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Of the meetings of members of the American Psychiatric Association, APA's "Joint Institute" is unique. Focusing one year on federal issues, and the next on state issues, the Joint Institute is an intensive course in lobbying and public affairs, and a forum for discussion of psychiatry's political and public relations issues. This year's Joint Institute presented an array of sessions on state issues of interest to psychiatry.
The leaders who gathered recently in Fort Lauderdale, Fla., are those who spearhead legislative and public affairs initiatives in their home states, representing psychiatry and psychiatric patients in a sometimes hostile environment. As in most big organizations, the real work is done by relatively few members, and the people who attend the Joint Institute are those people.
The Joint Institute is an excellent opportunity for them to share experiences, hear of legislative and public affairs advances and defeats, and generally hone their skills in the battles back home. Ron Shellow, M.D., and Richard Harding, M.D., chair and cochair of the Joint Commission on Government Relations, respectively, help shape the legislative portion of the program with the help of the APA Division on Government Relations, headed by Jay Cutler. Nada Stotland, M.D., chair of the Joint Commission on Public Affairs, works with the APA Division of Public Affairs to provide a workshop-style program on public affairs issues. John Blamphin is director of the division.
The core of the institute program is in its plenary session speakers, and probably the wisest advice institute participants heard this year came from state legislators. They spoke as one in repeatedly urging psychiatrists to get involved in dialogue with their state legislators long before they have issues to press.
Arkansas Senator Jay Bradford, urging psychiatrists to develop broad coalitions with other physicians and patients, also said, "You must cultivate a relationship with legislators." Legislators, he said, received hundreds of letters and other communications from constituents, and psychiatrists need to "put a face on your letter" by getting to know the legislator in advance of seeking his or her support on a particular matter.
Connecticut Senator Kevin Sullivan commented that physicians are generally a "weak community" in influencing legislation and that legislators are frequently not well informed on parity issues. The process of advocacy, he said, is never a "one-shot" effort, but requires sustained, continuous work with legislators. He urged psychiatrists to stay with the message that "Treatment Works."
Ohio Representative Charleta Tavares agreed with Sullivan that more education must be done on parity issues. She also suggested that psychiatrists can "help us by making sure your patients are registered to vote."
Other legislators zeroed in on specific issues. Louisiana State Representative Jerry Thomas, M.D., a legislator and physician, discussed the near-success of a psychologist-prescribing bill in the last term of the Louisiana legislature, and warned psychiatrists that they "must get other physicians on [their] side." Psychiatrists should remember, he said, that "politicians don't like this kind of legislation. They call it a turf battle. You and I know that it isn't." The bill almost passed, he said, because psychologists were successful initially in convincing legislators that they would provide mental health services to patients in coordination with nonpsychiatrist physicians. Thomas himself was the key legislator in the bill's defeat.
The issue of psychologist prescribing provoked the most spirited discussion of the institute. APA's Shellow predicted that without intense, active opposition from organized psychiatry, one of the state legislatures would likely approve psychologist prescribing within five years.
"We need all of medicine to get behind us," Shellow said. "This is not just psychiatry's problem." He also indicated that the question of nurses' prescribing privileges must be approached differently because they have medical training, although it is limited.
If legislator guests were prominent among those who spoke at the institute, a governor delivered much the same message: Governor Ben Nelson of Nebraska, a state with the only unicameral legislature in the nation, told audience members again what they had heard in the previous two days: Get involved in the election process before you advocate for your cause, and develop a coalition with your patients and have them speak with legislators.
"Mental health care has been the stepchild of the care delivery system," Nelson said, but has achieved wider acceptance today. "We have to stand and fight for it. . . . It can't be the last on a list of priorities."
The practicalities of how an organization such as APA can influence the legislative and public appreciation of the issues faced by psychiatry and psychiatric patients were discussed in several forums during the meeting. Officers of the Kamper Group, which produces "advocacy advertising" such as the "Harry and Louise" commercials aired in opposition to the Clinton health care reform proposal, argued the advantages of an aggressive, multimedia campaign to press psychiatry's issues. They said that one of the major goals of such a campaign would be to "reframe the debate" about parity and other issues. Costs of such a campaign would be high.
Is there a potential on the Internet for advocating psychiatric issues and organizing legislative and public information campaigns? Several speakers thought so. Matthew Sorensen of State Farm Insurance Companies and Bill McCloskey of BellSouth Corporation outlined the comprehensive use of the Internet made by both their organizations for building grass-roots programs and lobbying ("constituent mobilization"). Pointing out that 36 percent of Americans use computers and 25 percent have e-mail addresses, McCloskey suggested that an investment in using the Internet would reap high dividends.
When attendees were not in general sessions listening to expert advice, they were working together in small groups with APA's Division of Public Affairs staff on such topics as "Can't-Miss Media Relations" and "Communicating With Today's Readers." Developing skills as communicators with the media is seen as a key to successful public affairs initiatives.
APA uses the occasion of the Joint Institute to honor legislators who have supported psychiatry and district branches that have excelled in public affairs networking and programs. This year awards went to the West Hudson Psychiatric Society for its coalition activities; the New Jersey Psychiatric Association for a public information project; the Alabama Psychiatric Society for a public information project; the New Orleans Area Psychiatric Association (a chapter of the Louisiana Psychiatric Medical Association) for its public affairs program; and the Ohio Psychiatric Association for coalition activity.
APA's prestigious Jacob K. Javits Public Service Award was presented to Texas State Representative Garnet F. Coleman. Distinguished Legislator Awards were made to Connecticut State Senator Kevin B. Sullivan and Arkansas State Senator Jay Bradford.
APA received support for the Joint Institute from Abbott Laboratories, Bristol-Myers Squibb Company, Eli Lilly and Company, Forest Laboratories, Janssen Pharmaceutica, Pfizer Inc., Pharmacia & Upjohn Inc., Scios, SmithKline Beecham Pharmaceuticals, Solvay Pharmaceuticals, Wyeth-Ayerst Laboratories, and Zeneca Pharmaceuticals.