{"title":"Interstate Mental Health and Substance Use Disorder Practice: Policies, Clinical Considerations, and Legal Implications.","authors":"Michelle Bedoya, Rachel Presskreischer","doi":"10.1176/appi.focus.20250002","DOIUrl":"10.1176/appi.focus.20250002","url":null,"abstract":"<p><p>In the United States, mental health and substance use disorder care is provided by a range of professionals, including psychiatrists, psychologists, and master's-level clinicians. These professionals are overseen and regulated at the state level by field-specific boards. Considerable variation between states in the educational and clinical supervision requirements for licensure creates challenges for license portability. To address these challenges, beginning in 2014, states have adopted practice compacts in medicine, psychology, counseling, and social work that allow clinicians licensed in a participating state to practice either via telehealth or in person in other participating states. This article discusses the nature of these compacts and provides legal and practice considerations for clinicians interested in joining a practice compact in their profession.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 3","pages":"323-329"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advocacy and the Opioid Epidemic: Positioning Providers to Influence Policy and Improve Public Health.","authors":"Aaron S B Weiner, Lauren H Weiner","doi":"10.1176/appi.focus.20250006","DOIUrl":"10.1176/appi.focus.20250006","url":null,"abstract":"<p><p>In 2024, for the first time in more than a decade, the year-over-year rate of American opioid overdose deaths demonstrated a sustained downward trend. Years of public policy interventions that changed clinical practice, shaped population-level behaviors, and enacted measures to prevent overdoses finally prevailed. Advocacy from behavioral health professionals has been central to this milestone, which inspires a call to action for increased professional advocacy moving forward, yet research indicates that many practitioners do not feel empowered to engage in advocacy because they lack familiarity with the process. With limited training programs in advocacy, this article attempts to fill the gap, examining effective policy advocacy related to opioids and other substances, the role behavioral health professionals have played in successful policy changes, suggestions for integrating advocacy practice into clinical training programs, and guidelines for professionals to promote advocacy at local, regional, and national levels.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 3","pages":"314-322"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Advocacy: An Imperative for Our Patients.","authors":"Dorothy E Stubbe","doi":"10.1176/appi.focus.20250013","DOIUrl":"https://doi.org/10.1176/appi.focus.20250013","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 3","pages":"342-344"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207507/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546438","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eric Rafla-Yuan, Mandar Jadhav, Melissa A Peace, Laura Willing
{"title":"Advocacy in Psychiatry.","authors":"Eric Rafla-Yuan, Mandar Jadhav, Melissa A Peace, Laura Willing","doi":"10.1176/appi.focus.20250003","DOIUrl":"10.1176/appi.focus.20250003","url":null,"abstract":"<p><p>Advocacy is a fundamental responsibility of all physicians, and psychiatrists are uniquely positioned as advocates because of their expertise in understanding the intersection between mental health, social determinants, and systemic barriers. Defined as giving voice to advance patient and population health, physician advocacy spans a continuum of activities, including micro-level efforts focused on individual patients, meso-level initiatives targeting organizational and community improvements, and macro-level interventions addressing systemic changes. Advocacy training enhances competence in these domains, but significant gaps persist in advocacy integration into medical education. Although insufficient institutional support, lack of formalized requirements, and limited recognition in academic or career promotion hinder advocacy skill development, professional organizations provide opportunities to develop and refine advocacy competencies, obtain mentorship, and identify avenues for engaging with policy makers. Through advocacy, psychiatrists have made significant contributions at individual, community, and national levels-and continue to be essential in driving systemic change to improve health.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 3","pages":"298-306"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207497/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Ethical Issues in Mental Health Policy and Substance Use Disorders.","authors":"Greg Kreitzer, Jacob M Appel","doi":"10.1176/appi.focus.20250009","DOIUrl":"10.1176/appi.focus.20250009","url":null,"abstract":"","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 3","pages":"338-341"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bianca Busch, Shannon Bennett, Michelle E Jacobs-Elliott, Arielle Linsky, Jessie Green, James Aluri, Meera Menon
{"title":"Exchange of Mental Health Information With Parents of College Students.","authors":"Bianca Busch, Shannon Bennett, Michelle E Jacobs-Elliott, Arielle Linsky, Jessie Green, James Aluri, Meera Menon","doi":"10.1176/appi.focus.20240047","DOIUrl":"10.1176/appi.focus.20240047","url":null,"abstract":"<p><p>College students are increasingly reporting higher rates of mental health concerns, creating significant demand for services at campus mental health centers and among community providers. As providers work to address this growing need, they may encounter challenges when considering whether to communicate with students' parents. This communication is often complicated by privacy laws, institutional policies, and the intricacies of family dynamics. Additionally, providers must balance students' rights to confidentiality with the potential benefits of parental involvement in their care. This review examines these complexities, exploring the legal, ethical, and practical considerations that shape communication between mental health providers and the parents of college students.</p>","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 3","pages":"330-335"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ryan K McBain, Megan S Schuler, Nabeel Qureshi, Samantha Matthews, Aaron Kofner, Joshua Breslau, Jonathan H Cantor
{"title":"Expansion of Telehealth Availability for Mental Health Care After State-Level Policy Changes From 2019 to 2022.","authors":"Ryan K McBain, Megan S Schuler, Nabeel Qureshi, Samantha Matthews, Aaron Kofner, Joshua Breslau, Jonathan H Cantor","doi":"10.1176/appi.focus.25023019","DOIUrl":"https://doi.org/10.1176/appi.focus.25023019","url":null,"abstract":"<p><strong>Importance: </strong>Although telehealth services expanded rapidly during the COVID-19 pandemic, the association between state policies and telehealth availability has been insufficiently characterized.</p><p><strong>Objective: </strong>To investigate the associations between 4 state policies and telehealth availability at outpatient mental health treatment facilities throughout the US.</p><p><strong>Design setting and participants: </strong>This cohort study measured whether mental health treatment facilities offered telehealth services each quarter from April 2019 through September 2022. The sample comprised facilities with outpatient services that were not part of the US Department of Veterans Affairs system. Four state policies were identified from 4 different sources. Data were analyzed in January 2023.</p><p><strong>Exposures: </strong>For each quarter, implementation of the following policies was indexed by state: (1) payment parity for telehealth services among private insurers; (2) authorization of audio-only telehealth services for Medicaid and Children's Health Insurance Program (CHIP) beneficiaries; (3) participation in the Interstate Medical Licensure Compact (IMLC), permitting psychiatrists to provide telehealth services across state lines; and (4) participation in the Psychology Interjurisdictional Compact (PSYPACT), permitting clinical psychologists to provide telehealth services across state lines.</p><p><strong>Main outcome and measures: </strong>The primary outcome was the probability of a mental health treatment facility offering telehealth services in each quarter for each study year (2019-2022). Information on the facilities was obtained from the Mental Health and Addiction Treatment Tracking Repository based on the Substance Abuse and Mental Health Services Administration Behavioral Health Treatment Service Locator. Separate multivariable fixed-effects regression models were used to estimate the difference in the probability of offering telehealth services after vs before policy implementation, adjusting for characteristics of the facility and county in which the facility was located.</p><p><strong>Results: </strong>A total of 12 828 mental health treatment facilities were included. Overall, 88.1% of facilities offered telehealth services in September 2022 compared with 39.4% of facilities in April 2019. All 4 policies were associated with increased odds of telehealth availability: payment parity for telehealth services (adjusted odds ratio [AOR], 1.11; 95% CI, 1.03-1.19), reimbursement for audio-only telehealth services (AOR, 1.73; 95% CI, 1.64-1.81), IMLC participation (AOR, 1.40, 95% CI, 1.24-1.59), and PSYPACT participation (AOR, 1.21, 95% CI, 1.12-1.31). Facilities that accepted Medicaid as a form of payment had lower odds of offering telehealth services (AOR, 0.75; 95% CI, 0.65-0.86) over the study period, as did facilities in counties with a higher proportion (>20%) of Black residents (AOR, 0.58; 95% CI, 0","PeriodicalId":73036,"journal":{"name":"Focus (American Psychiatric Publishing)","volume":"23 3","pages":"353-361"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12207508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
David C Mohr, Francisca Azocar, Andrew Bertagnolli, Tanzeem Choudhury, Paul Chrisp, Richard Frank, Henry Harbin, Trina Histon, Debra Kaysen, Camille Nebeker, Derek Richards, Stephen M Schueller, Nickolai Titov, John Torous, Patricia A Areán
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