Friday, October 25, 2013

What I Learned: Part 1

Hello from San Diego and the 44th annual American Academy of Psychiatry and the Law conference. One of the annual traditions associated with this conference is my series of "What I Learned" posts, which preserves little factoids, pieces of trivia and topics for me for future reference, and also tells members a bit about what they missed if they couldn't make the conference. For those interested in a more real-time experience, you can follow live coverage on my Twitter feed @ClinkShrink.

In spite of a three hour time difference and associated jet lag I did make it to the morning poster session. While I didn't get to every single poster, I did enjoy one that looked at the rates of military service for prisoners who committed suicide in New York over several years. One of the interesting things about this study was the fact that it was exempt from IRB review because all of the information was in the public domain as the result of a journalist's FOIA request. Having completed the story, the journalist turned over all the data to the poster's authors. Sweet. I don't recall all the numbers due to jet lag and mawazo mengi (keep reading), but the bottom line was that only three percent of the prisoners who completed suicide had a history of military service. Weird. Are veterans less likely to kill themselves in prison than while on active duty?? The poster wasn't designed to answer that question, but it certainly did raise the question in my mind.

Immigration issues are an emerging area of active forensic work now, and this was reflected again in this year's conference. I attended a panel presentation by psychiatrists from Yale and the Philadelphia program, who talked about the basis for deportation ("removal proceedings") and the common questions asked of forensic psychiatrists. An alien can file to be protected from removal based on a real history of persecution or being members of a group at risk for persecution, by being a victim of torture, or if their life or freedom could be threatened by return to the home country. The respondent's testimony about these issues must be credible. Psychiatrists are sometimes asked to testify as to why an alleged torture victim may have inaccurate recall of details related to their experiences, or why their demeanor or emotional reaction while discussing torture appears to be inconsistent with the experience. (All of this discussion brought to mind the prosecution of rape cases where the victim is "put on trial.") A psychiatrist might be asked to testify about a respondent's diagnosis and treatment needs and whether those treatment needs can be met in the home country. One panelist talked about transference and counter-transference issues in immigration evaluations, particularly about her own discomfort about testifying about deficits in her own country of origin's mental health system. I also learned it's good to know about culture-bound syndromes for these evaluations, like "mawazo mengi" ("brain fag"---yes, that's "fag" not "fog") or racing thoughts with headaches.

I was quite pleased to attend a panel presentation about the Goldwater Rule. As regular readers know, this is a persistent interest of mine that I've blogged, podcasted and written about before (here, here, here, here, and here). Now, the Shrink Rappers are finally not the only ones talking about this. The AAPL ethics and peer review committee put on a joint presentation in which they played several television interviews with psychiatrists commenting on criminal defendants in the news as well as on the President. There was vigorous and unanimous agreement about where the talking heads "crossed the line" of professional ethics, how the interviews could have been handled better and what recourse our profession had to address the offenders. Complaints have been filed within the APA against media consultants who violated our ethical rules, and in some states this may also be the basis for a licensing board complaint. Interestingly, social media was not even mentioned. I suspected this may be due to an inherent fear and suspiciousness about the use of social media by forensic psychiatrists. On a side note, but one I plan to track, is that the role of psychiatrists in national security issues and consultation to covert agencies was presented as a "grey area" of ethics. (Oh, I'd say it was a darker shade of grey myself.)

Finally, I attended a panel presentation on the management and reduction of inpatient violence put on by some of my Maryland colleagues. There was a review of the literature on risk factors related to inpatient violence (staffing levels, patients with a history of substance abuse and/or violence, an overstimulating---noisy---environment) and also a presentation of one inpatient unit's plan to reduce inpatient violence. The unit set up a designated "milieu manager" who did hourly rounds on the unit to touch bases with all the patients and keep an ear out for emerging tensions. They did patient-specific limited and targeted observation (a change from the usual practice of continuous, 24/7 observation). I forget the numbers on the assault rate, but what stood out in my mind was that the scores on the patient satisfaction survey I think tripled. The unit got the hospital award for the most improved patient satisfaction. Very cool project, and it was all set up, designed and run by the nursing staff.

Finally, the evening entertainment was a showing of the 1938 film "The Amazing Dr. Clitterhouse." Definitely worth watching even if you only watch the insanity trial at the end of the film. I may need to track down a clip of the "expert" testimony in that case. For peer review, of course.

The conference runs through Sunday and you can follow my coverage today and tomorrow @ClinkShrink. Thanks for attending with me.


Anonymous said...

Glad to hear discussion about the Goldwater Rule. Hopefully, they will crack down harder on violators.