Members Spread APA's Message on the Hill

A force of 91 APA members descended on the nation's capitol on APA's 2005 Advocacy Day in March to educate their representatives and senators on a variety of mental health issues.

“Members of Congress want to hear from their constituents, including psychiatrists, about major issues,” said Nicholas Meyers, director of APA's Department of Government Relations (DGR). “Our Advocacy Day program is designed to prepare APA members to be effective mental health advocates. Participating APA members spend about two days in intensive grass-roots advocacy and communications training and learning about national legislative issues before their congressional visits on Advocacy Day.”

The participants represented 54 district branches and state associations and came from 45 states and the District of Columbia, according to Mazie Fitzgerald, DGR's federal legislative coordinator.

Meyers noted that a larger budget allowed DGR to bring 60 more APA members to Washington this year than for 2004 Advocacy Day.

Among the APA leaders who participated were former APA presidents Richard Harding, M.D., and Marcia Goin, M.D.; Assembly Speaker James Nininger, M.D.; Jeremy Lazarus, M.D., chair of the Council on Advocacy and Public Policy; Tom Noyes, M.D., and Dudley Stewart, M.D., chair and vice chair of the Committee on Government Relations, respectively; and John Wernert, M.D., chair of APA's political action committee, APAPAC.

Grass-Roots Advocacy Works

Collectively, the 91 participants logged 270 visits with members of Congress or their aides, according to Fitzgerald.

Meyers commented, “Grass-roots advocacy on Capitol Hill can affect legislative outcomes.”

For example, Sen. Gordon Smith (R-Ore.), a strong supporter of mental health issues, had introduced an amendment to the Senate budget resolution with Sen. Jeff Bingaman (D-N.M.) to establish the bipartisan Commission on Medicaid, which APA supports, according to Meyers.

Smith, the guest speaker at a reception for APAPAC donors attending Advocacy Day, “expressed his concerns about the impact proposed cuts to Medicaid's budget would have on Medicaid recipients with mental illnesses,” explained Meyers. “Sen. Smith urged APA members to raise these concerns when they met with their senators the next day.”

Apparently they did just that. Shortly afterward, the Senate passed the Smith-Bingaman amendment, which eliminated the cuts and established the Commission on Medicaid.

Prescription Drug Benefit

Many APA members were interested in a presentation on how the final federal regulations for the new Medicare Part D prescription drug benefit will be implemented this year. Mental health advocates are concerned about the lack of safeguards for mentally ill individuals who currently receive drug coverage under Medicaid. Beginning on January 1, 2006, they will be covered under Medicare Part D. Thousands of these beneficiaries, known as dual eligibles, may experience gaps in coverage when their Medicaid outpatient prescription drug coverage ends, according to Jennifer Bright, vice president for state policy at the National Mental Health Association, who spoke at the Advocacy Day program.

Health legislative aides to House and Senate members who have supported legislation on mental health issues briefed APA members about various initiatives including congressional caucus briefings on substance abuse and parity legislation for mental health services (Psychiatric News, April 15).

Staff of APA's Office of Communications and Public Affairs discussed a variety of techniques to help APA members engage members of Congress and their aides in conversation and to stay focused on points they want to make about mental health issues.

“I recalled during my congressional visits being advised to use anecdotes or examples to illustrate the negative impact of certain policies on patients,” Harding told Psychiatric News. “I often find that the senator or representative I am talking to knows someone with a mental illness and as a result knows about, for example, the problems resulting from the lack of parity in mental health treatment.”

Anna Dolan, M.D., legislative representative of the Psychiatric Society of Westchester County, said she talked to several legislative aides of New York representatives or senators.

“I found them to be accommodating and eager to understand the issues. It was a good first start, but we need to continue our advocacy efforts if we expect to see any improvements” in laws that affect mental health care, Dolan told Psychiatric News.

Several new participants shared their views on Advocacy Day with Psychiatric News during a reception for participants.

“I underestimated how interested and receptive members of Congress or their aides would be in what I had to say about mental health issues,” said Michael Genovese, M.D., J.D., a member of the APA Committee of Residents and Fellows.

Genovese joined a delegation of APA members from the New York region for the congressional visits. “I was lucky to have many seasoned advocacy veterans I could observe before I decided to talk to the aide of New York Sen. Charles Schumer. She was very interested in removing barriers to mental health treatment, such as the outdated Drug Addiction Treatment Act.”

That law limits the number of patients that physicians can treat for substance abuse with buprenorphine to just 30. APA is promoting legislation to lift the cap.

Michelle Clark, M.D., chair of APA's Committee of Black Psychiatrists, met with Rep. Donna Christen-Christensen (D-V.I.), founder and chair of the Health Brain Trust of the Congressional Black Caucus, and her senior health legislative aide, Aranthan Jones.

“I had established a relationship with Rep. Christensen before Advocacy Day,” said Clark, “because I viewed the Congressional Black Caucus as a potential resource and partner with the APA Committee of Black Psychiatrists on issues that affect the mental health of minorities.”

She noted that Christensen indicated that she supports most of the issues Clark raised.

“We then had a long conversation about the public mental health system in the U.S. Virgin Islands, which have inadequate resources, infrastructure, and personnel trained in psychiatry or the mental health professions,” said Clark. “I agreed to speak to these and other mental health issues at a June meeting of the local Alliance for the Mentally Ill in St. Croix.”

Tiffany Farchione, M.D., an APA/GlaxoSmithKline Fellow on the Committee on Advocacy and Litigation Funding, had participated in advocacy training and one congressional visit during the APA fall component meetings. She admitted to being anxious about visiting five congressional offices on APA's Advocacy Day.

However, “after the first visit went well,” she said, “I became more confident in my ability to advocate on mental health issues, and the remaining visits were fun.” ▪