Three Yale Department of Psychiatry residents and Chair John H. Krystal, MD, traveled to Washington, D.C. on May 12 to advocate for continued consumer access to behavioral health care in the proposed American Health Care Act of 2017.
Residents Jessica Isom, MD; Luming Li, MD; and Nkemka Esiobu, MD, accompanied Krystal to the offices of eight Senators on Capitol Hill to discuss how the House version of the health reform bill will impact patients, hospitals, and providers. The delegation also visited the National Institutes of Health and met with Anita Everett, Chief Medical Officer of the federal Substance Abuse and Mental Health Services Administration.
The doctors presented each legislative office with a one-page position paper outlining their concerns about the proposed bill. They said the legislation would threaten mental health parity, leave state Medicaid budgets vulnerable, eliminate consumer protections, and overwhelm hospitals due to uncompensated care.
Isom, Li, Esiobu, and Krystal regularly met in the months before their trip to plan the lobbying effort and to decide which Senate offices to visit. Li wrote a personal reflection about their preparation and experience in a piece she titled, "Reflections from the Hill:"
"Advocacy on the Hill can be challenging, since it’s never clear how much a single person or small group of people can impact an issue. However, that fact alone should never stop anyone from doing advocacy work.
Jessica Isom, Nkemka Esiobu, and myself had met with Dr. Krystal regularly to discuss about an advocacy day at the Capitol. We pinned down a date, and met monthly to discuss how and what to advocate for.
Because of the turbulent and volatile political news, our core message shifted from one meeting to the next. One week, we talked about the threatened cuts to the National Institutes of Health (NIH). Then Congress would approve a budget, and threats to overall mental health coverage would come through.
We diligently followed the news and changed our advocacy strategies accordingly. As our scheduled May 12th date neared, we buckled down and proposed to talk about the cuts to essential health benefits and state waivers to Medicaid by the American Health Care Act. (AHCA).
Then the day came.
Our schedule had a slew of congressional healthcare staffers lined up (because Fridays are the day Senators returned to their home state), and we were ready to go. We huddled in the Russell Building basement on Friday morning, and talked about a game plan. Dr. Krystal had brought his belongings to move around, and it felt like we were going on a fun, advocacy family vacation.
8:30 am was our first appointment, with a staffer for Senator Burr of North Carolina. We were excited to snag some homegrown North Carolina peanuts from the office. Jessica voiced an eloquent story about her family and the impact of various healthcare cuts to the North Carolina folks. The staffer was cordial, but did not have much to add beyond that the Republican Senate bill was being worked on, and that it would be a long-haul process for the healthcare bill to be voted on through the Senate and back to the House side again for negotiation and votes.
The next meeting was with Juan Gomez, a staffer from New Jersey. I told him the story of why I chose psychiatry — long wait lines in the ED, difficult practice settings in a time of resource shortage, unimaginable consequences to minorities and threatened vulnerable populations should the AHCA be passed. Juan was cool, and sympathized to our every word. Preaching to the choir was a fun endeavor, but we knew the harder work would be to convince the other side. The New Jersey office showcased some Welch’s fruit snacks to keep our energy high.
We then talked to our Connecticut state senators’ staffers, including Joe Dunn (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 Blumenthal health staffer). We shared stories about our Medicaid patients needing access to suboxone and about the need for auxiliary services including transitional living programs. Our Connecticut staffers were of course sympathetic, and told us to be in touch with more stories about our work. The meeting felt productive and meaningful.
I was appreciative of the fact our residency gives residents the opportunity to advocate for our beliefs and advocate for mental health and research rights on behalf of our patients, future patients, and friends.
Luming Li, MD, Yale Adult Psychiatry Residency Program, PGY-3
In the halls, we met our friends from the Child Study Center at Yale, who were there for a lobbying day for American Academy of Child and Adolescent Psychiatrists (AACAP). Notably, Dorothy Stubbe and Paul Bryant (a child forensics fellow) were there, meeting with Brian Steele right after us. It was nice to say “Hello" and give a couple of high fives before moving on to the next meeting.
We then took a texting and popcorn break at the ground floor of the Hart Building, where the Mountains and Clouds Sculpture by Calder stood. It was large and ominous, and reminded me of the dark and trying times ahead. It was a black, steely structure, man-made, that did not resemble any mountain I’ve ever climbed.
Next up was Angus King’s staffer, Patrick O’Neil. We mentioned a story about the scary and lengthy process to get mental health care in Maine, and that wait times to inpatient admission could take a few weeks. The staffer said he was not surprised, and said Senator King, on his Independent ticket, is very much concerned about the opioid crisis and mental health. He promised that the office personnel would carefully review the Republican healthcare reform bill when proposed. The concerns and questions we raised included some similar thoughts about cutting mental health benefits from insurance.
For our last set of meetings, we had to split up to cover Florida, the other Senator from North Carolina, and Nevada. Nevada was chosen strategically because we wanted to hear the Republican side from a potential Republican sympathizer.
Then we moved around the Congressional Buildings in lightening blitz mode, giving out informational folders to all who cared to receive them. One building was foreboding and forlorn while another had an efficient business character about them. The last had a beautiful elegance to its wickedly lengthy hallways. We stopped by Pat Toomey’s office to drop off a packet, and were encouraged to take some beautiful Lancaster chocolates. We took a few, and went to find Marco Rubio’s office. By the time we arrived, the health legislative staffer was already out to lunch, literally, and we couldn’t set up an impromptu meeting. We lightened our luggage by passing out the rest of our materials to random Senators’ offices along our walk.
As we left the Hill, we were running behind schedule and needed to rush to the National Institutes of Health (NIH) for our next meeting. The NIH was an hour schlep in Rockville, MD. We grabbed a quick lunch at Chipotle and found our way to the NIH, where we met with several legislative policy folks. They hailed from NIDA, NIMH, and NIAAA (an acronym alphabet soup of agencies under NIH’s umbrella). It was terrific to hear about agencies' interaction with Congress and learn about how we could help them by sharing information to the appropriate parties. The staff divulged that advocacy through their agencies can happen in a subtle or not-so-subtle manner.
I learned that broadcasting impartial research findings is important. Cross-agency projects were quite possible, and were both dictated by leadership and legislation. It was heartwarming to see the passionate manner in which the staff talked about their work, and awe-inspiring to meet with the woman who was largely responsible to helping put together this year’s Surgeon General’s report on “Facing Addiction in America." We wrapped up the meeting with a kind handful of Lindt truffles, and then we were off to the horse races to catch a train back to meet with Anita Everett, the Chief Medical Officer of SAMHSA at Union Station.
Anita Everett brought her public health person, Doug Slothouber, to meet with us at the end of a long day. She shared with us about the agency priorities, including implementation of robust substances programs and first episode psychosis programs. One of the poignant points that I heard about was the idea that SAMHSA runs up against specificity vs. broadness with their programming. In addition, the agency needed to find a fine balance between evidence-based medicine and innovative programming. We mused about the possibility of robust behavioral health integration programs, challenges of developing innovation in mental health, and ended on a bright note of gratitude.
All-in-all, the day was refreshing, rainy, and hopeful, reflecting the damper and varied political opinions in Washington. I was appreciative of the fact our residency gives residents the opportunity to advocate for our beliefs and advocate for mental health and research rights on behalf of our patients, future patients, and friends. In addition, I was impressed by the diplomacy and generosity exhibited everyone as they openly shared about their perspectives and experiences.
As a small group, we were able to gather information, share our views, and continue conversations with many offices. We started relationships with new people and deepened conversations with old friends. Our presence was welcomed warmly, even by folks with other opinions.
It never slipped my mind that a small group of thoughtful people could help change the shape of the world, like Margaret Mead once said so brilliantly. We were well-fueled by candy from all parties of the political spectrum, and united by the wise pundits offered by the many smart people we met over the course of a single day.
My hope is that we will continue these advocacy endeavors in the future, locally, institutionally, and nationally. Physician advocacy is a professional duty, and individual voices can be heard. There truly cannot be health without mental health."