APA Members Advocate for Top Priorities, Including Equity, Parity
Abstract
APA’s 2021 Federal Advocacy Conference gave APA members the opportunity to hone their advocacy skills, learn about APA’s top legislative priorities, and share their personal experiences with lawmakers.
Karen Pierce, M.D., learned about the Collaborative Care Model (CoCM) firsthand. After running a busy clinic in Chicago that had a six-month waiting list at one point, she joined a CoCM practice that allowed her to work as a psychiatric consultant for 16 pediatric practices.
“These were practices that were clamoring for mental health care,” said Pierce, a child, adolescent, and adult psychiatrist and clinical associate professor of child psychiatry at Northwestern University. “There were patients in these practices who the pediatricians had tried to connect to psychiatric care, but they could not—not only because of access issues but also because of stigma. Under [the CoCM], they were able to provide care in their offices.”
“Last year we saw incredible advocacy engagement from our membership, with almost 5,600 psychiatrists answering APA’s calls to action, which resulted in nearly 20,000 letters, tweets, or phone calls to lawmakers,” says Saul Levin, M.D., M.P.A.
Expanding access to mental health care through the CoCM is an APA priority, and Pierce shared her experience during APA’s 2021 Federal Advocacy Conference. Her story was an example, she explained, of one of the most important aspects of advocacy: Sharing personal experiences with lawmakers that exemplify what a policy or law would mean to patients and psychiatrists.
The conference provided participants with practical advice on how to advocate effectively with lawmakers and their staffs. “It is imperative that the APA administration and its members be at the forefront as Congress deliberates on legislation that impacts mental health and substance use policies,” APA CEO and Medical Director Saul Levin, M.D., M.P.A., said in his opening remarks. “Advocacy is a cornerstone of the work we all do every day on behalf of psychiatry and our patients.”
The conference was split into two days: an advocacy training on June 5 and virtual Capitol Hill visits during which participants could speak directly with lawmakers and their staffs on June 10. The training day prepped members to speak with legislators about some of APA’s priorities, including mental health equity, mental health and substance use disorder (SUD) parity, the CoCM, telehealth, and graduate medical education (GME).
Advance Mental Health Equity
Earlier this year, the House of Representatives passed the APA-supported Pursuing Equity in Mental Health Act (HR 1475). It was introduced by Rep. Bonnie Watson Coleman (D-N.J.), who was the recipient of APA’s 2021 Jacob K. Javits Public Service Award (see box). Sen. Robert Menendez (D-N.J.) introduced a companion bill (S 1795) in the Senate, and APA staff explained the details of the legislation to attendees so they could urge their senators to support the bill. Watson Coleman joined APA’s virtual advocacy day, spoke to attendees about her legislation, and encouraged APA members to be actively involved in health equity advocacy.
Rep. Bonnie Watson Coleman Receives APA’s Javits Award for Public Service
During APA’s Federal Advocacy Conference, Rep. Bonnie Watson Coleman (D-N.J.) was awarded the 2021 Jacob K. Javits Public Service Award for her commitment and dedication to increasing patient access to mental health and substance use disorder services.
Established in 1986, the Javits award recognizes a federal or state public servant who has made outstanding contributions to the mental health community.
“Rep. Watson Coleman’s leadership is critical to our nation’s mental health,” said APA President Vivian B. Pender, M.D., in a news release. “Her focus on health equities goes beyond simply funding the services that are needed … to a wider lens of understanding how social determinants are impacting the mental health of diverse communities around the nation.”
Watson Coleman helped establish the Congressional Black Caucus Emergency Taskforce on Black Youth Suicide and Mental Health, which aimed to investigate the causes of the increasing suicide death rate among Black youth. In December 2019, the task force released a report titled “Ring the Alarm: The Crisis of Black Youth Suicide in America.” In conjunction with the release of the report, Watson Coleman introduced the Pursuing Equity in Mental Health Act in the 116th Congress, then reintroduced the bill again in March of this year. The House passed the legislation in May.
Watson Coleman is the first Black woman to represent New Jersey in Congress. Before her election to the House of Representatives, she served eight consecutive terms in the New Jersey General Assembly. She became the first Black woman to serve as majority leader and as the chair of the New Jersey Democratic State Committee. She is also the first Black woman to win the Javits Award.
“It’s an honor to work with your association and other activists,” Watson Coleman said at APA’s Federal Advocacy Conference. As the Pursuing Equity in Mental Health Act is now before the Senate, Watson Coleman emphasized that senators need to hear the voices of psychiatrists supporting the legislation. “Your voice is vitally important.”
“Ring the Alarm: The Crisis of Black Youth Suicide in America” is posted here.
The Pursuing Equity in Mental Health Act addresses a number of issues related to mental health equity. It provides grants for culturally competent mental health services, increases authorization funding levels for research and the Minority Fellowship Program and directs resources to federal departments to address health disparities.
“The issues that disproportionately affect Black mental health, such as racism, economic barriers, and social and criminal injustices, will not soon end,” said Dionne Hart, M.D., an adjunct assistant professor of psychiatry at the Mayo Clinic College of Medicine and Science. “It is crucial that we share our unique, sometimes painful, experiences to advocate for those living with serious mental illness.”
Ensure Mental Health and SUD Parity
Last December, Congress passed APA’s priority legislation, the Strengthening Behavioral Health Parity Act. The law provides federal and state governments with more tools and authority to hold health plans and insurers accountable to the Mental Health and Addiction Parity Act of 2008, which prohibits insurers from instituting more restrictive benefit limitations for mental health and SUD care than those that apply to medical or surgical care.
But ensuring that health plans are complying with the parity law is complex and resource intensive, and many states lack the necessary resources to do so. To address that issue, APA is supporting new legislation, the Parity Implementation Assistance Act, that would authorize federal grants to state insurance departments to boost their compliance activities. Sens. Chris Murphy (D-Conn.) and Bill Cassidy, M.D. (R-La.) and Reps. Tony Cárdenas (D-Calif.) and Brian Fitzpatrick (R-Pa.) have introduced the legislation in their respective houses of Congress.
Increase Use of the CoCM
Another APA priority is to expand the use of the evidence-based CoCM, which greatly enhances access to mental health care. When the model is implemented, consulting psychiatrists work directly with behavioral health care managers embedded in primary care offices to oversee psychiatric treatment and offer support on more complicated cases.
Reps. Lizzie Fletcher (D-Texas) and Jamie Herrera Beutler (R-Wash.) plan to introduce APA-supported CoCM legislation in the House. The legislation would provide grants to primary care practices so they can establish the CoCM, because one of the barriers to implementing the model is the associated startup costs. The legislation would also establish national and regional technical assistance centers to work with primary care offices to implement the model. Finally, the legislation would fund research to look at other models that integrate evidence-based mental health care with primary care.
Expand Access to Telehealth
Congress is deliberating how to address telehealth services past the end of the COVID-19 public health emergency (PHE). During the conference, participants learned about several key issues on which APA recommends that Congress act, including permanently eliminating the Medicare six-month, in-person visit requirement before providing telehealth services for mental health care that is scheduled to kick in after the PHE ends; extend the telehealth flexibilities put in place during the pandemic for at least a year after the PHE ends so telehealth services don’t abruptly stop and study the impact of those flexibilities on telehealth; and allow for the use of audio-only telehealth when there are no reasonable alternatives or when a clinician believes it is clinically appropriate.
Increase GME Positions
Earlier this year, the Physician Shortage Reduction Act of 2021 (S 834) and the Resident Physician Shortage Act of 2021 (HR 2256) were introduced in the Senate and House. Conference participants had the option to speak with their lawmakers about these bills, which would create 2,000 additional Medicare-supported GME positions a year for seven years, ultimately resulting in 14,000 new positions. The legislation was introduced by Sens. Bob Menendez (D-N.J.), John Boozman (R-Ark.), and Chuck Schumer (D-N.Y.) and Reps. Terri Sewell (D-Ala.), John Katko (R-N.Y.), Thomas Suozzi (D-N.Y.), and Rodney Davis (R-Ill.).
“As psychiatrists, we have an important role to play in advocating for change that benefits our patients and our medical specialty,” Katherine Kennedy, M.D., chair of APA’s Council on Advocacy and Government Relations, said during the opening remarks. “We must work hard to ensure that our voices are heard.” ■
