March 2016, Vol. 7, Issue 1
In This Issue



From the Newsletter Editor-in-Chief
Mona Amini, MD, MBA
March 2016
R-L: Dr. Mona Amini and Dr. Aris Mosley_ Newsletter Editor and Co-Editor RFM

Dear Colleagues:
A warm welcome to the Spring 2016 Edition of the Arizona Psychiatric Society Newsletter. I am thrilled to serve as your new Newsletter Editor-in-Chief, and aspire to work hard to establish dynamic themes through the year for your review. I am confident it is going to be an amazing year within the Psychiatric community with collaborative events, conferences, and the goal of increasing our number of APA membership.
New advances in the field of Psychiatry are on the horizon, and it is with great delight that our upcoming Arizona Psychiatric Society Annual Conference theme will be "Innovations in Psychiatry". You may register directly from the link on this newsletter. From the mental health advocacy side, you will read in the AZ Medical Association's Legislation Update, on a bill that encourages telemedicine coverage expansion for a wider net of patient coverage including telepsychiatry.  From our community partners, we are pleased to provide an introduction to the great work accomplished by David's Hope and Step Up Arizona, a mental health criminal justice summit organized by David's Hope for this summer, featuring national keynote speaker of note, Judge Steven Leifman. Among other key contributions, in this edition we are introduced to our current APS Legislative Chair, Dr. Carol Olson, and learn about her long-standing interests in the mental health field, and also welcome Timothy Miller, new Regional Field Director, State Government Affairs, providing regional support from the APA to our western region.
Looking to future editorials, I would like to create an open dialogue that engages individuals and contributors to our newsletter. We all have rich experiences to contribute for continuous learning.
Thank you for this great opportunity and honor to serve the society. 
Mona Amini, MD, MBA
P.S.: Please share your feedback and follow us on Twitter @AZPsychSociety or on Facebook through the group page "AZ Psychiatric Society."
Premium Corporate Sponsor 2015-2016
Dr. Segal and his sons at Society Picnic

Roland B. Segal, MD, FAPA
Arizona Psychiatric Society, President

Thanks to Dr. Amini and the members of the ECP Event Planning Committee for bringing the Society together on February 27th at the Farm at South Mountain. It was great to see so many members, together with their family members, relaxing together and connecting on topics of both a professional and social nature. The feedback received was very positive, and the Society will look to plan events that offer this type of connection in the future.

As to great educational events, the Society has planned a top notch program for the Annual Meeting of the Society, and a social event the Friday evening before. With the collaboration of Dr. Gwen Levitt, Research Director for Maricopa Integrated Health System, Inc., the Society is expanding the peer poster presentation to a juried breakfast session during the Annual Meeting. It is our goal to have this Meeting attended by as many psychiatrists and other mental health professionals in our provider area as possible, so I hope you will share the information regarding the Annual Meeting with all of your collaborative peers. 
My tenure as President concludes after the APA Annual Meeting, and I look forward to continuing to be involved on the Council, and in particular on legislative and advocacy matters. I believe each one of us can make a great difference to our professions by participating in the grass roots advocacy opportunities communicated through the Society, the APA, and by being active and connected with our own State and U.S. Senators and Representatives. Thank you to all who are members and make this commitment to support our profession and be engaged. It has been a pleasure to serve the goals of the Society as your President.
INTRODUCING.........Copper Springs Hospital, a newly constructed, state of the art, seventy two bed freestanding psychiatric hospital located at:

10550 West McDowell Road
Avondale, Arizona 85392
Phil Sheridan, Chief Executive Officer is actively looking for psychiatrists to be part of this new facility which is scheduled to open May 10, 2016.  
Call Phil at 801-884-3809, or e-mail PhilSheridan@SPSH.com to be part of this team.

The Legislative Update from ArMA - Week 9: Legislative committees head into the final stretch

ArMA's lobbying team works steadfastly throughout the legislative session to track and advocate for and against bills. This week was a hectic one in terms of activity in the standing legislative committees - there are 19 of them in the Arizona House and 15 in the Arizona Senate, by the way - as the cutoff date for clearing bills through committee draws near. For all but two committees on each side, the cutoff date is Friday, March 18th - meaning that for them there is only one week (and one more meeting) left to consider bills they've been assigned. The two exceptions on each side are the Appropriations Committees (they get an extra week) and the Rules Committees (which normally only consider whether bills are constitutionally proper, after they have cleared their assigned committees). Bills that are not heard and approved are dead, as a general rule. So, this is yet another point in the session at which a lot of proposed legislation is winnowed out. Next week will be a busy week...
Doctor of the Day at Arizona's Capitol
This program offers a wonderful opportunity to enhance the visibility of the medical profession and gain greater credibility with the elected officials whose decisions impact the way medicine is practiced in Arizona. When you represent the Arizona Medical Association as "Doctor of the Day," you provide invaluable medical assistance should any emergency arise at the Capitol complex. You are otherwise free to attend committee meetings, watch sessions of the House and Senate, and meet with individual legislators to offer your views on issues which will affect your patients' ability to receive quality health care - and your ability to provide it. The program runs from January through April, Monday - Thursday, 9am - 1pm. Follow us on Twitter @arma_docs via #AZDocoftheDay.
"Week 9: All quiet on the Western front" concerning APRN bill
Despite anticipated action, it has been very quiet and there has been no further movement by the nurses' groups on their APRN scope of practice expansion legislation, after the demise of Senator Nancy Barto's SB 1473 several weeks ago. ArMA's advocacy team continues to meet with legislators to keep them informed as to our staunch opposition to any "scaled-back" version as long as it attempts to eliminate for CRNAs the "direction and presence" provisions for physician oversight, gives CRNAs unneeded prescribing rights, or permits them to provide pain management services.
WEEK 10 UPDATE:  ArMA is negotiating an agreement on the APRN scope with which physicians should be very pleased. To learn more, become a member today and receive our weekly newsletter with the latest on those negotiations!

Senate passes improved version of CSPMP Bill
With the addition of a very helpful floor amendment, SB 1283, the bill requiring physicians and other prescribers to check the controlled substances prescription monitoring program (CSPMP) database before prescribing opioids and benzodiazepines, was approved by the AZ Senate on a 30-0 vote yesterday. The floor amendment made a number of improvements to the bill and narrowed the scope of it, somewhat delaying the implementation date to a more realistic one in late 2017. ArMA is pleased with the progress made to make this bill more workable and less burdensome. We will continue to work on refinements to SB 1283 over in the House, including removing or delaying the inclusion of all classes of benzodiazepines in the list of drugs that require CSPMP queries.
Coalition urges Senate action on HB 2502, Interstate licensure compact
Last week we saw HB 2502, the interstate medical license compact bill sponsored by Rep. Heather Carter, pass the House by an impressive 59-0 margin. However, Sen. Barto has expressed concerns about the bill and it has not made it on an agenda. Various supporters have made efforts to allay her concerns, but so far to no avail. That impasse stimulated the recent action by the AZ Chamber-led coalition of health care, technology and business interests in publicly pressing for committee action next week on HB 2502. In a strong but positive way, the Arizona Chamber of Commerce & Industry made a written plea to Chairman Nancy Barto and the entire Senate Health & Human Services Committee on Wednesday about the importance of hearing HB 2502. This broad group of industry leaders is convinced that adoption of the compact here is critical for physician recruitment and workforce development.
Telemedicine coverage expansion bill advances in House
More progress was made this week on a helpful bill for telemedicine services, SB 1363, sponsored by Sen. Gail Griffin (R, LD 14). SB 1363 further expands the telemedicine insurance coverage statutes enacted a couple of years ago. Although there was health insurer opposition early on, a compromise was struck in the Senate and the insurers are no longer opposing the bill. The bill has successfully passed the Senate in mid-February and on Wednesday was given unanimous approval in the House Insurance Committee. In its current form, SB 1363 will require telemedicine services to be covered by insurers regardless of where it is delivered in this state (previously the patient needed to be in a rural area), and it adds pulmonology to the list of services included, effective 1/1/18.
ArMA is stronger with your support! JOIN TODAY.

Medical Director Opportunity with Cornerstone Behavioral Health Startup in Tucson
  • 37 hours per month, but may work up to Full-Time providing psychiatric services in an inpatient setting, primarily geropsychiatry and integrated dual diagnosis
  • Practice assistance
  • Loan forgiveness
 Qualifications and Experience:
  • Board Certified Psychiatrist 
  • Must have current license to practice without restriction. 
  • Previous Medical Director experience desirable.
  • Experience with managed behavioral health care essential. 
  • Knowledge of quality management and NCQA requirements highly desirable. 
CLICK HERE to apply.  For more information, contact Alissa Van Komen, Corporate Manager of Talent Acquisition, Cornerstone Healthcare Group, D: 469-621-6710; M: 469-271-9507; E: avankomen@chghospitals.com 

REGISTER ONLINE, PRINT A BROCHURE to mail or fax in your registration, or contact Teri (teri@azmed.org), 602-347-6903.  

for the Peer Poster Breakfast Session, which will be juried for prizes, is due by midnight, April 15, 2016.  CLICK HERE to submit your abstract through the online link.  
Mary Lou Brncik
Director and Founder, David's Hope

Dear Arizona Psychiatric Society Members,

I am writing to introduce myself to the members and associates of the Arizona Psychiatric Society. My name is Mary Lou Brncik and I am the founder and director of a non-profit organization, David's Hope. Our mission is to reduce the number of people with mental illness and addiction who are incarcerated. I want to thank the Society for your endorsement of the Arizona Mental Health Criminal Justice Coalition and Step Up Arizona 2016, a mental health criminal justice summit being held June 9-10 at the Mesa Convention Center. The summit will focus on crisis response/ law enforcement, the courts/mental health courts and reentry. We are very much honored, to have received an endorsement for the summit from the APS as well as from the Arizona Sheriffs' Association.

My life brought me into this work, I did not seek it out but rather it sought me, as my son David living with schizophrenia, repeatedly found himself interacting with law enforcement in Maricopa County where he lived while in his early twenties. In 2009 he was tasered six times in the back. I just thank the Good Lord that he wasn't hit with real bullets. After a person is tasered, there are no deals to be made and a plea deal to a felony was the only resolution. David's crime, not stopping and standing still but instead running in circles, while experiencing extreme paranoia, hallucinations and delusions was charged as felony aggravated assault on a police officer. We know that officers aren't psychiatrists, they don't know or care why a person is not following their commands. They have to take action to ensure the safety of all, as best they can. Outcome was the tasering, and thus the felony conviction. No help from the courts was to be found.

This was the first of several incidents David had involving law enforcement. Miraculously, after we had put a lien on our house to afford the cost to retain an attorney, one of very few in Arizona who knew anything about criminal defense of a person with mental illness, David was placed on probation rather than being sent to prison. To my great delight, his attorney was able to secure him a place on the Maricopa County Adult Probation unit, which specializes in working with individuals living with serious mental illness. This was the beginning of a time of great learning for David and me. We learned that the criminal justice system, though so frightening and at times brutal also has many good and compassionate people working within its framework and especially within this special unit, where the officers function more as counselors and social workers than as law enforcement officers. Of course they can wear that hat too but only when all other options are gone.

At the time of David's first arrest, I began to help other families with loved ones who had been arrested and incarcerated due to untreated mental illness. One family at a time, one person at a time, I worked to teach those who were going through this impossible challenge, the ins and outs of surviving and working to support their incarcerated or soon to be incarcerated loved one with mental illness.

In December 2012, I was asked to take the leadership of the Arizona Mental Health Criminal Justice Coalition. The coalition had been created as a work group to assist members of the Maricopa Adult Probation Department, Correctional Health Services at the Maricopa County Jail and the County's Regional Behavioral Health Authority. I had been working with the coalition for several years, assisting to support and grow the work they were doing, when to my surprise, I was asked to take the leadership of this amazing group of mental health criminal justice stakeholders. Their goal was identical to the goals of David's Hope, reducing incarceration of those with mental disorders, so indeed it was a real honor and a perfect match.

Today we have grown the coalition to include a formal list of endorsers that consists of organizations which have signed on as supporters of our mission. The endorser agreement can be found on our website at http://davidshopeaz.org.  This letter of support, is a public statement that an organization supports our mission of promoting treatment rather than incarceration of those living with mental illness and addictions.
In 2016 we are working to promote awareness and implementation of the national Stepping Up Initiative throughout Arizona's 15 counties and tribal regions. Stepping Up is a national initiative to reduce the number of people with mental illnesses in our jails. You can learn more about the initiative at http://stepuptogether.org.  

On June 9 and 10th, David's Hope - Arizona Mental Health Criminal Justice Coalition is go ing to be holding a mental health criminal justice summit at the Mesa Convention Center. Our keynote speaker will be Judge Steven Leifman, who is the architect of Stepping Up. You can read more about Judge Leifman here.

The judge will be joining us along with his Miami-Dade County Superior Court team, sharing with us the best practices they have implemented, which have made their court a model nationwide. One of the reasons why Judge Leifman is so near and dear to my heart, isn't his education, though of course his isn't lacking, nor is it even his stamina, though he certainly has fought against all odds for a very long time. What most draws me to Judge Leifman can be summed up in one of his most often repeated messages paraphrased. "It isn't that we don't know what we need to do to fix this problem. This isn't rocket science. What challenges us the most isn't understanding how to fix this but it is in finding the people who are willing to do it."

We invite you to join with us, as a link in our lifeline to those with mental illness and addictions who are involved in our criminal justice system. You can see more details about the summit and register to attend Step Up Arizona 2016 at http://stepupaz-2016.eventbrite.com.  I can be reached directly at 602-872-4685 if you would like more information. We covet your input and participation, as we work together to improve mental health criminal justice collaboration in Arizona.

With appreciation,
Mary Lou Brncik

APS Legislative Chair
Chair, Department of Psychiatry, MIHS

I am a native of Phoenix and was born on Christmas Day at Good Samaritan Hospital, with a twin brother preceding me by 5 minutes.  My parents moved out from Chicago in the late 50s and my Dad worked at Motorola for the rest of his career; my mother was a teacher and started a school, Kachina Country Day School, which was in operation for over 30 years and provided me many summers of useful employment.  I graduated from Arcadia High School and then went back to Pennsylvania to Bryn Mawr College, from which I graduated in 1984.  I went to the Stanford University School of Medicine, then returned to Phoenix to do an internship in Internal Medicine at Good Samaritan Hospital, before starting my residency in Psychiatry at the University of California, San Diego.  Just a few weeks before moving to San Diego I met my future husband on a blind date and I ended up going back and forth between San Diego and Phoenix for the next few years; I transferred to the Maricopa Medical Center residency program for my final year of Psychiatry training, got married, and stayed on at MIHS to become an Inpatient Attending, then Director of the Psychiatric Consultation Service for several years, then Inpatient Director, and finally Chair of the Psychiatry Department since 2005.  I have a long-term interest in Forensic Psychiatry and am certified in that subspecialty; I serve as Chair of the Psychiatric Security Review Board for the State of Arizona, which has jurisdiction over individuals found Guilty Except Insane for violent crimes in the state.  I also am dedicated to education and training of future psychiatrists, and as Department Chair have overall responsibility for the two psychiatric residency programs at MIHS (in general psychiatry and child and adolescent psychiatry).  I have been President of the Medical Staff at MIHS and I serve on the Executive Council of the Arizona Psychiatric Society and am Chair of the Legislative Subcommittee of that group.  In addition to my husband, I have a son who is 14 and started at Brophy this year.

Psychiatry attracted me because I am fascinated by character and personal histories and Psychiatry is one of the few fields in Medicine in which one has the time to learn about one's patients in the context of their whole life.  I also like the fact that practicing good Psychiatry is an art as well as a science.  I do not like the trend of psychiatrists relinquishing important pieces of the therapeutic armamentarium (e.g., psychotherapy) to other disciplines and focusing on medication management alone, nor do I like the fact that there seems little recognition that some severely ill and treatment resistant patients need a longer time in the hospital than is typical, and they should get it if they need it. 

I have been in involved in advocacy for several years now, visiting the legislature when bills important to our profession are introduced, and speaking to the media in an effort to educate the public on important issues.  I think there is a hunger for information about psychiatric topics, among both legislators and the public, and we need to get out of our comfort zone and speak up for our patients and our profession.  The APS provides a focus for lobbying efforts at the legislature and in the media, and I encourage interested psychiatrists to become more involved in our efforts. We should all know who the legislators for our districts are, and we should be emailing or calling them when issues of concern to our profession arise.  Letters to the editor can also be effective, and we should be willing to speak to reporters to educate on mental illness.

I've never regretted my decision to choose Psychiatry, and it is an exciting time for our field, when the "powers that be" seem to be recognizing that mental health issues are important and worthy of investment.  Our involvement is needed to make sure that investment is made wisely and well.

As part of the APA's effort to improve state advocacy support, they have brought on four Regional Field Directors to work with members and District Branches on state issues.  Tim Miller is responsible for working with all of the Western states and is based out of Denver, Colorado.  Before starting with the APA in November of 2015, Tim worked with the American Academy of Neurology on in-depth policy research, analysis and report development in support of state and federal advocacy priorities.  He is here to help with advocacy, messaging, communications, and legislative strategy.  Tim is your liaison to the APA Government Affairs team.  If you have any questions for him or would like to be more involved, he can be reached at tmiller@psych.org or 651-470-3637.  

Choices in Recovery/Mental Health Resources is an online resource with support information for schizophrenia, schizoaffective, and bipolar disorder patients.

The resources are there to help individuals be informed, participate, and take action.

Discover worksheets, workbooks, decision aids, multicultural resources, and helpful organizations. These tools can help your patients get involved in their own mental health recovery journey, make medication and treatment decisions, and work toward personal goals.

The mental health resources are helpful to the individual and members of his or her treatment team or support network. For additional updates, patients or caregivers can subscribe to the free Choices in Recovery Newsletter. 


Joseph F. Abate, Esq.
APS Lobbyist

A summary of the Health Care Legislation relevant to psychiatry that has been introduced in each of the House or the Senate through March 16, 2016 in the Fifty-Second Legislature, Second Regular Session (2016), is available to view and/or print by CLICKING HERE.

With the announcement by Majority Whip Senator Adam Driggs that he is not running for re-election, and the many different incumbents who will be setting their caps for election in new positions, it is believed that the legislature will work to resolve the budget issues quickly and that there is little time left for final bills to get through the House or Senate. 

Of note, KidsCare, HB2309, which is supported by the Society and widely by physician groups, was advanced through the House, but was not presented for a vote in the Senate, and the clock is running out.  

S1473, the APRN legislation (nurse's scope of practice legislation), did not advance out of Senate. H2236, a strike everything amendment to APRN, was adopted as a negotiated compromise with physician stakeholder groups on March 16, 2016, and removes the requirement that a registered nurse practitioner perform certain acts in collaboration with a licensed physician. Adds to a registered nurse practitioner's expanded scope of practice consultation and referral to certain licensed health practitioners as outlined.  Refer to the Memorandum from the Senate Health and Human Services Committee for more information.  

H2501 on Board consolidation was introduced to both take advantage of certain economies of efficiency and also to avoid antri-trust complications as seen in the recent Supreme Court decision regarding the Dental Boards.  The Bill, as amended, will create and order a general study of whether the Boards should be transferred over to DHS and looking for other certain economies of efficiency.    

Physician stakeholder groups have worked with legislators over several sessions to improve the system and the regulations proposed by S1283 controlled substances prescription monitoring program to mandate the use of Arizona's prescription drug monitoring program (PDMP) by prescribers.  For a memorandum explaining the background and provisions S1283, CLICK HERE.

If you would like any additional information regarding the legislative session, please contact the APS Lobbyist, Joe Abate, at 602-380-8337.  If you are interested in being a part of the Legislative Committee of APS, chaired by Dr. Carol Olson, please contact teri@azmed.org.
Dr. Gurjot Marwah at the Picnic with her daughter and husband Dr. Neil Marwah
Scottsdale, Arizona, March 2016

Payam Sadr, MD, FAPA
Gurjot K. Marwah, MD
Arizona Assembly Representatives

Dr. Gurjot Marwah and Dr. Payam Sadr both attended the APA Area 7 Meeting in Scottsdale, Arizona from March 4 to 6, 2016. The last time the Area 7 Meeting was held in Phoenix was in Spring of 2012, and all were delighted to return to Arizona. The Area 7 Meeting had a record attendance for this session, perhaps attributable to our wonderful spring weather, or to the welcome provided by Dr. Gurjot and Neil Marwah by opening their home to an evening meal on Saturday and the opportunity to converse and exchange ideas in a relaxing, social setting under the Arizona skies.
CLICK HERE for a summary of the highlights of that Area 7 Meeting.

Announcement of Newest Arizona Psychiatric Society Distinguished Fellows and Fellows of the APA

American Psychiatric Association has elected the following Arizona
Psychiatric Society members to the status of Distinguished Fellow of the
APA, to be honored at the APA Annual Meeting in May with a President's
Reception and a Convocation of Distinguished Fellows.

Joel Edward Parker MD DFAPA
Cynthia M Stonnington MD DFAPA
Monica J Taylor-Desir MD DFAPA
Karen L Weihs MD DFAPA
Rodgers McKinley Wilson MD DFAPA

In addition, the following members of the Arizona Psychiatric Society were
approved for Fellow status by the APA, and these Fellows will be honored
during the Convocation ceremony in May:

Margaret E Balfour PhD MD FAPA
LaDan Goble MD FAPA
Leticia G Jacinto MD FAPA
Joanna K Kowalik, MD MPH FAPA
Steven Kwoh MD FAPA
Randall Kenneth Ricardi DO FAPA
Jerry J ThomaS MD FAPA
Houshang Aminian MD LFAPA
Houshang Semino MD LFAPA

On behalf of the entire membership of the Arizona Psychiatric Society, we
congratulate these newest Distinguished Fellow and Fellows of the APA on
their distinguished careers and thank them for their continued support and
membership in the APA and our Society. We would also like to recognize the
extra efforts of the many Distinguished Fellow members in the Society who
provided letters of support.


Nominations for Distinguished Fellow must be submitted through the District
Branch. If you are interested in more in formation on the requirements,
please visit http://www.psychiatry.org/join-apa/become-a-fellow or contact
the APS administrative office (teri@azmed.org, 602-347-6903).
Distinguished Fellow nominations for recognition at the 2017 APA Annual
Meeting are due to be submitted to the APA on or before July 1, 2016;
Fellow nominations are due on or before September 1, 2016.

Newest Life Members:
The following members of the Arizona Psychiatric Society were recognized by
the APA for reaching the following Life membership status (at the May 2016
APA Annual Meeting):

Glenn Lippman MD DLFAPA
Aimee Schwartz MD DLFAPA
Michael Howard Stumpf MD DLFAPA
Pamela Anne Pappas MD LFAPA
Edward Michael Gentile DO LFAPA
Kevin A Stahl MD LAPA
Mavis Joan Donnelly MD PC LAPA
Michael Mahl MD LAPA

50-Year Members:
Of special note, we recognize the following members who achieved the
pinnacle of 50-Year Members in the APA as of January 2015:

Emanuel C Wolff MD DLFAPA
Howard E Wulsin MD DLFAPA
James M Pedigo MD LAPA

These members will be acknowledged in the Convocation at the 2016 APA
Annual Meeting.

We recognize these Society members for their years of dedicated service to
the APA and the Society and to their contributions to the field of
psychiatry and the enrichment of our mental health community.

Picnic Collage
The Farm at South Mountain
February 27, 2016

It was a beautiful spring day at The Farm at South Mountain.  Thanks to all of the APS members and their family members who came out to enjoy the day.  It truly was a lot of fun--great food, conversation, and a relaxing setting!  CLICK HERE for a photo album of the day.  Dr. Traci Wherry and her son were the winners of our getting to know you drawing.  

American Psychiatric Association Excellence Awards
April 18, 2016, Washington, DC
A Tribute to "Orange Is the New Black"

The executive producer of "Orange Is the New Black" and two of the show's actresses-Natasha Lyonne and Dascha Polanko-are participating in the inaugural presentation of the American Psychiatric Excellence (APEX) Awards at the Mayflower Hotel in Washington, D.C., on April 18. The evening, whose theme is meant to shine a national spotlight on the incarceration of people with mental illness, will be hosted by award-winning journalist Cokie Roberts. A reception will begin at 5:30 p.m. followed by dinner at 6:30 p.m. PURCHASE YOUR TICKETS now for this special event. It is being held in conjunction with the Stepping Up National Summit, whose goal is to reduce the criminalization of people with mental illness.

As part of the Transforming Clinical Practice Initiative (TCPI), APA will offer training to psychiatrists to support practice transformation through nationwide, collaborative, and peer-based learning networks. 
Free training is available to psychiatrists through online modules and live trainings. CME credit is also offered. Content is similar for both training sessions so you may choose to participate in one or the other based on your learning preferences and availability.      

Online Modules - CLICK HERE to get started! There are two parts to the training containing seven modules in all. It is recommended that participants complete both parts 1 and 2.  For a flyer to share with peers, whether member or non-member, CLICK HERE.

APA FREE MEMBER CME:  March Course of the Month is now available:
Physical Examination in Psychiatry: Common Scenarios Requiring Physical Examination

BannerGrand Rounds for the Department of Psychiatry, Banner-University Medical Center Phoenix:  March 25, 2016, 12:00 Noon to 1:00 pm, Medical Education Amphitheatre, John Racy, MD, "Disciplining Intimacy: Personal Reflections on Psychotherapy in Psychiatry"  

MHA AZ SEEDS CONFERENCE, May 20-21, 2016, a joint project of MHA AZ and ASU Center for Applied Behavioral Policy, "B4Stage4," The Salvation Army's Phoenix Citadel Corps, 628 North Third Avenue, Phoenix, AZ  85006.  CLICK HERE for more information.

Congratulations to the Psychiatric Residency Program at Maricopa Integrated Health Systems, Inc. for repeating the distinction of the American Psychiatric Association 100% Club, at the Bronze Level for 2015.  Thanks to the RFM leadership at MIHS that contribute to this effort, including RFM Co-Representative Dr. Aris Mosley and Committee Members Dr. Matthew Salmon and Edwin Kim.  

A Spring Mixer for all Arizona psychiatric residency programs is being planned with April as the most likely target month.  For additional information, please contact Dr. Aris Mosley, Dr. Wanda Shao, Dr. Jesse Reinking, or Dr. Brandon Yates.  
February 11-13, 2016
Las Vegas, Nevada

Brian Espinoza MD
Interventional Psychiatry

This was my ninth year in attendance. Sponsored by the Nevada Psychiatric Association, a District Branch of the APA, this conference continues to grow and remain the largest Psychopharmacology Conference in the country. A sellout crowd of over 1500 attended with a new venue at the Bally's Hotel, Las Vegas.

From anxiety disorders to ECT, Alzheimer's updates to marijuana abuse, to review the highlight notes from the workshops attended, please CLICK HERE.

Next Report: The 26th Annual International Society for ECT & Neurostimulation (held in conjunction with the Annual APA meeting); May 15, 2016.

Robin T. Reesal MD
Rwanda Psychiatrist

Dr. Robin Reesal, Newsletter Chair of the Society from 2012-2014, has been working with his wife, Helen Ewing, RN, DHSc, in Rwanda, and has shared us his personal journey and insights into the culture and the people of Rwanda.  Our thanks to Dr. Reesal for opening our eyes and hearts to the beautiful diversity of the world we share.  

My two years in Rwanda have rekindled family memories of the lifestyle associated with growing up in a resource poor country. I can better appreciate the opportunities my family gave me by coming to North America. 

Storytelling is one of the oldest and most traditional ways of sharing information. I hope that sharing my experiences I will add to the readers understanding of cultural diversity. Multiculturalism is playing a greater role in mental health as North American demographics change. Alterations from DSM IV to DSM 5 reflect psychiatry's awareness of cultural differences and its importance to clinical practice.

The past - suburbs    
There are limited opportunities for advancement when growing up in a resource poor country. Many non-governmental agencies and religious organizations provide educational opportunities for children in these places. If one is lucky enough to attend a private school and have parents who can pay for the books and clothes, advancement is possible. My father was one of those children who benefited from a private school education after the Second World War. His father worked hard and sent their son to a boarding school before age five. Tearful Sunday good byes were the norm for mother and son.

When I walk down the dirt road to our house in Kigali, Rwanda, I pass through my own family history. I relive the stories told to me by my father. I see the characters he described growing up in his village. I pass the bars, smell the beer and listen to the sounds associated with the soccer broadcasts. I see the men waiting at the day's end for their paychecks, knowing they will cross the street and spend much of it on alcohol before they return to their families.

I pass the barefoot child in dirty shorts and a torn tee shirt with a stick in his hand rolling a bicycle tire. I watch another group of preteens playing soccer with a ball made of paper wrapped with twine. They should be in school but they are not.

The present - downtown 
Some scenes of desperation in downtown Kigali can be distressing. Recently, while waiting for a taxi a young local woman walked up to me and asked for money. She had a baby in her arms. When I did not respond to her initial request, she uncovered on one side and began breast-feeding her baby in front of me. A host of emotions and thoughts flooded my brain.

Walking from work to the University I pass other distressing situations.  Through my eyes, you would have seen a middle-aged man sitting on a tattered cloth blanket he put on a crumbling sidewalk. He sits there with old clothes, unshaven, no legs and a hand out for money. Sometimes I see him coming or going from his spot. You see a small figure wobbling from side to side "walking", using his arms as legs, to go down the street.

On another day a young Rwandan man I do not know, dressed in a suit asks his motorbike taxi to stop.  There is panic on the man's face as he races towards me. There are tears in his eyes as he approaches urgently. He says, "You have to help me! My daughter is in the hospital and she needs surgery. I do not have the money to pay. Can you lend me the money? I have a job, I can pay you back."

A few months ago, a friend and his wife told me of their experience. They found a woman lying in the grass on the side of the road who needed medical attention. They brought her to their house. Locals helped them attended to her.  The woman recovered within a few hours with water and food. She had come to the city looking for work. She had no money, no job, no shelter and no support.  She had not eaten in three days.

Another view of African life 
When I walk down my dirt road or travel in Rwanda and other developing countries, I see Mercedes cars and Lexus cars, as if I was in Scottsdale. The drivers and occupants are dressed to suit the lifestyle the cars represent.

One can rent a house or apartment that is reminiscent of North America or Europe. The amenities can include 4G internet, electricity, hot water, upper end furnishing and a monthly rent of 2,500 to 3,000 USD.

My office is in an 18-floor office building with an atmosphere that is similar to any North American metropolitan center. This Africa is close to "home" in atmosphere and appearance. Life here represents the future and a growing middle class that is connected to multinational industries.     

Safety versus freedom
I can safely walk in my Rwandan neighborhood past the bars and surrounding poverty. Could I do this in most African countries? No. Would I attempt to do this in another African country? No. The strong Rwandan military presence and emphasis on law and order allows me this option. The price for safety is a heavy military and top down authority. This can mean limiting personal freedoms for some. Rwandan officials follow the principle that safety and stability enhances the business atmosphere.  \

Rwandans can participate in their countries future through local and national elections. There is a parliament with high number of women backbenchers. Rwandans have access to local, national and international newspapers, radio stations and T.V. stations. They have internet services. 

The value of life
Do people value their lives here? Absolutely. However, death and dying is a part of daily life, perhaps more so than North America. Health care is not the same. A lack of human and medical resources can make the difference between survival and death. What may be a simple medical fix at home can be complicated here. People die of malaria a common condition. In the last two weeks we have watched two professionals grieve the loss of their spouses. One of these losses was the chair of the department of psychiatry. The man who built Rwandan psychiatry, less than 60 years old, is no longer here. Yes, his wife and children valued his life, as so many of us did.
Colonialism vs nationalism
The battle of "colonialism" and "nationalism" continues. It is the backdrop to the individual stories. This tug of war plays a role in the delivery of resource poor countries around the world. I have yet to see an easy solution to this issue which negatively colors many lives. The friction over this topic hovers over workplaces and has brought patients to my office.   

The brighter side
In Africa, there is resilience, strength, courage and innovation. One young African man I met is setting up an employee assistance programs. He and his North American business partner have trained Rwandan's to become counselors. An accounting program graduate prevented a suicide of a company employee who thought he was going to be fired during a performance evaluation. His intervention was simple. He asked about suicide, which is not commonly done.

Summing up
African life can be overwhelming, touching and inspiring. Longterm success can be enhanced by remembering the cliché "take one day at a time".
My time here has re-acquainted me with my family heritage. I am reminded of the sacrifices made by immigrant families in Europe and North America to give their children a "better life". Their efforts come to fruition through the kindness of others. 
There is cultural richness within our Arizona Psychiatric Society and the communities where we live. Our diversity brings us strength and the ability to understand those we serve.

An updated version of the poster created by the American Psychiatric Association and the Arizona Psychiatric Society to support parity enforcement, "Fair Insurance Coverage: It's the Law," is available here for download (with both English and Spanish translation) and is posted at http://azpsych.org

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