It’s Never Too Early to Start Being an Advocate

Being an advocate in Washington, D.C., can be daunting, especially for a physician in training. While one never knows whether or to what extent advocates can influence politics, I know that individuals can make a difference. With health care legislation now making its way through Congress that proposes to cut coverage for millions of Americans and reduce access to mental health care, it has never been more important to act in solidarity with our colleagues and build a voice in Washington.

Recently I had the opportunity to do just that—I was fortunate to be part of a delegation to Capitol Hill with the Yale Department of Psychiatry. My chair, John Krystal, M.D., eagerly supported an “Advocacy Day” for residents and invested much time in preparing two other residents and me for the event. Also, we scheduled meetings with a number of congressional staffers, including those working for members of Congress from Connecticut and our home states, and with both Democrats and Republicans.

Particularly memorable were our meetings with the Connecticut senators’ staffers, including Joe Dunn (Sen. Chris Murphy’s staffer, who admirably wrote the bulk of the mental health reforms for the 21st Century Cures Act), and Brian Steele (an eager health staffer for Sen. Richard Blumenthal). The staffers emphasized that physicians are able to help lawmakers by sharing stories about our patients. We talked about our Medicaid patients who need access to suboxone and discussed the need for auxiliary services including transitional living programs. The Connecticut staffers were very sympathetic and told us to send them more stories about our work.

After the meetings, we went to Rockville, Md., to meet with staff at the National Institute on Drug Abuse, National Institute of Mental Health, and National Institute on Alcohol Abuse and Alcoholism. They enthusiastically told us about their work. It was terrific to hear about their interaction with members of Congress and their staffers and learn how we can help them by sharing information with members of Congress and consumers. It was awe-inspiring to meet the woman who was largely responsible for putting together the Surgeon General’s report—“Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health.”

Our day finished with an illuminative meeting with Anita Everett, M.D., the chief medical officer of the Substance Abuse and Mental Health Services Administration (SAMHSA) and now APA’s president. She told us about SAMHSA’s priorities, including implementation of evidence-based substance use treatment programs and first-episode psychosis programs. We discussed the development of robust behavioral health integration programs and the challenges of charting innovation in mental health.

In summary, I am appreciative that my residency program provides an opportunity to advocate on mental health issues on behalf of our patients and future patients. In addition, I was impressed by the diplomacy and generosity exhibited by everyone with whom we met as they shared their perspectives and experiences. We started relationships with new people and deepened conversations with old friends. Our presence was warmly welcomed, even by people with opinions different from our own.

A quote by Margaret Mead inspires me to continue this advocacy work: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.” Physician advocacy is a professional duty, and individual voices can be heard. There truly cannot be health without mental health. ■