Capitol Hill Fellowship Gives Resident Insider’s View of Legislative Process

It’s been a pleasure and a privilege to serve as the 2014 APA Jeanne Spurlock Congressional Fellow the last six months. The fellowship provides psychiatry residents, fellows, and early career psychiatrists an opportunity to work in a congressional office on federal health policy.

The fellowship was created in honor of the late Jeanne Spurlock, M.D., who was an APA deputy medical director and head of the Office of Minority and National Affairs, as well as a staunch advocate for children and minorities.

My fellowship experience gave me the opportunity to serve on the House Armed Services Committee (HASC) Subcommittee on Personnel.

The fellowship started with lots of background reading on the current reorganization of the military health system, which culminated in a hearing on this topic. I wrote the educational background material for the committee members, the opening remarks of the subcommittee chair, and many of the questions posed to the witnesses. I served as the subject-matter expert during meetings with medical special-interest groups pursuing a relationship with the Department of Defense (DoD) or seeking TRICARE coverage of specific therapeutic modalities.

I was surprised at how often I was called on to review the evidence base of therapeutic modalities that had grabbed the attention of members of Congress. This showed me the importance of a well-organized political action strategy to get your issues taken seriously by elected officials.

Although my recommendations weren’t always accepted, lawmakers appreciated the presence of a neutral physician able to translate the medical literature into lay terms, especially in the area of mental health treatment. In light of the committee’s oversight function, we had many briefings with DoD and the military services’ leaders around their efforts on suicide prevention, improvment of the Armed Forces’ mental health overall, sexual-assault response and prevention, the opening of combat positions to women, and more efficient collaboration with the Veterans Administration, among other topics.

Each fiscal year, the HASC is responsible for passing the National Defense Authorization Act, which sets DoD policy as a companion to the annual appropriations bill that releases funding for defense spending. As the bill cycle heated up, I focused on reviewing and giving recommendations on proposed health care legislative provisions, many of which focused on military mental health. I received a priceless education in diplomacy as I discussed my concerns and recommendations with House members’ staffs and sought compromises that stayed as true as possible to the medical literature in the setting of complex political considerations. My time on the HASC really challenged my clinical and research interpretation skills in ways I did not expect. I also wrote many health-related parts of the bill, including spotlighting the forward-thinking suicide and resilience research that the Army is currently conducting. The bill recently passed the House.

The mentoring and guidance I received during my fellowship was unmatched. Working under the direction of committee staff, I fully participated in all subcommittee activities and was accepted as a member of the team.

Congressional staff are far more accessible and interested in their constituents then they receive credit for. We had meetings and gave professional recommendations regardless of political affiliation or personal views. My eyes were opened to how powerful special-interest lobbies can be, not from the backroom deals seen on television, but by organized grassroots efforts energized by a common issue.

There is no excuse for psychiatrists, and all mental health care providers, to be politically inactive on the local, state, and national levels. Lawmakers need mental health care experts to inform policymaking, and our patients need political advocates. I challenge you to become politically active through APA, your district branch, and the APA Political Action Committee (APAPAC).

I want to give special thanks to the staff in the Department of Government Relations and my subcommittee staff leader for her generous mentorship and teaching. ■