Front Matter
Publication: A Psychiatrist’s Guide to Advocacy
A Psychiatrist’s Guide to Advocacy
A Psychiatrist’s Guide to Advocacy
Edited by
Mary C. Vance, M.D., M.Sc.
Katherine G. Kennedy, M.D.
Ilse R. Wiechers, M.D., M.P.P., M.H.S.
Saul M. Levin, M.D., M.P.A., FRCP-E, FRCPsych
Note: The authors have worked to ensure that all information in this book is accurate at the time of publication and consistent with general psychiatric and medical standards, and that information concerning drug dosages, schedules, and routes of administration is accurate at the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice continue to advance, however, therapeutic standards may change. Moreover, specific situations may require a specific therapeutic response not included in this book. For these reasons and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of physicians directly involved in their care or the care of a member of their family.
All names used in case vignettes are pseudonyms, and some details have been altered for privacy.
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Copyright © 2020 American Psychiatric Association Publishing
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First Edition
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Library of Congress Cataloging-in-Publication Data
Names: Vance, Mary C., editor. | Kennedy, Katherine G., editor. | Wiechers, Ilse R., editor. | Levin, Saul M., editor. | American Psychiatric Association, issuing body.Title: A psychiatrist's guide to advocacy / edited by Mary C. Vance, Katherine G. Kennedy, Ilse R. Wiechers, Saul M. Levin.
Description: First edition. | Washington, D.C. : American Psychiatric Association Publishing, [2020] | Includes bibliographical references and index.
Identifiers: LCCN 2020000545 (print) | LCCN 2020000546 (ebook) | ISBN 9781615372331 (paperback ; alk. paper) | ISBN 9781615373116 (ebook)
Subjects: MESH: Community Psychiatry | Patient Advocacy | Patient Rights
Classification: LCC RC454 (print) | LCC RC454 (ebook) | NLM WM 30.6 | DDC 616.89—dc23
LC record available at https://lccn.loc.gov/2020000545
LC ebook record available at https://lccn.loc.gov/2020000546
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
Contents
Contributors
Foreword
Acknowledgments
Part I
Understanding Advocacy
1 What Is Advocacy, and Why Is It Important?
Mary C. Vance, M.D., M.Sc.
Ilse R. Wiechers, M.D., M.P.P., M.H.S.
Katherine G. Kennedy, M.D.
2 Conceptualizing Advocacy
Ilse R. Wiechers, M.D., M.P.P., M.H.S.
Debra A. Pinals, M.D.
Danna E. Mauch, Ph.D.
Kaila Rudolph, M.D., M.P.H., M.B.E.
Katherine G. Kennedy, M.D.
Mary C. Vance, M.D., M.Sc.
3 Where Do We Fit In? Advocating for Our Patients and Our Profession
Eric Plakun, M.D.
R. Dakota Carter, M.D., Ed.D.
Katherine G. Kennedy, M.D.
Advocacy Role Model Interview: Julie Chilton, M.D. Advocacy Through Self-Disclosure
4 How Do I Become an Advocate?
Onyi Ugorji, M.D., M.B.A.
Mary C. Vance, M.D., M.Sc.
Jessica S. Bayner, M.D.
Advocacy Role Model Interview: Jeffrey Akaka, M.D. Advocacy Through Organized Medicine
Part II
Practicing Advocacy
5 Patient-Level Advocacy
J. Corey Williams, M.D.
Mary C. Vance, M.D., M.Sc.
Kristin S. Budde, M.D., M.P.H.
6 Organizational Advocacy
Luming Li, M.D.
Thomas N. Franklin, M.D.
Advocacy Role Model Interview: Ken Duckworth, M.D. Advocacy Through Organizational Leadership
7 Legislative Advocacy
Katherine G. Kennedy, M.D.
8 Education as Advocacy
Katherine G. Kennedy, M.D.
Falisha Gilman, M.D.
9 Research as Advocacy
Stephanie V. Hall, M.P.H.
Jennifer Kononowech, L.M.S.W.
Andrew J. Gerber, M.D., Ph.D.
Steven J. Ackerman, Ph.D.
Kara Zivin, Ph.D., M.S., M.A.
10 Engaging the Popular Media
Daniel S. Barron, M.D., Ph.D.
Kristin S. Budde, M.D., M.P.H.
Jessica A. Gold, M.D., M.S.
Kimberly Yonkers, M.D.
Joan M. Cook, Ph.D.
Advocacy Role Model Interview: Jeremy Kidd, M.D., M.P.H. Advocacy Through Communication With the Public
Part III
Advocacy for Special Populations
11 Advocacy for Children and Families
Debra Koss, M.D., FAACAP, DFAPA
Adam J. Sagot, D.O., FAPA
12 Advocacy for Older Adults
Melanie Scharrer, M.D.
Gary Epstein-Lubow, M.D.
Ilse R. Wiechers, M.D., M.P.P., M.H.S.
13 Advocacy for LGBTQ Patients
Eric Yarbrough, M.D.
14 Advocacy for Immigrants, Refugees, and Their Families
Jennifer Severe, M.D.
Michelle B. Riba, M.D., M.S.
Allan Tasman, M.D., DFAPA, FRCP
15 Advocacy for People With Substance Use Disorders
Myra Mathis, M.D.
Ayana Jordan, M.D., Ph.D.
Bachaar Arnaout, M.D.
16 Advocacy for Military Service Members
John Chaves, M.D.
Rohul Amin, M.D., FAPA, FACP
17 Advocacy for Veterans and Their Families
Harold Kudler, M.D.
18 Advocacy for Patients in Medical Settings
Kaila Rudolph, M.D., M.P.H., M.B.E.
Rebecca Weintraub Brendel, M.D., J.D.
19 Community and Public Sector Advocacy
Jeanne Steiner, D.O.
Allison Ponce, Ph.D.
Michael Rowe, Ph.D.
Kenneth Thompson, M.D.
20 Advocacy for People With Mental Illness at Risk for Criminal Justice Involvement
Debra A. Pinals, M.D.
Danna E. Mauch, Ph.D.
Index
Contributors
Steven J. Ackerman, Ph.D.
Staff Psychologist, Austen Riggs Center, Stockbridge, Massachusetts
Rohul Amin, M.D., FAPA, FACP
Major, Medical Corps, United States Army; Staff Psychiatrist and Internist and Assistant Professor, USUHS-SOM; Program Director, NCC Military Psychiatry Residency Program, Bethesda, Maryland
Bachaar Arnaout, M.D.
Assistant Professor, Department of Psychiatry, Yale University, New Haven, Connecticut
Daniel S. Barron, M.D., Ph.D.
Resident Physician, Department of Psychiatry, Yale University, New Haven, Connecticut
Jessica S. Bayner, M.D.
Child and Adolescent/Adult Forensic Psychiatry Fellow, University of Pennsylvania, Philadelphia, Pennsylvania
Rebecca Weintraub Brendel, M.D., J.D.
Director, Master of Bioethics Degree Program; Associate Director, Center for Bioethics; Assistant Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts
Kristin S. Budde, M.D., M.P.H.
Assistant Professor of Psychiatry, Yale University, New Haven, Connecticut
R. Dakota Carter, M.D., Ed.D.
Medical Director, Rock Prairie Behavioral Health; Medical Director, Brazos Valley Psychiatry; Adjunct Faculty, Texas A&M University Department of Psychiatry, College Station, Texas
John Chaves, M.D.
Captain, Medical Corps, United States Army; Staff Psychiatrist, Blanchfield Army Community Hospital, Fort Campbell, Kentucky
Joan M. Cook, Ph.D.
Associate Professor, Department of Psychiatry, Yale University, New Haven, Connecticut
Gary Epstein-Lubow, M.D.
Associate Professor of Psychiatry and Human Behavior and Associate Professor of Medical Science, Warren Alpert Medical School of Brown University; Associate Professor of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island
Thomas N. Franklin, M.D.
Service Chief, The Retreat at Sheppard Pratt, Baltimore, Maryland
Andrew J. Gerber, M.D., Ph.D.
President and Medical Director, Silver Hill Hospital, New Canaan, Connecticut; Associate Clinical Professor of Psychiatry, Columbia University Medical Center, New York, New York
Falisha Gilman, M.D.
General Psychiatry Resident, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
Jessica A. Gold, M.D., M.S.
Assistant Professor, Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, Missouri
Stephanie V. Hall, M.P.H.
Ph.D. student, Department of Learning Health Sciences, University of Michigan, Ann Arbor; Research Health Science Specialist, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
Ayana Jordan, M.D., Ph.D.
Assistant Professor, Yale Department of Psychiatry, New Haven, Connecticut
Katherine G. Kennedy, M.D.
Assistant Clinical Professor, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
Jennifer Kononowech, L.M.S.W.
Project Manager, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
Debra Koss, M.D., FAACAP, DFAPA
Clinical Assistant Professor, Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey
Harold Kudler, M.D.
Adjunct Associate Professor, Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
Saul M. Levin, M.D., M.P.A., FRCP-E, FRCPsych
Chief Executive Officer and Medical Director, American Psychiatric Association; Chair, Board of Directors, APA Foundation; Clinical Professor, George Washington University School of Medicine and Health Sciences, Washington, D.C.
Luming Li, M.D.
Assistant Professor, Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
Myra Mathis, M.D.
Addiction Psychiatry Fellow, Yale Department of Psychiatry, New Haven, Connecticut
Danna E. Mauch, Ph.D.
President and CEO, Massachusetts Association for Mental Health, Boston, Massachusetts
Eric Plakun, M.D.
Medical Director/CEO, Austen Riggs Center, Stockbridge, Massachusetts
Debra A. Pinals, M.D.
Clinical Professor of Psychiatry, University of Michigan Medical School; Clinical Adjunct Professor, University of Michigan Law School; Director, Program in Psychiatry, Law, and Ethics; Medical Director of Behavioral Health and Forensic Programs, Michigan Department of Health and Human Services, Ann Arbor, Michigan
Allison Ponce, Ph.D.
Associate Professor of Psychiatry, Yale School of Medicine, New Haven, Connecticut
Michelle B. Riba, M.D., M.S.
Professor, Department of Psychiatry, University of Michigan; Associate Director, University of Michigan Depression Center, Ann Arbor, Michigan
Michael Rowe, Ph.D.
Professor of Psychiatry, Yale School of Medicine, New Haven, Connecticut
Kaila Rudolph, M.D., M.P.H.
Attending Consultation-Liaison Psychiatrist, Boston Medical Center; Instructor of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
Adam J. Sagot, D.O., FAPA
Child and Adolescent Psychiatry Fellow, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Melanie Scharrer, M.D.
Geriatric Psychiatry Fellow, Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Jennifer Severe, M.D.
Assistant Clinical Assistant Professor, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
Jeanne Steiner, D.O.
Professor of Psychiatry, Yale School of Medicine, New Haven, Connecticut
Allan Tasman, M.D., DFAPA, FRCP
Emeritus Professor, Chairman, and Schwab Endowed Chair in Community and Social Psychiatry, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
Kenneth Thompson, M.D.
Medical Director, Pennsylvania Psychiatric Leadership Council, Philadelphia, Pennsylvania
Onyi Ugorji, M.D., M.B.A.
Board-certified psychiatrist, Miami, Florida
Mary C. Vance, M.D., M.Sc.
Assistant Professor of Psychiatry and Scientist, Center for the Study of Traumatic Stress, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Ilse R. Wiechers, M.D., M.P.P., M.H.S.
Associate Professor of Clinical Psychiatry, University of California San Francisco, San Francisco, California; Assistant Clinical Professor of Psychiatry, Yale University School of Medicine, New Haven, Connecticut; Associate Director, Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, Department of Veterans Affairs, New Haven, Connecticut
J. Corey Williams, M.D.
Child and Adolescent Psychiatry Fellow, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Eric Yarbrough, M.D.
Past president of AGLP: The Association of LGBTQ Psychiatrists; Chair, Council on Minority Mental Health and Health Disparities, American Psychiatric Association, New York, New York
Kimberly Yonkers, M.D.
Associate Professor, Department of Psychiatry, Yale University, New Haven, Connecticut
Kara Zivin, Ph.D., M.S., M.A.
Research Scientist, VA Ann Arbor Healthcare System; Professor, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
Disclosures
The following contributors to this book have indicated a financial interest in or other affiliation with a commercial supporter, a manufacturer of a commercial product, a provider of a commercial service, a nongovernmental organization, and/or a government agency, as listed below:
John Chaves, M.D. Funding: APA Public Psychiatry Fellowship
Gary Epstein-Lubow, M.D. Member: Advisory Council on Alzheimer’s Research, Care, and Services, Certification Group, Division of Nursing Homes, CMS Center for Clinical Standards and Quality; National Committee for Quality Assurance Exclusions Expert Work Group
Adam J. Sagot, D.O., FAPA Member: Advisory Committee, American Academy of Child and Adolescent Psychiatry; Regional Council of Child and Adolescent Psychiatry Eastern PA/Southern NJ; Advocacy Committee, New Jersey Psychiatric Association; Graduate Medical Education Committee, Rowan University School of Osteopathic Medicine
Mary C. Vance, M.D., M.Sc. Funding: APA Public Psychiatry Fellowship
The following contributors have indicated that they have no financial interests or other affiliations that represent or could appear to represent a competing interest with the contributions to this book:
Steven J. Ackerman, Ph.D.; Rohul Amin, M.D., FAPA, FACP; Bachaar Arnaout, M.D.; Rebecca Brendel, M.D., J.D.; Kristin S. Budde, M.D., M.P.H.; Thomas N. Franklin, M.D.; Andrew J. Gerber, M.D., Ph.D.; Falisha Gilman, M.D.; Stephanie Hall, M.P.H.; Katherine G. Kennedy, M.D.; Jennifer Kononowech, L.M.S.W.; Debra Koss, M.D., FAACAP, DFAPA; Harold Kudler, M.D.; Saul Levin, M.D., M.P.H.; Luming Li, M.D.; Debra A. Pinals, M.D.; Michelle B. Riba, M.D., M.S.; Kaila Rudolph, M.D., M.P.H.; Jennifer Severe, M.D.; Ilse R. Wiechers, M.D., M.P.P., M.H.S.; Kara Zivin, Ph.D., M.S., M.A.
Foreword
As psychiatrists, we are some of the greatest advocates that our patients have. We work on our patients’ behalf every day, convincing insurance companies that a patient needs the mental health care we are recommending, writing letters supporting a patient’s request for workplace accommodations, and educating family members about the patient’s illness and what the patient needs from them to get the most out of psychiatric care.
Advocacy beyond the level of the individual patient, such as before state or federal governments, takes place on a broader scale but is not very different. Rather than promote the interest of an individual patient, we focus on what the community of mental health patients, their psychiatrists, and the overall health care system needs to make quality mental health care accessible and affordable.
As a resident fellow, I was introduced to advocacy when I became a member of the American Psychiatric Association’s (APA’s) Joint Commission on Government Relations, now called the Council on Advocacy and Government Relations. Advocacy giants taught me the importance of having practitioners and patients speak regularly to their legislators on the national and state levels about the difficulties they are facing and how these problems can be solved. It became clear to me that if we as psychiatrists did not advocate for our patients and the profession, we would never achieve parity between mental health care (including for substance use disorders) and all other medical care. And, in fact, that is what we did.
Collectively, the tens of thousands of psychiatrists who belong to the APA combined forces with other advocates for mental health and worked tirelessly for years to convince Congress that mental health was not less significant than cancer or diabetes to the health of our nation. As a result, we saw the passage of the Mental Health Parity and Addiction Equity Act in 2008. This act was a significant step toward equality for mental health care, payment parity for psychiatry, and equity in the treatment of the serious diseases with which our patients struggle. Through actively educating decision makers, building relationships with them and their staff, and repeatedly making personal contact, we can effect meaningful change.
Supporting advocacy in the political context is also extremely important. Through APA’s Political Action Committee, psychiatrists are able to support candidates who are willing to listen to our patients’ stories, promote a mental health agenda that includes better access to care, advocate research funding, and allocate the funds necessary for psychiatric residency programs to meet the growing demand for mental health care.
I quickly learned that we do not need to be professional lobbyists to effectively advocate for our patients and our profession. Indeed, it is often the personal stories of constituent patients, family members, and psychiatrists that are the most persuasive and motivating in conversations with our elected representatives. Our knowledge, experience, professional affiliation, ability to share experiences, and right to vote all give us tremendous power. Psychiatrists are in a position to impact where and how patients receive their care, the quality of care they receive, and the future of our profession.
I encourage all of my colleagues to embrace this opportunity to improve lives and to ensure continued progress in the diagnosis and treatment of mental illness, including substance use disorders. I acknowledge that the beautiful iconic buildings of Washington, D.C., such as the U.S. Capitol, and similarly beautiful state capitol buildings can be very intimidating. However, we need to remember that legislators are influential people and are in a unique position to help or produce challenges for our profession and our patients.
This book helps you build the skills and confidence that make advocacy less intimidating and mysterious in those grand settings of legislators. In addition to discussing the critical work of legislative advocacy, the book also explores multiple other forms of advocacy that can create meaningful change and addresses the specific advocacy needs of several special populations. I am impressed with the expertise and experience of the contributors to this book. Their insights make for a good educational read that provides illuminating facts and case studies that will enable you to engage families, patients, and other physicians to become advocates for improving mental health access and the quality of mental health care in this country.
Enjoy, learn, and act on that knowledge. APA and its advocacy and policy experts are standing by ready to assist you!
Saul M. Levin, M.D., M.P.A., FRCPhysicians-E, FRCPsych
Acknowledgments
The editors would like to thank the following individuals for their generous contributions of time, expertise, and assistance with the process of bringing this book to fruition: James Batterson, Tanya Bradsher, Colleen Coyle, Yoshie Davison, Jon Fanning, Kristin Kroeger, Katie Ling, John McDuffie, Craig Obey, Ranna Parekh, Erika Parker, Debra Pinals, Mary Raucci, Laura Roberts, Patrick Runnels, and Daphna Stroumsa.
In addition, we would like to express our deep gratitude to our families and friends, who helped us with all aspects of our lives, from housework to homework to health issues, while we labored over language and struggled with sentence structures. A special shout-out goes to Marcus and Izzy; Ted, Kiley, and Teddy; and Mike and Maggie.
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Published In
A Psychiatrist’s Guide to Advocacy
Pages: i - xvii
History
Published in print: 31 March 2020
Published online: 5 December 2024
© American Psychiatric Association Publishing
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