NPA Newsletters
November 2025
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President's Perspective
Thoughts from NPA President, Barry Cole
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Nevada Day 2025 Today we celebrate the admission of Nevada to the United States. It was 1864, during the bloodiest period in our nation’s history. Technically, Nevada did not have the population required to be admitted to the Union, but during the Civil War Nevada’s wealth allowed for an exception. Then, like today, the “Golden Rule” was used to justify admission; he who has the gold (in Nevada’s case, the silver), makes the rules. 161 years later, our state’s poor and hungry may be about to have their SNAP benefits taken away. Our lone Republican Congressman is all in for the federal government shutdown, and our Democrats representing Nevada in Congress are all in for keeping the government shut down for as long as it takes to convince the Republicans that they can’t win on the Obamacare issue. For those who are fascinated by the psychosexual thinking of Freud, you have to wonder if it’s genital dimensions that are at play, was a Haldol salt lick used by mistake in the Capitol kitchens, or have all those in Washington, DC suffered lobotomies? 42 million Americans are at risk of food insecurity, and neither the Ds or Rs appear to care. They just posture, lie about the behavior of the others, and are collectively playing “Russian Roulette” with actual people’s lives. What about the majority of Nevadans who are now Non-partisan and believe both parties are feckless. Why can’t we elect anybody with a raised middle finger to either our Nevada Legislature or Congress? They came for our health care; they decided to round up all the homeless and mentally ill; they will potentially come for our food; and on 10/30/25 it was announced that all national guard units in the nation would have 500-member riot control, specialized teams. You want to believe that in your office, you are safe and you have some control over what you do? In your home, you are the “ruler” of your castle? World History teaches us that it’s all an illusion. What you have today is nothing but a transient privilege, not an actual right, and that courts and judges have never stopped despots. Why am I so nihilistic? Why am I so concerned? Why am I even bringing this to your attention? If you think these are normal times, and this is just a passing “phase” let me remind you that in the 1860s around 3/4th of a million people likely perished. Imagine what casualties would be now with the technology available. Our state’s motto is “Battle Born.” We revere our role in the slaughter. Today’s polarization is so toxic that short of aerial spraying of America with anti-psychotics exactly how do we regain balance and remember we are ALL Americans, one “melting pot” people, regardless of the hyphenation we use. We have one collective, made up, sanitized history, so if you (or your grandparents) wanted to be an American, you need to act like one. Remember the “shining city on the hill” and the “beacon of hope” we learned about in school? Nevada Day 2025, is an opportunity to renew our commitment to our belief that we are “one people” with “liberty and justice for all.” I hope we will rise above this collective nonsense, remembering that the greatest quality we may have is taking care of our least well off. Try to remember the actual “Golden Rule” and treat others as we would be treated by them.
Do you read The NY Times? Today, October 29, 2025, the New York Times ran a story about Utah building a campus to mandate housing and treatment for those around Salt Lake City who are unhoused (https://www.nytimes.com/2025/10/29/us/politics/utah-trump-homeless-campus.html?smid=nytcore-ios-share&referringSource=articleShare). In this article, a new 26 acre-campus was described in Las Vegas, intended to “treat” 900 people. That Las Vegas facility will cost $200 million, and exactly who will staff it remains ill-defined. How do you feel about states “disappearing” undesirable people with serious mental health challenges, substance use disorders, or just being poor and not having a permanent home? Do you see any parallels to the involuntary rounding up of all people of Japanese ancestry in the early days of the Second World War? Any similarities to Germany sending Jews, Gypsies, Communists, critics to concentration camps in the 1930s and 1940s? Do you recall the thousands who disappeared from Argentina during the 1980s? In our effort to “clean up our streets” who decides which of us is “undesirable?” Psychiatrists often treat some of the most socioeconomically disadvantaged among us. We provide care in state facilities, Veterans facilities, dedicated SUD facilities, jails and prisons, and often our patients are involuntarily detained, with medications forcibly delivered after procedural reviews. Having hundreds of people compelled to the edge of town, given unwanted treatment, denied basic liberty, sounds like a disaster in the making regardless of what “benevolent intent” our elected officials verbalize. I hope our members of the Nevada Psychiatric Association are troubled by this “criminalization” of mental health services. I hope our members will give this more than passing thought, but imagine a reality where people are picked up, and taken to facilities where they will be “out of sight.” According to the New York Times, the $200 million cost for the Las Vegas campus is being paid for by the area’s casinos. This means that our core Nevada business, gaming and tourism, must be adversely impacted by the unpleasantness of our unhoused population having mental health and substance use challenges. I would suggest that before setting up “concentration camps” we first improve our overall mental health system, you know, the one where we have ranked worst in the US for 11 consecutive years. Perhaps we could invest in “outreach” and mobile crisis alternatives to bring needed services where people actually are living. I am saddened about, and afraid of what is being proposed. Next year we will go to the polls to pick our members of the House of Representatives, one-third of our US Senators, half of our Nevada State Senators and all of our Nevada Assembly. Know who you are voting for, what they say is what they mean, and question them when they are evasive. It’s my belief that the 2026 and 2028 elections will be the most consequential of my 72-year lifetime. Don’t sit these elections out and see what happens. Apathy allows tyranny to grow and flourish.
It’s a beautiful day in the neighborhood October 1, the day we recall the 60 who died in 2017. The day we started a new federal fiscal year, so happy new year, 2026. The day we shut down “non-essential” parts of the federal government because our two party system has reached an impasse. The end of “paper” payments to/from our federal government. Perhaps, the ending of telemedicine and requiring in person office visits? Perhaps, the increasing oversight of nurse practitioners prescribing stimulants to twenty and thirty year old women? Perhaps, the ending of women in the military if they can’t meet top performing male physical fitness standards? Perhaps, using our cities as training facilities for members of the military? Perhaps, deporting everyone not known to be a member of an identified Native American tribe, since none of us had modern visas, and all of us “overstayed.” Yes, this is “in your face” sarcasm. This is questioning every assumption, because our federal government is failing to do its job yet our members of Congress won’t miss a single paycheck or benefit. How many Americas are there? One for those who have substantial means, access to lawyers and accountants, doing their best to pay as little as possible in taxes. One for the majority of Americans, working hard, trying to keep up, hoping to give their children a better life. One for poorer Americans, unsure where their next meal comes from, how they may receive affordable healthcare, wondering if they will be homeless next month. This isn’t about politics, this is about philosophy and values. What does a better country look like? What metric defines a “great America?” I thought the definition of a great country was how well it cared for its least fortunate members. I ask that every member of the NPA take time to reflect, remember, reconsider long held assumptions. There may be major changes ahead, or there may be no changes at all. As we commonly said at NMHI/NNAMHS, the more things change the more they stay the same. The coming year will provide an opportunity to express yourself at a poll near you. Be educated about the candidates. Don’t just vote ideology, but understand that even candidates of your “party” may be ignorant about the issues they profess. Challenge candidates to get past slogans and buzz words, and to provide specific, actionable legislation. Offer to tutor them if you support them. Offer to campaign for them if you believe they will make a difference in Carson City and Washington, DC. Give to our PAC, the NSMA MED PAC, and the APA PAC if you want to see change. If you don’t care, want to freeload, do nothing. Others will try, you may benefit from their generosity, but then DO NOT COMPLAIN about the way things turn out. You don’t have any reason to complain if you don’t care. Welcome to Adult Town, where people put their money where their mouths are. I challenge every NPA member to give $500 to our PAC between now and December 31st. I hope every General Member will contribute $500 per quarter for all of 2026, so we will have the funds needed to be heard in Carson City as well as the Trial Lawyers.
The Price to Open Doors Last weekend, the Nevada State Medical Association, NSMA, held its 121st Annual meeting in Reno. I attended the MED PAC meeting and learned that not too long ago, we could “open doors” for a minimum political contribution of $200. Today, to open doors in Carson City “starts” at $800, and the Trial Lawyers personally give ten times more than any other groups. I have previously written about fund raising for our NPA PAC. I have reviewed our collective giving and can say we only gave $800 to two state senators and $500 to three state assembly members for the 83rd Legislature. This level of giving maybe opened two doors, but we may have left 61 others closed. At the NSMA meeting, we were constantly reminded to give to the MED PAC, and in the MED PAC meeting two people moved around the room with their mobile telephones and a “Square” unit to take our donations. The suggested donation per person was $1000, and we were again reminded that Trial Lawyers give ten times that amount. Let me ask you this question: do you believe change is necessary to move Nevada from worst in mental health in the USA to anything better? I am not wishful enough to think we could ever be best in the country, but worst year after year is awful. Doing the same thing every year and expecting a different outcome is Einstein’s definition of insanity. Will you donate to the NPA PAC, sufficiently to make a meaningful difference? $10, 20 or 50 annually makes no real difference. $250, 500, 1000, or more annually makes a difference. Let me remind you, our own lobbyist said if we had $250,000 in our NPA PAC we would be considered formidable. Please, as we approach the 4th quarter of calendar year 2025, donate generously to our NPA PAC. Help us influence the political process and know that candidates will “declare” in the Spring, and the primary will be in early June, 2026. Medicaid cuts are coming thanks to the BBB, but won’t become effective until after the general election in early November. Please, give often, give a lot, our PAC accepts checks, credit cards, and Zelle contributions. It’s easy to donate, and I plan to do so quarterly for the coming year. What do you plan to do?
Is this another age of anarchy? Yesterday, Charlie Kirk was assassinated/murdered in UT, our neighboring state. I never heard Mr. Kirk speak, didn’t follow him on social media, but believe murdering him was wrong. I am old fashioned, and still hold to an outdated idea that “thou shall not murder.” Two weeks ago children were murdered as they started their school year and attended a religious observance. Every day there is another individual shooting, mass shooting, act of terror. I awaken looking for my Haldol salt lick and wonder what can be done about this? Even Mr. Kirk opined that the price for having a Second Amendment would be some senseless killing, now he is the victim of it. What happened to “free speech?” The idea that adults talk and don’t hit each other, shoot each other. Does the Second Amendment guarantee me the right to kill someone with whom I disagree? I hope in this organization, it does not, and all members know they may freely express their beliefs, whether we agree or not. I shall never come “armed” to our meetings. Between 1890 and 1914 some historians called those years the age of anarchy in the US. Political killings, attempted assassinations, actual assassinations, bombings were common, expected and led to the “Great War.” In the 1950s, 1960s, into the 1970s we saw the rise of racial murders, formation of “Panthers” and eventually the SLA terrorizing Northern and Southern California. The discussion was outwardly political, some talked about their long held grievances and said that injustice had to be addressed by whatever means necessary, but actions taken were mostly judged to be criminal. We counted the dead in Vietnam, AL, MS, and other places nightly as we ate dinner and Walter told us he just “reported the news, didn’t make it.” We tried yet failed to stop communism, extremism, racism, and lost so many people that I wonder now how I even made it. As leaders about mental health what can we do? Nothing, because it’s certainly easiest. Pull the covers up, tell yourself it doesn’t involve you. Avoid everything. Something? What can we do? Make a public statement about our collective disappointment and disgust? Offer our thoughts and prayers? Write strongly worded letters to the editor? Make a PAC contribution to help elect those who may one day make changes for us? Agree that a national day of anti-violence is warranted, and “protest?” Should we go on strike, withhold our services, and refuse to participate in “the system” for a day, week, month until substantial changes happen? I clearly don’t have the best answer, and don’t actually believe there is one best answer. I see this as “incremental” at best, with many, repeated small actions necessary, and that will take time. Do we have that time? How long can we wait and just keep dying? I ask for members' input about these questions, our troubled society’s behavior, and whether continued silence is appropriate for our organization. I may or may not be politically correct for bringing any of this up for our discussion, but if the President of the NPA won’t do it, who will? I am inclined to be a trouble maker. What about you?
Nevada’s Cyberattack If you are not aware, Nevada has fallen victim to a major cyberattack, and Nevadans are experiencing hardship just having basic access to needed services. I have been watching the press briefings on 8/27 and 8/28, talking with our Executive Director, Roberta Again, and determined no major state disruptions impact the NPA directly. That said, our patients are having challenges if they need to access Medicaid, get their car registered, renew their Real ID driver’s license, while State leadership is directing some to local food banks, saying unemployment checks, state payroll and PERS pensions are being processed manually. We are so dependent upon computers, software, systems working when they need to work, it’s terribly disruptive not to have full access. I am challenged without internet 24/7. What’s known is that the attack was detected on Sunday, 8/24, morning, and action was taken to shut down critical components by afternoon. Since Monday, 8/25, some components of state government have been unavailable. Who did this, why did they do it, what information was taken, what outcome was desired by the criminals remains unknown as of 3 pm on Thursday, 8/29. When will all state services be restored is unknown, as is breach of personal information. I have previously written about my belief that NPA can provide leadership for our members addressing disaster preparedness and planning. The Governor said today that the key aspects of disaster recovery involve mitigation and preparedness. Let me conduct a brief thought exercise with you. What are you doing right now to tighten your computer system security? Change any passwords recently? If Las Vegas experiences an earthquake tomorrow, have you backed up your data to an offsite location (cloud)? If electricity is lost due to grid failure, EMP, terrorism, and you are not able to use computers, how will you practice modern psychiatry? Do you have paper forms already made? Do you have carbon paper to make copies? Do you have real prescription pads? Can you practice “pre-electric medicine?” Would you like the NPA’s Disaster Preparedness Committee to develop a manual for surviving whatever may happen in NV? Would you serve on this committee and let your imagination go wild figuring out what we need to do individually and organizationally? When I got my MPA degree I took a class on disaster management and literally assumed these all happened in Las Vegas over a few weeks: fires, volcanic activity, earthquakes, floods, plane crashes into areas of high density housing; we didn’t even begin to think about failure of “just in time” readiness operations. Trying to respond to a bad situation has to happen now, before it occurs, not after it begins to happen. It will then be too late. Please contact me directly or our NPA management team: Roberta Again and Samantha Radler. We need to get started preparing right now. Thanks. B
APA Update On 8/14, the APA’s quarterly update was given. Guiding principles for advocacy in 2025 included: staying focused on psychiatry, mental health and substance abuse; being nonpartisan; partnering across the house of medicine and seeking broader mental health collaborations and alliances; attacking positions with science and evidence-based medicine vs. attacking people; protecting vulnerable communities including institutions and patients; protecting and standing tall on already existing APA policy compendium; respecting that we have membership and staff across all parts of the political spectrum, valuing and acknowledging all perspectives; being strategic, wisely using both public statements and other advocacy levers; working with the new Administration and Congress on both sides of the aisle. Regarding the APA’s Annual Meeting: The Board agreed to pilot 4.5 days of the 2026 Annual Meeting instead of 5 days given the low attendance on Wednesday afternoons and allowing for more convenient coast-to-coast travel for attendees; supported exploring opportunities for sponsoring plenaries, including hospital systems, industry or technology companies and others, staying mindful of utilizing unrestricted educational grant opportunities; approved having the Administration explore a potential clinical trials plenary, including presentations by the clinical trials' Principal Investigators; agreed that a community Psychiatry hub will continue at the Annual Meeting and that APA will not host a separate Mental Health Service Conference in the fall of 2026. Regarding the APA’s Strategic Plan, the APA will develop a comprehensive and actionable strategic plan that aligns APA's unique assets and capabilities with the unmet and emerging needs of psychiatrists, with a clear focus on driving growth in membership, revenue, and organizational impact for APA; through a collaborative, research-driven approach, the project will engage key stakeholders, gather and synthesize qualitative and quantitative insights, and facilitate strategic planning to define 4-5 top-level strategic goals; the outcome will position APA for long-term success by ensuring clarity, consensus, and alignment on a strategic direction that fosters growth and increased member value. I would add that membership in organized medicine is decreasing, the APA has had budget shortfalls, some believe that the APA should take definitive positions, and therefore establishing membership value is challenging. The APA plans to increase money making opportunities, rebrand itself and institute its “OneAPA Culture” refresh that emphasizes civility. Regarding the APA’s commitment to Diversity, Inclusion and Equity (DEI), all required changes to comply with the new federal standards have been made. There will still be a commitment to DEI, but appointments and hiring for key positions cannot be limited to single, defined, individuals. We can expect more changes, and our leadership team in Washington, DC is working hard on our behalf. We will send two members of the NPA to the APA’s Federal Advocacy training in October, Drs. Joshua Fitzgerald (Federal Government Affairs Representative) and Crystal Oden (Chair of the Social Media subcommittee).
Trying not to be political Last year I was told I was too political. I had to laugh, as the NPA is a 501(c)6 organization, therefore by definition is intended to take political positions, and engage in political action. We have a lobbyist on our payroll 24/7/365. Can the NPA challenge and shape our political institutions? I admit, most of us are comfortable in our lives, and won’t be out on picket lines, acting as human shields for the disenfranchised, causing trouble, or writing editorials such as this. That said, have you read the latest edition of the APA’s Psychiatric News (August 2025), with its lead story: “Mental Health Consequences of US Immigration Policy?” It is eye opening. I am troubled by the President’s Executive Order in July that unhoused (aka homeless) people (“Ending Crime and Disorder on American Streets”) will become another “disappearing act.” As a 72-year old, a child of the aftermath of World War II, having family members who died in Nazi death camps after they were rounded up, or just shot where they lived, I am appalled that any American President would so reject the principles that made this country exceptional. Most don’t recall large state hospitals with thousands of patients working on farms, sent there to be housed for life, but there are not enough beds today in Nevada’s state hospitals to “round up” more than a few dozen people. The federal government doesn’t have beds for the expected 750,000 to be involuntarily hospitalized around the US. These trends frighten me because history teaches that when we run out of ghettos to disappear those we don’t want to see, we may decide to kill them. We can only shuffle the deck chairs on the Titanic for so long, then we all drown when the ship sinks. I have my own views about immigration, being the grandson of mostly immigrants, having started medical school in Mexico, but there is a real moral hazard for our society if our best action is forced disappearance, mandated institutionalization, or worse, deliberate extermination. Some will say, “oh, Cole, that will never happen here.” Perhaps I have a less rosy view of humanity than others, and would counter with “it’s already started.” Once we abandon the rule of law, involuntarily hospitalize the unhoused, deport/export to various third-world countries our “unwanted,” how do we look at ourselves in the mirror and not see evil? A dear colleague, and medical school classmate, asked “will this pass the ‘your momma test’?” What he meant, would you do this or that to/for your mother if you would do it to someone else’s mother? Is it time to ask the famous question from the past, “what will you tell your children you did?” Over the coming 15-18 months many cuts will happen in our Nevada Medicaid system (they’ve already been announced). Perhaps there will be a special Legislative session in the Fall, after we know the full extent of the federal cuts and required changes, to fix what we can to protect the vulnerable. Maybe nothing serious will happen or at the 11th hour there will be compromise and reason. Expect to eventually be asked by someone “what did you do?” I hope we all say we advocated, agitated, and aggravated for our patients, our communities, and for ourselves.
We need to raise $250k I spoke with our NPA lobbyist, Ms. Lea Cartwright. According to her, attending the 4 early events where candidates for office are introduced would cost $4000. She also said a few multiples of that might give us the ability to support a couple of candidates. Ultimately, Lea explained that $250,000 would make sure all 63 Legislatures knew who the NPA was, what we stood for, and had the resources to have their attention. This is where NPA’s Political Action Committee (PAC) comes in. We’re in a system where political access often requires financial commitment. If we want legislators to listen, support the bills we draft, and help shape policies that improve our professional lives, then we must strengthen our PAC’s ability to engage. I’ll admit—this wasn’t always my belief. But after working with the Legislature in 2023 as an unpaid citizen lobbyist and again in 2025 as someone who contributed directly to campaigns, my perspective shifted. Money doesn’t buy affection—but in Carson City, it does buy access and a seat at the table. If we want to be taken as seriously as groups like the Trial Lawyers, we need to elevate our efforts. I propose that every NPA member, regardless of membership level, commit to fund the NPA’s PAC for the coming year. Think about how much you want something to change in Nevada, and ask what that’s worth to you? $10/month, your foot’s in the door. $25/month, maybe that opens the door. What about $100-1000/month for 12-15 months? That’s the kind of support that moves the needle. Think of the impact: Monthly contributions from our 120 Resident-Fellow Members and 130 General Members sustained over a year. What could that become for our Government Affairs Committee and Lobbyists to invest in our collective future by the general election in November 2026? Enough to change a regulation you dislike, pass a bill that could make your practice easier, with less prior authorization work, how about putting one of us in office? We have a citizen legislature, no “career” politicians, but it still takes $300,000-500,000 to be elected to the Nevada Legislature. Let’s invest in our future and make our voices impossible to ignore. Your PAC contribution could mean fewer hoops for prescriptions, better mental health coverage, and recognition for your expertise it’s not just politics, it’s personal. Zelle: npapac@nvpsychiatry.org
Fiduciary Responsibility and Financial Management As President of the NPA, I receive emails from the APA daily, and I am asked to attend various training sessions to make sure we run the NPA properly. Recently, I attended the annual “orientation” for new District Branch (DB) officers. What I heard gave me pause, and I want to share some of this with all NPA members, especially those serving on our Executive Council (EC). Our NPA, Is a DB of the APA, it is a lawful business, and must always conduct itself as such. Members of the NPA’s EC are “board members” and “trustees” of the corporation (yes, we are a NV corporation registered with NV’s Secretary of State). EC members have a legal duty for follow NPA’s Constitution and Bylaws, use reliable methods of accounting, make sure the NPA complies with local, state and federal registrations, pays all taxes on time and files an annual 990 form with the IRS even if we have no income. APA keeps a list of “model DB resources” for us to use, and we routinely seek advice from our attorney, CPA, bookkeeper, IT consultant and others. Members of the EC have oversight of our Executive Director’s performance and pay, strategic decisions, finances and policies of the corporation; our Executive Director (ED) implements the EC’s strategies, has day-to-day management of the organization, follows policies of organization (Operation Manual (OM)), ensuring NPA’s EC has what it needs to do its job. Being a member of the EC creates three interconnected duties to the NPA: Duty of Care, Loyalty and Obedience. Duty to care means no heads in the sand, considering all reasonably available information before making a decision, consulting with experts/committee members/other appropriate people to ensure voting is informed, and exercising good faith (honesty and fair dealing). Duty of loyalty means not having conflicts of interest, with sense of unity meaning that those on the EC keep to official positions,, and we respect confidentiality meaning that EC members do not discuss EC meetings other than with other EC members if in doubt, keeping discussion professional and informative, and sticking to what is reported out. Obedience simply means following the rules, all of them. To be clear, all NPA members are welcome to attend nearly all component meetings unless in “closed” or Executive session, but if you are not a member of the committee you do so without voice or vote, as an observer. All NPA meetings are closed to non-NPA members, so do not share meeting links with non-members. The information above most applies to our members of components and the EC. Please “follow the rules.” Know there are legal consequences for the NPA if members do not follow the rules. If in doubt, disclose potential conflicts of interest, large or small, by reading the published agenda in advance, considering your circumstances, and announcing to the group the nature of conflict(s). You may be told that disclosure is adequate, advised to recuse from the discussion/vote, asked to leave the room for a few minutes while there’s discussion and voting, but it’s best to be clear and open about conflicts. Thank you, and please ask for clarification if needed.
Fourth of July Weekend 2025 7/3: Wishing all members of the NPA a wonderful holiday weekend. Please be prudent, safe and have fun remembering the beginning of the US as we now know it. Contact lost friends, think about those who are gone and contributed so much. Know that NPA is evolving, and will continue to change for some time. We are so much more together. Plan to keep you all looped in. Thanks for your membership. 7/4: The “Big Beautiful Bill” (BBB) has passed from the House to the Resolute Desk for signing. What impact this will have on healthcare, remains to be seen. NPA’s FY26 (7/1-6/30) is now in effect for us, and our initial financial forecasts have not been as strong as in prior years, but we are not hurting as an organization. We are belt tightening, compensating, and we need more members to engage, to do some of the work of running the NPA. For 47 years we have been a voluntarily run group. As we remember the nearly 250 years of our nation, let’s keep the needs of those we treat in our thoughts, hope the impact of reductions in Medicaid and SNAP won’t be as hard as predicted, but do what we can to “hope for the best, and prepare for the worst.” That may be the best we can do. There will certainly be fireworks, don’t you think? 7/5: Working today on lists of members of committees, describing what each committee does, and thinking about how best to explain our NPA policy that RFMs will do something to earn free attendance to the ANPU in Las Vegas. Easiest option might be to join a committee, attend 50% of meetings in a year, as is required for our General Members. For those more academic in focus, write an essay when we have the RFM contest in late fall, or develop a poster to exhibit at the ANPU, or organize and present a statewide CME Grand Rounds, or vice-moderate a couple of ANPU sessions with an experienced moderator, or raise money for our NPA PAC, or recruit a non-member to become a member, or whatever you can to “give back.” Organizations live because their members are active, care, contribute, but flounder with apathy. Please, take this new policy seriously, and if you are a RFM, know that you always have access to the ANPU contents for 90 days with virtual attendance. The policy change has to do only with complimentary in-person ANPU attendance. 7/6: The “Big Beautiful Bill” (BBB) has been signed into law. Now we wait to see how the anticipated cuts in 2026 will impact us and our fellow Nevadans. Nothing about what I see or hear warms my heart. I am worried about unvaccinated kids in our schools and communities, potentially having less to eat, while older people may have no nursing home beds for their care, and those in between these two age extremes may experience challenges that we will be expected to fix when they report feeling afraid, anxious, depressed, and ask us, “why are they doing this to me.” If we dismantle healthcare, limit SNAP benefits even for those with demonstrated food insecurity, decide only “working” people and truly permanent/stationary disabled qualify for benefits at all, and our colleges and universities are inadequately funded to provide education or conduct proper research, where do we wind up in 5, 10, 25 years? I don’t know, and assume those who wanted the passage of the BBB didn’t care that much about the details as much as the sound bites. Sadly, this is real life, with no “do overs” planned. Tomorrow and Tuesday, I see my patients face-to-face, Wednesday via tele, and perhaps I will begin to consider generics again for their cost savings, perhaps order fewer labs and imaging studies, try to cut some corners where necessary without compromising quality of care. Maybe I won’t have to do anything for a while as the “cuts” come after the mid-term elections, but I am not planning “business as usual” for this coming year. Are you? What are you considering? Please, let’s start a conversation, share ideas, and craft solutions.
Starting a new fiscal year Our Nevada Psychiatric Association (NPA) financially operates on a fiscal year, July 1-June 30, as does the government of our state. Our Certified Public Accountant (CPA), specializing in non-profit organizations, has the NPA filing its IRS-990 form and paying taxes due because of our lobbying expenditures based on a calendar year. Should you wish to thoroughly understand the finances of the NPA please know that our 990 forms will be different from our monthly and “annual” financial documents used by the members of the Executive Committee (ExC), Executive Council (EC), and the Finance and Budget Committee (FB) for their day to day deliberations and decision-making during the fiscal year. I have promised you transparency regarding the operation of the NPA. You are entitled to any information you wish, but please keep your requests reasonable, and know that we compensate our bookkeeper and CPA based upon their time. I am proud to say that our financial processes work effectively. After months of analysis, lengthy committee discussions, tough decision-making by many hard-working members, I anticipate adequate cash on hand to meet all financial obligations in FY26 starting on 7/1/25. We will continue to maintain sufficient cash reserves for unplanned, unforeseen circumstances; have a generous “contingency” cushion beyond what would be considered “rainy day” funds; continue to make contributions to our long-term investments so we may one day be self-funded without having our Annual National Psychopharmacology Update (ANPU). While you may hear that Chapters will not be as richly funded this year, that holiday parties may have to be self-funded, travel that is not essential to our core operation has been cancelled, meetings are now only virtual, all to reduce our operating costs, we are not having financial problems, but we are actively and intentionally controlling our operating costs during a time of uncertainty. We continue to explore settlement with GAME/Medscape, not litigation, so we may continue to offer the ANPU without potential legal challenges over the similarity of their conference’s trademarked name to ours, there are other economic considerations that could lower our FY26 income while our production costs for the ANPU continue to rise. If you have specific questions, concerns, please contact our Executive Director (ED), Roberta Again or me. As members, you need to know what we do. The NPA belongs to all of its members.
Advocacy Experience July 1, 2025 the NPA-supported, fourth-year resident advocacy experience will begin for Landon Hester, MD, from UNR. NPA will provide 0.1 FTE funding for this unique opportunity, with the goal of giving Dr. Hester necessary preparation to serve as our State Government Affairs Representative. Dr. Hester will work closely with the NPA’s lobbying team, CartwrightNV, in Carson City to communicate our message, make clear our position. He will participate this coming year in Interim Committee, Regional Board, Licensure Board, various Commission and other meetings. Next year, Dr. Hester will work with our Government Affairs Committee members to identify viable candidates in the primary election, then select those winners best matching our interests for support in the general election. As Dr. Hester will follow Dr. Lesley Dickson, the NPA expects that he will acquire the knowledge she had after twenty years with this accelerated education, and be fully prepared to represent the interests of the NPA’s members in the 84th Legislature (Feb-June 2027). Join me in congratulating Dr. Hester, welcoming him as a member of our extended lobbying group, and wishing him much success as our new State Government Affairs Representative.
We passed the FY26 Budget The Executive Council (EC) passed the Fiscal Year 2026 budget on Thursday night, 6/26/25. We will be operating a lean budget for the coming year, using some of our cash reserves to cover expected deficits, but still have sufficient reserves for other urgencies that may arise. There will be no travel in the planned budget, all meetings of any size will be virtual other than the Annual National Psychopharmacology Update (ANPU), limiting activities from the central office to the chapters, exploring ways to bring more value to membership, and every effort to limit spending. This is a fundamental change for the NPA as we evolve into a functioning non-profit corporation, planning for long-term self-funding, making fewer “one off” decisions, and having the NPA operate consistently and predictably. At our last EC meeting we put our developing Operation Manual (OM) in effect, and over the coming year we will take steps necessary to align our OM with our Constitution and Bylaws (C&B). In the future, NPA will have processes to operate, a governance structure to make decisions, committees that deliberate and recommend, with an EC to decide and implement. The NPA in July 2026 will not be the NPA in July 2025. Please let us know what you think about this evolution. Do you have ideas or suggestions? Will you join one of our 20+ committees? We make this organization better together. Thanks.
NPA members, Where’s the NPA going? There are about 275 of us in the NPA. One-third are in greater Reno, and two-thirds are in metro Las Vegas. We keep a lobbying team on retainer, and track the activities of Legislature when in session, and then monitor interim committees, commissions, and news stories the rest of the year. What do you believe matters for us as Psychiatrists practicing in NV? What should we speak about? Is it just access to us specifically? Is it access to any mental health care? What about insurance payments? Absence of prior authorization? Social issues that impact our patients and us equally? Opportunity for more necessary licensure-related education, perhaps having a quarterly state-wide grand rounds, in addition to our Annual National Psychopharmacology Update? Please let our Executive Director, Roberta Again, know what’s important for you. We are trying to make the NPA more member-responsive. Your voice matters. B
At the May Executive Council (EC) meeting the Operation Manual (OM) was approved. After 47 years, the Nevada Psychiatric Association (NPA) put an OM into place. It’s still a work in progress, and needs your help to make it better, align it with our Constitution and Bylaws (C&B). Many parts of the OM cannot happen until we revise the C&B. We are soon posting the OM on the NPA’s website and ask that all members read it, tell us what’s good, bad and ugly. Do you see "unintended consequences” happening? The OM covers: governance structure, component structure, appointments to components, finances, membership, meetings, publishing, affiliates and other entities, central office administration, amendments, with many appendices for supplemental detail. The C&B is intended to be “rigid” and “absolute” while the OM should give us organizational consistency, provide ongoing direction. Over the coming year you will see changes, and we on the EC hope you like these developments. The OM subcommittee has worked for 2 years, and needs your valuable input to make this a “living” document. Thank you!
Have you wanted to be part of a Nevada Psychiatric Association component, but did not know what might be interesting? The NPA has many components, committees and subcommittees, and all of them need more active members. Most are open to all NPA members from residents to life, only a few require that you be a General Member (finished with training). Here are the current components: Annual National Psychopharmacology Update Planning (ANPUPc)-dealing with all activities and matters pertaining to our psychopharmacology update Audit (AUDc)-addressing “audits” should we need one Awards (AWc)-developing new awards and identifying people to receive them Disaster Preparedness (DPc)-getting ready for the “big one” and preparing briefing papers to help us continue practice despite whatever may come Education (EDc)-expanding our statewide education from more than one annual meeting to several educational offerings through the year; launching a statewide Grand Rounds meeting Elections (ELc)-overseeing the annual election we have each February Finance and Budget (F&Bc)-managing the finances, budget and investments of the NPA (the money committee) Conflict of Interest (CoIsc)-identifying conflicts of interest and educating all of us about means to avoid them Constitution and Bylaws (C&Bc)-maintains the NPA’s constitution and bylaws to allow for us to operate the organization Operation Manual (OMsc)-maintains the NPA’s operation manual and makes necessary updates to keep it in conformance with the Constitution and Bylaws Contract (CONTsc)-reviewing all NPA contracts, helping to evaluate opportunities Government Affairs (GAc)-addressing all local, state and federal government activities for which we want to have some voice Federal Government Affairs (FGAsc)-a specific subcommittee only addressing federal government activities State Government Affairs (SGAsc)-a specific subcommittee only addressing local and state government activities Membership (MEMc)-improving the member experience for NPA members, helping to recruit and retain members Distinguished Fellowship (DFsc)-identifying qualified members for Distinguished Fellowship status, and helping those members be recognized and awarded by the APA Fellowship (Fsc)-identifying qualified members for Fellowship status, and helping those members be recognized and award by the APA Nominating (NOMc)-Encouraging NPA members to run for offices, overseeing the development of our slate of officers Outreach (OUTc)-providing support in our communities through other non-profit groups, supporting one-off community efforts, addressing impacts on physician wellness Social Media (SMsc)-positioning the NPA for visibility, enhanced membership communication, and letting prospective members see who we are Membership Engagement (MEsc)-doing more to recruit more to join the NPA, stay in the NPA, and find more value from their membership Public Affairs (PAc)-acting as the spokesperson for the NPA and working directly with the Public Affairs Representative Communications (COMMsc)-assisting Public Affairs with effective communications about NPA’s positions, sponsored activities, and helping with our lobbying with GAC Tellers (TELc)-the group counting ballots when we have elections, and “certifying” the results of our elections While joining a committee may not seem like much, it is very important, so much so, if you attend 50% of any committee’s meetings each year you will be awarded a complimentary registration for the Annual National Psychopharmacology Updated, valued at $990. Please get involved, and discover what is going on at the NPA. By the way, do you have a “long-range” view? We have a couple of planning components addressing 5-10-20 years into the future. Ready to be a “trend forecaster?”