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Continued from page 10 psychiatrists utilize LPS statutes and assess violence risk. Dr. Connor Barn-
hart, UCSF PGY-3 Resident and NCPS Council Co-Representative, presented
the ethical dilemma associated with advocating for a patient’s psychiatric recovery while evaluating
their disability status. Dr. Hannah Potvin, UCSF attending psychiatrist, discussed the challenge of bal-
ancing patient safety, medicolegal precautions and treatment progress in addressing acute-on-chronic
suicidality in the outpatient setting.
Ethics Committee Chair Dr. Marvin Firestone provided commentary after each case. The panel conclud-
ed with a robust and thought-provoking discussion between audience members and panelists.

Dr. Raymond Reyes adds: “The panelists each elucidated types of interactions between psychiatric phy-
sicians and their patients, wherein dual agency or mixed loyalty may occur. One take-home message is
that the physician must do their best to be aware when the beneficence toward the patient challenges
the commitment to the employer, court, insurer or other outside entity. It is only when the doctor is
able to recognize the existence of dual agency that allows for room to act in an ethical and more deci-

2022 DEI Panel Recap

Francis Lu, MD

Dr. Lu is the Kim Professor in Cultural Psychiatry, Emeritus, UC Davis, presented
on diversity, equity, inclusion, and anti-racism (DEIA) resources based on his
webpage at https://www.admsep.org/subpages/resources/deiaresources.pdf.

First, Dr. Lu discussed the changes that relate to cultural and social issues
in the DSM-5-Text Revision (TR) that was published on March 19. In Section I, the
introduction, new sections were added on the impact of racism and discrimination
on psychiatric diagnosis and how attention was paid to these issues in the DSM-5-
TR. In Section II, the Culture-Related Diagnostic Criteria and Codes, Issues and
Sex-and Gender-Related Diagnostic Issues sections were updated with new text
and references. The Other Conditions that May be a Focus of Clinical Attention
are now primarily Z codes instead of V codes with additional guidance for coding
as part of the diagnosis: “A condition or problem in this chapter may be coded 1) if it is a reason for the
current visit; 2) if it helps to explain the need for a test, procedure, or treatment; 3) if it plays a role in
the initiation or exacerbation of a mental disorder; or 4) if it constitutes a problem that should be con-
sidered in the overall management plan.” These conditions or problems correlate well with the social de-
terminants of mental health (SDoMH), as studied by the APA Presidential Task Force on SDoMH: https://
www.psychiatry.org/psychiatrists/social-determinants-of-mental-health-task-force

In section III, the Outline for Cultural Formulation section titles remained the same except for Part D
where “treatment team and institution” was added: “cultural features of the relationship between the indi-
vidual, treatment team, and institution.” Part C entitled “psychosocial stressors and cultural features of
vulnerability and resilience” had the addition of this extremely important sentence: “These [stressors,
challenges, and supports] include social determinants of the individual’s mental health such as access to
resources (e.g., housing, transportation) and opportunities (e.g., education, employment); exposure to
racism, discrimination, and systemic institutional stigmatization; and social marginalization or exclusion
(structural violence).” Secondly, he discussed other DEIA resources at the APA website. The APA Division
of Diversity and Health Equity has an education website on underserved populations: https://
www.psychiatry.org/psychiatrists/cultural-competency/education The Presidential Task Force on Struc-
tural Racism Throughout Psychiatry has a webpage: https://www.psychiatry.org/psychiatrists/structural-
racism-task-force The APA Resource Documents entitled “How Psychiatrists Can Talk to Patients and Fam-
ilies about Race and Racism (2020),” which provides excellence guidance with clinical vignettes, and
“Advocating for Anti-Racist Mental Health Policies with a Focus on Dismantling Anti-Black Racism (2021)”
can be found at https://www.psychiatry.org/psychiatrists/search-directories-databases/library-and-
archive/resource-documents

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NORTHERN CALIFORNIA PSYCHIATRIC SOCIETY Page 11 March/April 2022