiary’s creditors, divorce claims
and estate taxes. If assets are instead
held for a beneficiary in a lifetime trust,
it may be possible to avoid creditor and
divorce claims, and minimize estate taxes,
all while maintaining flexibility for the
beneficiary.
As physicians, the focus is on taking care
of patients, but remember to take care of
your family. A trusted advisor can help
you implement and periodically review an
estate plan so your family and estate are
protected for the long term. This amounts
to time very well spent.
__________
This is Aaron Vickar’s fourth and final article
for Missouri Psychiatry. Aaron Vickar is an
investment advisor with Buckingham Asset
Management, which provides investment
management services as a membership benefit
to EMPS members. For more information,
please call 1-800-711-2027 ext. 241 or visit
www.investmentadvisornow.com.
Review Beneficiary Designations
A beneficiary designation—such as a
“transfer on death” designation on a
savings account or a beneficiary named
on a life insurance policy or retirement
plan account—controls where these assets
pass on death, regardless of where an
individual’s will or revocable trust directs
assets to pass. It is critical to properly
coordinate beneficiary designations with
the overall estate plan.
Implement a Revocable Trust Rather
Than a Will
Most people would identify a will as
the document that controls where an
individual’s assets pass on death. A
revocable trust, also called a living
trust, is a “will substitute” with several
advantages. With a properly funded
revocable trust, an individual may avoid
the need to probate assets upon death (a
slow, costly and public process) and may
plan for periods of lifetime incapacity.
Pass Assets to Future Generations in
Trust Rather Than Outright
An individual’s will or revocable trust
13
4/21/11 9:20:32 AM
Missouri Psychiatry
2nd Quarter 2011
Medicaid and State Budgets
By Nathan Martin
promises a continued bleak forecast for
Medicaid and other state programs, at least
for the immediate future.
__________
Paula Johnson staffs the division of State
Regulation & Legislation within the APA
Department of Government Relations. This is
her first contribution to Missouri Psychiatry.
Contact Paula at [email protected] with
questions or comments.
To Read More. . .
The Kaiser Foundation’s
Statehealthfacts.org has recently
added new and updated data on
Medicaid and CHIP, as well as other
topics. For more information, go to:
http://www.statehealthfacts.org/
The Foundation’s Commission on
Medicaid and the Uninsured has
added “Top 5 Things to Know About
Medicaid” to its many resources about
how the Medicaid program works and
whom it serves. Visit: http://www.kff.
org/medicaid/8162.cfm
Since 2009, state legislatures have
cut nearly $2 billion in non-Medicaid
mental health spending, according
to a recent report from the National
Alliance on Mental Illness. The
report, available at http://www.nami.
org/Template.cfm?Section=state_
budget_cuts_report, included state
budget cuts to mental health services
between 2008 and March 2011 and
found that 32 states and Washington,
DC, reduced funding by $1.8 billion.
The National Association of State
Mental Health Program Directors
(NASMHPD) in February offered
a Congressional briefing examining
state mental health funding. Here is a
link to their presentation:
http://www.nasmhpd.org/general_
files/meeting_presentations/Hill%20
Briefing%20Feb.%2016%202011/
Kevin%20Martone%20Powerpoint.
pdf
14
MPA Newsletter Second Quarter Template.indd 14-15
2nd Quarter 2011
EMPS and St. Louis CAP Team Up for NAMIWalk
Continued from page 11
While states have begun to benefit
from the upturn in the U.S. economy,
disappearing federal stimulus dollars, slow
revenue growth and spending pressures
ensure that budget balancing tops the
legislative agenda in most states this year,
according to a survey of state legislative
fiscal directors by the National Conference
of State Legislatures. That scenario
Missouri Psychiatry
M
ark your calendar with the date
of the 2011 NAMIWalk, the National
Alliance on Mental Illness St. Louis’
annual walk in Forest Park. Plan to join
an estimated 1,500 other people and a
few well-behaved, leashed dogs in a show
of support for individuals and families
affected by mental illness.
On Saturday, May 28, NAMI St. Louis
will sponsor its largest event of the year to
raise funds to support local programs for
consumers and their families. Check-in
time is 8am at the Upper Muny Parking
Lot in Forest Park. The walk will start at
9am. Walkers will have a choice of 1 mile
or 3.1 mile courses.
For the first time, Eastern Missouri
Psychiatric Society and the Greater St.
Louis Council of Child Psychiatry will
lead Team EMPS-StLCAP for their
members, families and friends.
David I. Berland MD, president of the
Greater St. Louis Council, said his 96
members are pleased to partner with
EMPS for this important event. “NAMI
has given voice to those afflicted with
mental illness and done more to show
their respect for these courageous people
than any other organization,” Dr. Berland
noted. “We consider it an honor and
privilege to walk with NAMI.”
This year’s fundraising goal of $175,000
will help pay for the education classes,
support groups and advocacy that NAMI
St. Louis offers free to consumers and
families each year. “The funds also will
help us educate the public about mental
illness and, hopefully, reduce the stigma
that unfortunately still exists,” explained
Darwyn E. Walker, executive director at
NAMI St. Louis.
The 2010 NAMIWalk in St. Louis raised
more than $140,000, with the lead walk
team contributing over $8,000. Twentyeight teams raised at least $1,000 each.
By creating a partnership, Team EMPSStLCAP aspires to be among the top 20
fundraisers this year.
managing special events for medical
professionals, and has assisted onsite
with several EMPS continuing medical
education programs.
It’s easy to register to walk or donate. To
join Team EMPS-StLCAP or to donate,
please visit the group’s team page at
www.nami.org/namiwalks11/STL/EMPSStLCAP and click on “join the team.” To
support an individual walker, go to the
EMPS-StLCAP team webpage and click
on the name of the walker. This will take
you to their personal walker webpage
where you can make a secure credit card
donation by clicking “sponsor me now.”
Please mail offline donations to NAMI St.
Louis, 1750 S. Brentwood Blvd., Suite
511, St. Louis, MO 63144.
In April, EMPS contributed $500 at the
Supporter Sponsor level towards the Walk,
a sum it has donated for the past several
years. “We consider NAMI a valuable
resource in our work with patients,”
EMPS President Susan A. Minchin MD,
PhD said recently. “In fact, NAMI St.
Louis is the only organization EMPS
supports with a financial contribution.”
EMPS has hired Noel Flynn MEd, CMP,
CMMM, a St. Louis-based certified
meeting professional, to manage Team
EMPS-StLCAP for the 2011 walk. Ms.
Flynn specializes in planning and
To learn more, contact Noel Flynn at
314-963-9710 / [email protected]
or the NAMI St. Louis office at 314-9624670. Visit the NAMI St. Louis website at
http://www.namistl.org
__________
Nathan Martin is a development associate with
NAMI St. Louis. This is his first submission to
Missouri Psychiatry. For more information,
contact Nathan at 314-962-3347 or nmartin@
namistl.org.
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4/21/11 9:20:34 AM
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Upcoming Events
Saturday, May 14
First Annual “Hands Across Missouri for Mental Health” Unity
Picnic at Forest Park Pavilion #6 on Wells Drive, just off Skinker
Blvd. and Highway 40/I-64. Registration at 10:30am, ceremony
starts at 11am, followed by a free picnic lunch, refreshments and
many prizes until 1:30pm. Sponsored by Self Help Center, Mental
Health America of Eastern Missouri, Steve Curran’s The Walk, and
the Empowerment Center. For information, call Barb Anderson at
314-781-5492 or Nancy Bollinger at Self Help Center at 314-7810199, or visit mha-em.org.
Saturday, May 14 – Wednesday, May 18
Aloha! Attend the 2011 APA Annual Meeting in Honolulu, Hawaii,
and earn up to 40 CME credits. Hear Archbishop Desmond Tutu at
the Convocation. Learn about the latest evidence-based practices,
translational research from NIMH and DSM-5. Visit http://www.
psych.org/annualmeeting.
Saturday, May 28
2011 NAMIWalk in Forest Park at Upper Muny parking lot.
Registration at 8am, walk starts at 9am. For information, contact
NAMI St. Louis at 314-962-4670 or visit http://www.namistl.org.
Thursday, Oct 27 - Sunday, Oct 30
2011 Institute on Psychiatric Services, San Francisco, CA
We strive to offer content in Missouri Psychiatry that
represents our membership and encourage members to participate in its creation. For communications regarding the
newsletter or to submit articles, letters to the editor, upcoming events or advertisements, please contact:
Daniel T. Mamah, MD, MPE
Editor, Missouri Psychiatry
Department of Psychiatry
Washington University
660 South Euclid Avenue
St. Louis, MO 63110
OR
[email protected]
Newsletter Disclaimer: The opinions expressed herein are
those of the authors and do not necessarily state or reflect
the views of Missouri Psychiatric Association. Publication
in this newsletter should not be considered an endorsement.
Copyright ©2011 by Missouri Psychiatric Association. All
rights reserved. No part of this document may be reproduced or used in any form or by any means, electronic,
mechanical, or otherwise, including photocopy, recording,
or by an information or retrieval system, without the prior
written permission of the publisher.
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