Advocacy Has Maximum Impact When We All Speak Up

APA held its fifth annual Advocacy Day a few week ago. This three-day meeting in Washington, D.C., was designed to help our members bring their message to congress. This year, 100 members participated, representing 44 district branches and state associations. I was particularly gratified that one-third of the attendees were residents and early career psychiatrists, advocating for their and our future.

The program, produced by APA's Department of Government Relations (DGR), with assistance from other APA departments, provided training in crafting our message to communicate effectively with elected officials and their staffs. In addition to the intensive hands-on learning, participants also heard from VA Secretary James Peake, M.D., on improving access to mental health systems of care for veterans and their families, as well as representatives from veterans' and families' groups, rural health, the VA, Mental Health America, and Congress on the needs of military personnel and their families (see Original article: Care for Vets, Active Military Focus of APA advocacy Effort).

It is, of course, difficult to measure the direct impact of such sessions. Not only do we represent only one organizaton visiting our elected legislators, who hear from many organizations on a variety of health care issues, but also our ultimate success requires a more consistent and long-term strategy addressed to both policymakers and the public. We have developed a strong partnership between psychiatrists and DGR's staff, who constantly assess congressional activities and forge effective working relationships with congressional staff. But even an excellent staff and the efforts of a small number of dedicated APA members are not enough. We psychiatrists also must communicate with elected leaders to speak on behalf of our profession and our patients.

Our words carry a lot of weight: we are highly educated professionals, we can provide good information to congressional staff, and we vote! In-person visits make the process real, but as busy psychiatrists, we cannot visit Capitol Hill frequently. Nonetheless, we should at least consider meeting with our elected officials during their home visits. These meetings provide an opportunity to tell them what is important to us and our patients. If we can't visit, we can communicate through letters and telephone calls. DGR, in collaboration with APA's Office of Communications and Public Affairs, prepares materials for our use—templates and talking points to assist us so that we can communicate easily with minimal incursion on our busy lives.

As an example, a few weeks ago APA staff sent letters from me to all members of the House of Representatives urging passage of the strongest possible parity legislation (HR 1424) to bring an end to insurance discrimination against psychiatric disorders and urging rejection of any weakening amendments. Your communication with your legislators to put an end to this discrimination is vital. Log on to the APA Web site and follow the prompts to “Advocacy.” Your efforts can make an important difference.

There are additional ways to inform and educate the public. The tragic events of the past several weeks resulting in the deaths of students as well as a New York City therapist focus attention on the relationship of psychiatric illness to violent behavior. These unfortunate events raise public awareness, but they also foster stereotypes and stigma, and can be fertile ground for antipsychiatry groups.

We know that violent behavior in persons with treated mental illness is rare; they are more likely themselves to be victims of violence (Psychiatric News, February 1). Violent behavior by psychiatric patients accounts for less than 5 percent of all reported violence, and the most reliable predictors of such behavior are untreated or undertreated symptoms, substance abuse, and a history of previous violent behavior. Calls for firearm registries or laws may have unintended consequences, diverting attention and funds from mental health services and promoting stigma that may further prevent people from seeking needed care. Episodes of violence also foster accusations that medication itself may predispose to violent behavior, but it is more likely that patients who stop taking medication will suffer a recurrence of symptoms.

Speak up! Provide this information to physicians, health and mental health professionals, teachers, clergy, and others in the community; write an op-ed column (APA staff can help) for your local newspaper, speak on a talk show. Promote care while negating stigma and stereotyping. Put your voice into action for our profession and our patients. ▪