Members Learn About MH Advocacy at APA’s State Advocacy Conference

In his opening remarks at APA’s 2020 State Advocacy Conference, APA President Jeffrey Geller, M.D., M.P.H., summarized its purpose: “Now, more than ever, we as psychiatrists need to be involved in advocacy at the state level,” he said.

The conference took place virtually on Saturday, September 26, bringing together physician advocates, state representatives, and other elected officials to discuss the importance of state advocacy and encourage APA members to become involved. Topics of discussion ranged from the basics of state-level advocacy to how psychiatrists can advance social justice through advocacy.

APA CEO and Medical Director Saul Levin, M.D., M.P.A., noted that the staffs of APA’s Department of Government Relations and its Division of Policy, Programs, and Partnerships have developed robust state advocacy campaigns and model legislation, including those for mental health parity, the Collaborative Care Model, and, most recently, telemedicine. To date, 12 states have enacted APA model parity legislation.

“Our members are our most valuable advocacy assets,” Levin said.

The Basics of State Advocacy

The conference kicked off with a session featuring state lawmakers who outlined key advocacy techniques, including sharing patient stories, concise messaging, and making clear requests.

It is vital that advocates know how the legislative process works in their states, emphasized Illinois Sen. Laura Fine. Many states have part-time legislatures that only meet a few months a year to discuss and vote on thousands of bills. Bringing up an issue with a lawmaker when she or he is not in the midst of a busy legislative session can make the difference in whether the issue gets the attention it deserves.

In terms of the importance of presenting data to legislators, the panelists agreed: It matters, but so do patient stories. “The idea is to present [how the data make a] difference in the lives of our constituents,” said Maryland Del. Terri Hill, M.D., who is also a plastic surgeon. “The stories are what carry the day.”

One of the most important things to keep in mind, the panelists reiterated, is to be patient. The legislative process can take a long time, but making the effort to communicate with legislators is always worthwhile. “Talking about these issues changes attitudes,” said Kentucky Rep. Kimberly Moser. “You are more likely to make a difference and get legislation that you want down the road because you’re laying the groundwork.”

In reinforcing the importance of advocacy, Colorado Rep. Yadira Caraveo, M.D., who is also a pediatrician, pointed out that if physicians aren’t involved, important decisions, potentially related to medical issues, are still going to be made. “And they’re going to be made by people who don’t have experience in clinics with patients,” she said. “There are myriad ways that you can get involved, so just pick one.”

Advocating for Access to Telemedicine

Before the COVID-19 pandemic, there were many barriers to telehealth across the country. In a session that delved into the potential ways that access to telehealth could be expanded beyond the pandemic, participants explained that while many of the barriers have been lifted due to temporary regulations, access still varies by state.

Psychiatrists can advocate for making the flexibilities become permanent in their states (see Psychiatric News). APA’s Department of Government Relations and Division of Policy, Programs, and Partnerships worked with members of APA’s Committee on Telepsychiatry to create model telemedicine legislation for the states, pointed out Shabana Khan, M.D., the session’s moderator and a member of APA’s Committee on Telepsychiatry. The language in that model legislation would make many of the changes that the panelists discussed permanent.

Panelist Avrim Fishkind, M.D., CEO of Empathic Soul Health and a past president of the American Association for Emergency Psychiatry, pointed out how much easier it is for patients to access the care they need via telehealth. It can be incredibly difficult for parents of children with autism to have the children seen in person, he said. “It is pure joy to be able to see patients with autism in their homes.”

“I’m hopeful [the expanded use of telehealth] is a permanent shift toward normalizing the culture of telehealth technologies,” said Steven Chan, M.D., medical director for digital health with addiction consultation and treatment at the Palo Alto VA Health System and co-chair of APA’s Committee on Innovation.

Keris Myrick, M.B.A., chief of peer and allied health professions with the Los Angeles County Department of Mental Health, noted that technology represents social connection. “And social connection is like life and air to people with mental health conditions,” Myrick continued. “There can’t be any more important time than now to make sure people have connection.”

Addressing Social Justice

In a conversation about opportunities psychiatrists have to advance social justice through their advocacy, Jonathan Nez, president of the Navajo Nation, outlined the challenges that American Indians have in accessing culturally appropriate mental health care.

“A majority of providers on the Navajo Nation are not equipped to provide services in a manner that is culturally relevant due to lack of education about the Navajo culture,” he said. “The general perception of how to treat mental health issues among American Indians and Alaska Natives differs wildly from Western medical models.”

Nez said he hoped that the conference would shed some light for members on the importance of discussing these issues with their lawmakers and emphasizing the need for additional resources for American Indians and Alaska Natives.

Oregon State Rep. Andrea Salinas encouraged psychiatrists to think broadly about their involvement in policies. “The issues your patients face are intersectional, and so are the issues we attempt to tackle in the legislature through policy change.”

Mosi Deterville-Makori, deputy director of the Birmingham Office of Peace and Policy, noted the importance of understanding the history and the forces that influence mental health treatments. “We have to revisit the history because the history is informing the present,” he said.

The November Elections

Tim Storey, executive director of the National Conference of State Legislatures, provided an overview of the November state elections. While the presidential election has received a great deal of attention this year (see Psychiatric News), there are almost 6,000 state legislative seats up for grabs in November.

He explained that, since 2018, Congress has passed about 155 pieces of legislation. States, however, have passed over 40,000 bills in the past two years. “Policy in America is happening in the states,” Storey said.

“While this year has been one of the most difficult in recent history, it’s given us the opportunity to talk to our legislators,” Katherine G. Kennedy, M.D., chair of APA’s Council on Advocacy and Government Relations, said in conclusion. “Legislators are looking for answers to the mental health crisis and disparities across the nation, and APA members have the knowledge and passion to help them address these and many other challenges.” ■