Welcome, and thank you all for taking the time to attend our 2019 Advocacy Training Webinar. Congress has just entered into 116th session, Producing Divided Government for the First Time During the Trump Presidency. As you all prepare to come to Washington, D.C., to advocate before your own members of Congress as the voice of psychiatry and our patients, we would like to thank you for your dedication to our field and for your interest in fighting for the issues facing those with mental health and substance use disorders. Our Department of Government Relations has designed this webinar to ready you for a successful and enjoyable experience. You'll be getting a bird's eye view of how the legislative process works and the fundamental importance of your role in the advocacy process. Whether you have had advocacy experience before or are new to advocacy, we hope that today's briefing and your experience in D.C. produce some aha moments for each and every one of you. I also hope you will take away tips today to use during your advocacy day as well as throughout your careers. Effective advocacy does not result from a single event or a day of training, but rather from repetition, relationship building, credibility, and a sustained commitment psychiatry needs your voice, passion, and insight, not only for this advocacy conference, but throughout the year and beyond. Your commitment to making the voice of psychiatry heard on Capitol Hill and in your state legislatures is vital. You are our voices, you are our advocates, and we are here to help equip you for the maximum success as an advocate for psychiatry during this lobby day and the 365 days a year into the future. And with that, I'd like to pass along to the Chief of Government Relations, Mr. Craig Obey. Thank you, Dr. Levin, and welcome to the American Psychiatric Association's Advocacy Training Webinar. The objective of this webinar is to introduce you to the basics of advocacy on the federal and state level and to help you feel ready to advocate before your representatives. Our goal is to enhance your familiarity with the legislative process, outline how to be an effective advocate, and facilitate your continued involvement in advocacy efforts going forward. We will also put you in touch with all the wonderful resources that APA has to offer to make you the best advocate possible. Now Dr. Patrick Runnels will walk you through what it means to advocate. Thank you, Craig. My name is Dr. Patrick Runnels. I am the Chair of the American Psychiatric Association's Council on Advocacy and Government Relations. Today, I would like to discuss the importance of being an advocate and what it means for psychiatry. Advocacy is your First Amendment right. Every citizen, every association has the right and opportunity to participate in the legislative process. In the APA context, this means drawing on our personal experiences and expertise to advance policies that ensure a strong future for psychiatry. Advocacy is an important means of raising awareness of mental health and substance use issues and ensuring that mental health is on the national or state agenda and in the public consciousness. What is advocacy? Essentially, advocacy is speaking on behalf of or in support of a person, place, or thing. Advocacy can include a wide array of tools, including public speaking, calling or writing your congressman, lobbying, publishing research, or filing an amicus brief. Advocacy through APNA enables you to participate in the legislative and policymaking process, and APA has many tools that can help you with your advocacy month after month, year after year. Meeting with your national legislators in D.C. is only one part of that. APA can also help you with tools for in-state advocacy and through mechanisms like the Congressional Advocacy Network. Government is making decisions every day about the future of psychiatry and the access of our patients to the care they need. We need to be at the table. There's an old saying, if you're not at the table, you're on the menu. That's another way of saying that others with goals that may not comport with yours are consistently advocating. So if you're not, you, your profession, and your patients are vulnerable. Each year, federal and state governments enact hundreds of laws and regulations that have a daily impact on your profession. Advocacy can lead to improvements in policy, legislation, and workforce development, as well as undercut victories that you may have previously achieved. Whenever you prepare for advocacy, you need to focus on your audience and your message. There are three basic steps to advocacy. First, have a purpose. Know your message and what you're asking for. Don't just recite facts and figures. If you can, tell them a story from your practical experience. Second, contact your legislators. Write to them. Call them in a town hall or go meet with them. Get to know them. Advocacy starts with taking the initiative to connect with your lawmaker and becomes increasingly impactful as you build a trusting relationship and educate them on the most important issues to you and your patients. Whether regarding telemedicine, rural psychiatry, the importance of parity and access, you help to set the agenda. Most legislators and their staff are generalists with relatively little deep knowledge about mental health. There are over 120 medical specialties in the United States. Legislators need advocates like you to teach them what distinguishes psychiatry from the others. Through advocacy, legislators can have a better understanding of what a psychiatrist does on a day-to-day basis and can better understand the needs of our ever-expanding field. Third, and I alluded to this a moment ago, learn your audience by building a relationship. When you come to a lobby day, use that either in a continuing step in developing a relationship you've already begun or as the first step in presenting yourself as a resource and building a lasting relationship. That means understanding how you can help them to help you. Later in this webinar, we will discuss the many tools you can use to advocate. But first, let's take a closer look at what lobbying actually is. Let me turn it back over to Craig Obie. Thank you, Dr. Reynolds. Lobbying is an integral part of our democratic political process. Such mythology has actually accumulated over the years about lobbying and lobbyists. Just so you know, most lobbyists don't wear Gucci loafers. Most lobbyists are not mercenaries who are somehow trying to influence government policies through nefarious methods. In fact, most professional lobbyists are mission-oriented, representing professions, issues, and causes like education, business, the environment, energy development, and, of course, psychiatry. Lobbyists provide expertise and can play a central role in helping legislators assess and respond to diverse and competing priorities and points of view. Lobbying is a means of providing information, analysis, and opinions to legislators and government leaders to allow for informed and balanced decision-making. Advocates don't just lobby government officials. It's also important to lobby the public to shape the conversation and advance the agenda in many ways, as well as through the media. Lobbying is a key mechanism through which APA uses persuasive data, the expertise of our members, and storytelling to advance APA's priorities through federal and state lawmaking. It includes defining our legislative goals and working to persuade key decision-makers to support our initiatives and points of view. Sometimes we may provide analyses in support of or opposition to bills already introduced, and at other times we may encourage a lawmaker to introduce new legislation to address a particular issue. But effective lobbying is not just about conveying a point of view. It's also about understanding your audience's point of view, what they find persuasive or unpersuasive, and how to engage them in a way that helps you to achieve your goals. Listening as part of a lobby visit to a legislator or staff can be even more important than actually pushing your agenda. It's also essential to remember that we do not lobby in a vacuum. There's always a context that can impact someone's receptivity to your goals and the parameters of your policy options, as well as things that can happen very quickly during the day that you happen to be there that can impact their thinking. It's essential to continually analyzing changing environments and modifying strategies if necessary to reach our goals. So who is a lobbyist? Take a guess from this list. District branches, APA staff, registered lobbyists, APA executive members, all physicians and their patients and their families, the general public. So who do you think the lobbyists are? Well, all of the above. When people hear the word lobbyist, it often conjures, again, images of backrooms and dealmaking by the professional lobbying class. But the truth is, we are all lobbyists. Effective lobbying requires consistent voices coming from multiple directions, including APA staff, elected officers, DB and SA staff, the membership at large, and our patients and their families. All of these people are psychiatry's lobbyists, and each has a critical perspective to provide for successful lobbying. Now that we've hopefully provided you with a greater understanding about what lobbying itself is, let's dive more deeply into lobbying in the APA context. When the APA lobbies, we're doing so under the umbrella of our organizational mission and vision. Our vision is to leverage our members, all of you, and your knowledge of the best evidence-based practices in psychiatry to influence government action that can serve our patients, our members, and our association as a whole. Our professional lobbyists know and understand how DC works. It is our job to use that knowledge and to bring your expertise to bear in our advocacy. Our goal is to effectively use the knowledge and guidance of our members to advance the priorities of psychiatry. Each year, the legislative agenda and political environment produces differing opportunities and threats. It's our job to recognize those opportunities and threats and work with you to seize or confront them at the right times and in the most effective ways possible. And of course, we use our expertise in the field to guide APA's agenda on Capitol Hill. Our vision is for congressional offices and state local politicians to think of you first, to think of psychiatry as their go-to source of information as they work on issues regarding mental health or substance use disorders. That means continual work by APA staff and by leaders like you to build those relationships and provide the resources policymakers need when they need them. In truth, you are the most effective advocate because you can provide the practical stories and everyday perspectives that drive legislators to make decisions. To discuss that further, I'd like to turn to Dr. Katherine Kennedy to discuss the fundamental importance of your role in our advocacy. Thank you, Craig. Yes, you heard him right. You are the most effective advocate. I'm Dr. Katherine Kennedy. As physicians, we have a distinct advantage when it comes to advocacy. Legislators and their staff want to listen to you because you understand how policy decisions affect the real world. Although APA staff does a great job of building and maintaining relationships with lawmakers and other government officials, they are not voters in these districts. We psychiatrists, on the other hand, are constituents, and we have the personal experiences and knowledge relating to how policies will impact our practices and our patients. And we need to be building relationships with legislators at the local level. Legislators would prefer to hear from an expert constituent, a physician, on health issues. In addition, lawmakers and their staff work on dozens of issues each and every day. It is impossible for them to be experts on every issue that comes across their desk, which can be piled with one-pagers from other single-issue meetings and provider groups. That's why they need to hear from you. You are the expert. Lawmakers and their staff often appreciate the perspective of physicians in training or those just entering practice because you can speak to workforce issues, a top health-related priority, and how you feel about overall trends relating to the provision of high-quality mental health and substance use-related services. Ultimately, lawmakers and their staff will view any physician interested in engaging in meaningful dialogue as a valuable resource. Being active and engaged now enables you to build a reputation and repertoire with your legislators that encourages their responsiveness. And now I would like to turn it back to Dr. Reynolds, who will speak about advocating in Washington, D.C. Now that you know why we lobby, we want to discuss what we lobby for. In order to lobby for something, we need to get the attention of lawmakers who are in the position to help us. This comes down to priority setting or influencing the legislative agenda. Priority setting is defined as the amount of attention or effort spent by an interest group on a policy issue that involves lobbying the legislators. More frequently than not, legislation is introduced for three basic reasons. One, legislators make proposals about issues that are personal, for priorities or interests, for the legislators themselves, their families, and their friends, often in response to their own experiences. Two, legislators prioritize issues of high importance to their districts that will be meaningful to their constituents. And three, legislators are reacting to current events and seeking to leverage them for publicity. During this conference, we will be lobbying for a few key issues. You will all receive the talking points for these issues at your Federal Advocacy Conference in Washington, D.C. Some issues that APA currently works on include mental health parity or assuring equal insurance coverage for our patients' health needs as for physical health coverage, appropriations for issues most important to us, which means funding for programs we support, and other policies that improve patient access to mental health and substance use services. Let me turn it back over to Craig. Thank you, Dr. Reynolds. This section will cover what you need to know about Congress itself, the makeup of the House and the Senate, key committees of jurisdiction, staff roles, and moving legislation forward to give you the background necessary to effectively advocate on Capitol Hill. We are now in the 116th session of the United States Congress. There are 435 voting members in the House of Representatives who are each up for re-election every two years. As of today, there are 235 Democrats and 199 Republicans and one vacant seat in the House. The House is led by Democratic Leader Nancy Pelosi, who is Speaker, and the Republican Minority Leader Kevin McCarthy. The House committees most relevant to the APA are Energy and Commerce, Ways and Means, Veterans Affairs, and Appropriations. The United States Senate consists of 100 members, two from each state. There are currently 47 Senators in the Democratic Caucus, which includes two Independents, and 53 Republicans. Their terms are six years, with approximately one-third of Senators up for re-election every two years. The Senate is led by Majority Leader Mitch McConnell, a Kentucky Republican, and Senate Minority Leader Chuck Schumer of New York. The key Senate committees for APA's efforts are Health, Education, Labor, and Pensions, otherwise known as the HELP Committee, the Finance Committee, the Veterans Affairs Committee, and the Appropriations Committee. In D.C., we work closely with all of these committees and others as well. When you have your fly-in meetings, be sure to check if your member of Congress is on any of these key committees. In a perfect world, this is how a bill would become a federal law. When a bill is introduced, it's referred to the relevant committee. Leadership of the committee will shepherd the bill through the subcommittee, hold hearings on it, and then mark up the bill, which means debate, amend, and consider it, and then advance it to the full committee. The full committee then votes and reports the bill to the floor. In general, only once a bill has been reported from its assigned committee can it be scheduled for consideration by the full chamber. That said, just because a bill is advanced by a committee does not mean it will ever be considered on the floor. If a bill is passed by one chamber, it is sent to the other, where the committee process typically is repeated, but not always. Sometimes a bill may have a companion bill, which is identical or similar to legislation that was already introduced in the other chamber. The chambers can consider their respective versions of the bill simultaneously or wait for the other chamber to act. However, if changes are made to an identical bill, the other chamber is required to consider and vote on the changes. If both House and Senate pass the same version of a bill, then it's presented to the President either for his signature or a veto. Congress can override a presidential veto with a two-thirds majority in both the House and the Senate. So how do bills get written in the first place? In a variety of ways. Congressional staff may or may not draft the legislation themselves. They also have drafting experts to call upon within Congress who help them draft legislation that meets goals of their members, the members who they work for. Sometimes we ourselves will provide draft legislation for consideration. But the main point is to understand that congressional staff are at the center of this process. That is why your meetings are so important, whether you're meeting with a member or their staff. And on this next slide, you'll see the breakdown of who works for each office. Many times, meetings on Capitol Hill will be taken by staff members rather than members of Congress. This is due to the hectic schedule of a member of Congress and the fact that, frankly, a lot of the time the staff are going to be more expert on the issues than the member might be. The typical congressional office has a staff hierarchy similar to what's shown on this slide. When meeting with your representative's office, you'll generally see the member or the chief of staff, legislative director, or a legislative assistant or correspondent. Depending on the office, the most junior staff person could be the primary staffer responsible for your issues. You just don't know. No matter whom you meet with and how young they look, keep in mind that every staff member is responsible for making sure your message gets back to their boss, your congressman or woman. And their impression of you, your knowledge, but also your kindness and your demeanor matters. You want to make them want to help you. These staff members are critical players in the policymaking process. In your meetings, be sure to say that you're a psychiatrist and that you carry the field knowledge and expertise about the priority issues you will discuss with them. Offer yourself as a resource in the future because you are building a relationship to advocate over the long term. Dr. Vito will now share how to effectively communicate with lawmakers. Thank you, Craig. Offices are swamped with meetings, so it is important to keep your meetings concise. There is a saying in sales called, like me, know me, trust me, buy from me. Your goal should be exactly that, be polite, authentic, and to the point. In your meetings, start with a brief introduction that includes mentioning you are a physician, a constituent, and where you practice. Then share your talking points and share real life examples. For example, a psychiatrist could go into a meeting and talk about parity. Instead of just defining parity, I would want to share an example. I might say the following, I had a patient who required a drug for his schizophrenia. Because of his insurance, I needed prior authorization of the drug. I spent three days calling around and trying to get approval. Meanwhile, my patient could have already benefited from the drug. This kind of drug approval is not always required for drugs for physical health ailments. Parity would make it so that prior authorization should either apply to all physical health drugs or not be allowed in general. And then I would close with my ask, enforcing mental health parity is important. I might follow up with a bill number or a relevant article in an email afterwards too. I might also tell a story of a family with a member with a history of substance use disorder who has been in and out of rehabilitation and how that family could go bankrupt if it weren't for finding providers in-network to supply support for their loved ones. Or I could discuss the lack of network options and why insurance providers need to cover mental health services. And then I would tie it back to parity for substance use disorder services. Regardless of your story, let your legislator know that you have a personal stake in how they act on our issues. And always remember to keep the conversation going. This is not limited to advocacy conference. You can schedule meetings throughout the year at your federal legislator's local offices or in Washington, D.C. if you are in town for a meeting or in your state capitol with state representatives. Repetition is key. The more they hear from you and the stories of your patients, the more they'll understand your message. We are happy to send this slide around after the webinar. Here are some simple reminders of what to do and perhaps more importantly, what not to do during your meeting with a legislator or a member of their staff. Don't mention your own personal politics or how they may differ from the lawmaker. Remember you are advocating for the common goals of psychiatry, so set aside your personal politics. Don't stick to data or scientific lingo. Lawmakers prefer to hear your personal stories and how you and your patients are being affected by policy. It's okay to admit you don't know the answer to a question. This gives you an opportunity to follow up with the individual and provide them with the correct answer at a later time. Always remember you are sharing your story and your message. Don't let the member or staff member stray off topic. Keep the conversation focused on your agenda. And some more, don't discuss political contributions. There's a time and place for that and it's not in a legislative meeting. However, if you are an APA PAC supporter, wear your pin to show you're an engaged and active physician leader. Don't wait to hear back from the member or their staff because it will likely will not happen. Always send a follow-up thank you note or email and remain in touch. Don't just let the relationship end with a meeting. Offer yourself as a resource and keep in contact with the office. This will strengthen your working relationship and eventually they will be coming to you for your advice and opinions. This is the most important step to becoming an effective lifelong advocate for psychiatry. Now that you know how to advocate with a strong pitch, we would like to direct you to learn about the wonderful resources that APA has to offer to help facilitate a dedicated role as an advocate for psychiatry from Aaron Phelps, APA State Affairs Director, to talk about advocating at the state level as well as what resources are available to you from the APA. And now, Aaron Phelps, APA's Director of State Government Relations, will take a few minutes to explain how you can engage in advocacy at the state level, whether that involves your state or your federal legislators. This section will cover the available resources for APA members and district branch and state association executive directors for when you return home. You can continue to utilize the advocacy skills and resources you have gained during the conference throughout the year. While you'll be focused on federal advocacy at this conference, it is also important to know how state government relations can benefit you after your meeting. State government relations is composed of a director and four regional directors who oversee state legislative and regulatory issues. State government relations works closely with APA members, district branch and state association executives, and state lobbyists to monitor relevant legislation in all 50 state legislatures and the District of Columbia. When a district branch or state association wants to get involved in state legislation or regulations, we are available to help develop strategy, write letters, testimony, and advocacy materials. We can also help with grassroots alerts to members. It is important to meet with your members of Congress after this conference. Members of Congress rated staying in touch with constituents as being the job aspect most critical to their effectiveness. Congressional staff said that contact from a constituent who represents other constituents has more influence than a lobbyist. Grassroots advocacy is critical for both state and federal legislative initiatives. APA members are encouraged to be involved in these efforts by becoming members of the APA Congressional Action Network. The Congressional Advocacy Network, or CAN, is a program developed to train and energize a national network of psychiatrists who will commit to communicate and build personal relationships with their members of Congress and speak on behalf of APA on issues facing mental health care. Congressional advocates serve as key contacts for the members of Congress so that when important issues come up before the U.S. Congress, APA can quickly get its message to targeted members of Congress through the direct personal communication. APA's Congressional Advocacy Network wants to match a committed psychiatrist with every member of Congress with a strategic emphasis on members of the House Energy and Commerce Committee, Ways and Means, Veterans Affairs and Senate Finance, the Health, Education, Labor and Pensions Committee, and Veterans Committee. Advocates can learn about ongoing efforts in D.C. and in the states by reviewing the monthly APA Advocacy Newsletter or visiting the Advocacy Action Center on the APA's website. Additionally, APA staff is always available to answer any specific question you may have. Psychiatrists are the best advocates for their medical specialty and for their patients. To help psychiatrists excel at advocacy, APA holds federal and state advocacy conferences to engage members and give them the tools they need to succeed. The federal conference brings you to Capitol Hill in Washington, D.C. to advocate before members of Congress in small meetings and share our issues. The state conference trains psychiatrists on how to effectively advocate at the state and local levels and bring that information back into their community. It also addresses topics of legislative interest around the country and is a forum for both learning and sharing successful advocacy experiences at the state and local levels. Both conferences have a butterfly effect. Once one of you begins to advocate and share messages about the issues most challenging to our field, this inspires others to do the same. Advocacy is contagious. Outside of face-to-face meetings and the conference, APA also has many wonderful virtual resources for advocacy. Here, you will see an image of the APA's advocacy platform, Engage. Engage lets you know when APA wants its members to speak up about a particular issue facing psychiatry in Congress or in your state. Pictured here are the APA Federal Advocacy Conference attendees from 2014. We will be taking a similar picture this year. Be sure to sign up for advocacy alerts if you have not already. The APA has many advocacy resources and we hope you will take advantage of them in your time as an APA member. Now let me pass off to our other speakers to wrap up what we learned today. Thank you, Erin. The APA is here to help. We can assist with scheduling meetings, providing information on legislation, and much more. You are the APA's strength. Your voice matters and lawmakers want to know how policy is affecting you and your patients. Remember, if you are not delivering your message, no one else will do it for you. Advocating can be done easily and quickly with the resources APA has available. As a constituent, the lawmaker is representing you and your interests. Your input is valuable and it is your right to have your voice heard. Remember that this webinar does not serve you just for the last hour. We hope that you will take this information on with you into your future activities and advocacy and share it with other members who might be interested in getting more involved. Similar to joining as an APA member, we hope that you consider yourself an advocate for the entirety of your career and will carry this information for many years ahead. You are an advocate every day. You talk to someone about mental health and policy. You will be making connections that will help serve the voice of psychiatry, such as with members of Congress, for many years. You are an advocate for life. Connecting locally with your lawmakers provides federal and state officials the opportunity to witness firsthand how physician-led mental health care assures the health and well-being of individuals suffering from mental health and substance use disorders. By showing them how APA's community of psychiatrists work collaboratively with other professionals to provide better health outcomes, you help lawmakers connect the dots between the policies they write and the work you're doing in the field. Thank you very much for participating in this advocacy training webinar, which was brought to you by APA's Department of Government Relations. Please don't hesitate to contact the department with any questions or comments related to advocacy efforts on the federal or state level. That's why we're here. You can reach the department by email at advocacy at psych.org. Thank you very much.

Advocacy Training Webinar

American Psychiatric Association

mental health advocacy

substance use disorders advocacy

legislative process overview

effective advocacy tips

psychiatrists as advocates