How to Be an Advocate

Tired of your patients being treated as second-class citizens by the health care system? Tired of you being treated as a second-class citizen by insurance companies? Frustrated at how few beds are available for individuals with mental illness? All psychiatrists have stories to tell about the daily injustices we face while trying to care for our patients. Most of us have gone as far as to muse, “Someone needs to do something about this.” And a few of us—though the number is growing every day—have realized that that someone is us.

It’s not easy to become an advocate, but given the current political situation and upcoming elections, it’s important to get outside your comfort zone and get involved. It may be hard to find time to advocate, and mentors in advocacy may be few and far between. Does this mean we should just go back to our desks and stop trying? No—it means there is an unmet need. Here’s a short, step-by-step guide to help you on your way.

• Step 1: Tap into your moral outrage. Yes, there is a name for that flash of anger you experience when you see a patient or colleague being treated unjustly by the powers that be. It’s moral outrage, a term that my first mentor in advocacy taught me and that captures the essence of what drives many people to advocate. We all have an innate ability to detect unfairness and inequality. What matters is what we do when we come across it. By paying attention to what sparks your moral outrage, you can identify the advocacy areas that you care about most. Focus your energy on these areas, and your moral outrage will be your fuel when you advocate.

• Step 2: Find your crowd. As another one of my mentors would say, “Advocacy is a team sport.” The bigger the problem you’re trying to fix, the more boots on the ground you’ll need to fix it. You need to surround yourself with like-minded people and work together to achieve a mutually agreed-upon goal. This is called coalition building, and it’s a vital skill for an advocate to have. By building—or joining—a group that is advocating for issues you care about, you’ll start to build the strength in numbers you need to succeed. In addition, the connections you make will provide you with invaluable mentorship and resources.

Not sure how to find or build that coalition? Start locally. Ask around in your hospital or practice about who has interest in advocacy. You may be surprised to find how many fellow advocates are out there! Also, APA and the National Alliance on Mental Illness (NAMI) are both excellent starting points. Connect with your APA district branch here and with your local NAMI chapter at https://www.nami.org/Find-your-local-nami.

• Step 3: Be specific. Many would-be advocates falter not from lack of enthusiasm, but from lack of direction. Because the definition of advocacy is broad, and because there is so much to advocate for, it’s easier to be passionate about the general idea of advocacy than to pick a particular topic on which to work. But the more specific you can be about the change you want to see, the more likely you are to succeed in making change happen—both because you (and your coalition) can better focus your efforts, and because policymakers respond best to direct, actionable, and specific guidance.

• Step 4: Make your voice heard. Once you’ve completed the steps above, you’re ready to get your message out to the public. To figure that out who your audience is, identify the stakeholders for your issue—the individuals and groups who have a vested interest in that issue. Of course, psychiatrists and patients will be among them, but so might legislators, insurers, administrators, and others. How you craft and where you deliver your message will differ depending on who your target audience is. For example, telling personal stories (“In my practice, I often experience …”) may be compelling for policymakers, and this may take the form of meeting with them at the state house or giving congressional testimony. In contrast, a board of trustees may be most interested in hearing about ideas that advance its organization’s mission, and your best access to these leaders may come in the form of working with a committee that reports to the board.

Even if you don’t have much time to devote to advocacy, writing to your congressional representatives is a good first step to making your voice heard. Find out who they are and sign up for alerts from APA’s Advocacy Action Center or your district branch to stay informed on current advocacy priorities.

And finally, the work of an advocate is never done, but even small actions make a difference. As psychiatrists, we are privileged to be thought leaders in mental health. We should use that influence to continually improve the care of our patients. ■