Good morning. Welcome to our session. I'm Dr. Dionne Hart. I'm the moderator for today's session, Becoming an Advocate, Moving from Outrage to Outreach. In our clinical work, psychiatrists often encounter systemic problems that trigger our moral outrage. Unless we acquire the advocacy tools we need to advocate for change, we risk exhaustion, burnout, and worse. Unfortunately, psychiatrists receive little or no training in how to advocate for structural change. This session will provide attendees with a framework for how to advocate for policies that help us help our patients, especially those who are structurally oppressed and socially disadvantaged. You will hear stories from our panelists on the front lines of advocacy and also be introduced to common advocacy tools, like how to give an effective elevator speech and best practices for engaging with elected officials to promote legislative change. We hope this will be the beginning of a conversation, so we encourage you to follow us on social media and tag APA Psychiatric and our panelists. The meeting's hashtag is APAAM23. The hashtags for this meeting are Let's Move Medicine and Advocacy. I have the pleasure of introducing our panelists. We have no relevant disclosures, except Dr. Catherine Kennedy is the author of an APA published book, A Psychiatrist's Guide to Advocacy. Dr. Catherine Kennedy is chair of the APA Council on Advocacy and Government Relations. She is a board-certified adult psychiatrist with a private practice in New Haven, Connecticut. Dr. Kennedy serves as an assistant clinical professor in the Yale School of Medicine, where she directs the legislative advocacy track within the Department of Psychiatry's Social Justice Health Equity curriculum and supervises psychiatry residents in psychodynamic psychotherapy. Dr. Kennedy co-edited the 2020 book, A Psychiatrist's Guide to Advocacy. Dr. Catherine Pano is the medical director for Right Track Medical Group in Oxford, Mississippi. She is the immediate past chair of the Mississippi State Medical Association Board of Trustees. She is also the past president of the Northeast Mississippi Medical Society. She also serves as a president-elect of the Mississippi Psychiatric Association, as well as the chair of Council on Legislation. Nationally, she serves as an alternate delegate to the AMA and the AOA. Dr. Pano is a member of the APA and serves on the PAC board. Her advocacy efforts are seen in the creation of an Alzheimer's caregiver program in Mississippi. She is also a national voice in the current fentanyl and mental health crisis, having testified before Congress. Dr. Jaslene Chatwell is an Arizona psychiatrist, active in advocating for her patients, profession, and community. She is a member of APA's Council on Advocacy and Government Relations, past president of the Arizona Psychiatric Society, and board president for Arizona's largest peer- and family-run mental health nonprofit, Hope Incorporated. Working alongside various stakeholders, she made valuable contributions to mental health parity and telehealth legislation in Arizona, opposing scope of practice legislation, and led advocacy with the Arizona Medical Board to reduce barriers for physicians seeking mental health care. Please join me in welcoming our chair. Thank you, Dr. Dionne Hart. You failed to introduce yourself, though. I don't know if this is too loud. All right, so I am going to give a little overview about how we understand advocacy, and then I'm going to turn it over to my panelists to give wonderful real-life examples of advocacy. And then we're going to have a workshop towards the end to help you think about your next advocacy effort and help you to develop an elevator speech for that. You'll see up there the learner's objectives, which is to understand how engaging in advocacy may actually help you avoid burnout. It's not mentioned there, but that's some of anecdotal and early evidence suggests that might be the case. I'm going to explain to you how advocacy is really a skill-based practice, just like how you go through residency training to learn clinical skills. And we're also going to talk a bit about how to better engage with legislators and again the elevator speech. So let's just start with a definition. A couple of ones that I think are very useful are these, that advocacy involves the pursuit of strategies outside the provision of medical care to affect a desired positive change in the health of individuals or communities. Another one is, it's the public voicing of support for causes, policies, or opinions that advance patient and population health. In addition, I think it's really important to underscore that advocacy is for the primary gain and in the best interest of the patient, community, and populations that you serve. And it respects the values of those patients, communities, and populations. It can encompass a wide variety of actions, but I do want to underscore that this is not an opportunity for your personal political speech. Certainly that is a right protected by the First Amendment. You have every right to voice your own personal political beliefs, but that would not be considered physician advocacy. Many of you may not realize that physicians actually have a duty to advocate. This was affirmed by the AMA over 20 years ago that says that physicians should advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being. And this was actually affirmed in 2002 as well by the American Psychiatric Association. So why do we need to advocate? I think many of you already know the answer, which is why you're here on the last day of the conference. But there are really multiple systems and structures that impact the clinical care that we're able to give to our patients. First and foremost, social and structural determinants of health. I want to say a brief word that I'm really delighted to let you know that the APA has just started. Oh sorry, thank you. Here's my little slide. Thank you. Please alert me if the slides somehow disappear. So social and structural determinants of health. I'm really delighted to let you all know that there is now within the APA a brand new caucus of social determinants of mental health, and I encourage you all to sign up for it and get involved. That's one step for moving forward. Certainly who pays for the care that our patients receive can make an enormous difference, whether that is publicly financed insurance, or managed care, or ERISA, or other commercial insurance. The place where the care takes place, those institutions, policies, and procedures can also make a difference. And we've only seen all too well over the last couple of years how the very state in which the care takes place may deny people access to care, especially as we know gender-affirming care and reproductive care as well. So I think I don't need to probably emphasize that as physicians I think that we need to advocate to create systems and structures that can reduce health disparities and inequities, especially for our minoritized and marginalized patients in their communities. Just to tell you that physicians can be highly effective advocates, we know how to work with data. We are respected by by legislators and other people in power, which doesn't mean that we deserve the respect, but it just means that we do have a voice that we can use to amplify the voices of people who might not be listened to. Again, minoritized and marginalized people and populations. And we also have firsthand clinical vignettes which are so compelling, more than data. Data is really important, but when you tell a legislator a story that illustrates a law and what would happen if it was passed or not, that story is going to stick in that legislator's head, and that is going to be the story that they're going to tell their colleagues. So don't overlook that goldmine that you have to offer to legislators. Physicians can advocate at a variety of levels. All of you in here I'm sure have already advocated for your patients at the individual level, maybe to receive a non-formulary medication. At the interpersonal level, maybe you've explained to their family members their diagnosis or what they can do to help support a patient. And some of you may also have advocated at the community level or at your institution to make change. Today we're going to be talking more about advocacy at the state and federal levels, but I have colleagues here at the conference who advocate at the global level for climate change at the COP conferences. There's a lot of things that you can do as a psychiatrist. You can identify problems that are structural or systemic that you see over and over again in your clinical practice. You, as I mentioned, can work with legislators. If you want to get more involved, you can give written or oral testimony, especially in your state. It's really easy to do that to your state legislative committee for a bill. You can write op-eds, which there's so many media outlets looking for content you'd be surprised at how easy it is to get your opinion published. And then certainly collaboration, raising awareness, talking to your colleagues, talking to lay people about the problems. I just want to emphasize, as I mentioned, that advocacy is just a set of skills. It can seem daunting, but if you break it down like any skill set, like clinical skills, into smaller categories, you can start to develop them, practice them. And again, it really helps if you have role models, if you have mentorship, if you basically can start developing your advocate skills during residency training so that you can develop them hand-in-hand. But I was just at a panel a couple of days ago. You can also start later on. It's never too late to start and to be an advocate. I will say that whatever issue you choose to advocate for, it should be something that you feel passionately about. I will never tell anyone what they should advocate for. Advocacy is a long road, and you need to be motivated by your own set of values, what you've learned from clinical encounters, your own lived experience, and so on. The three skill sets, when I say break them down, I mean, these have subsets as well, but I think of them as collaboration, negotiation, and communication skill sets. And just briefly, you know, they interact in all different ways for effective advocacy. Collaboration skills, don't go at advocacy alone. It's a team sport. You need to find other people who you can work with, network with your colleagues, join in, you know, whatever advocacy organization or professional organization in your state, and, you know, and also collaborating means listening to everyone and learning how to see through others' eyes. You already use collaboration skills when you're in teams, on the floors, or in an outpatient setting, and I won't really go into this, but it's really about centering others in your work in terms of collaboration. Negotiation, don't go, just because you have a perspective on a particular advocacy issue, don't think everybody thinks that way. There is always going to be an opponent, and so this is a whole area of thinking about negotiation, which many of you have already done, perhaps, at the end of your residency when you're trying to get a new job, or if you are still in residency, you're going to be probably, likely negotiating, so it's a skill that we use in everyday lives, and likewise in advocacy. One little pearl that I've learned is when you are talking, when you're trying to negotiate, it's really important to just stop and tell the other person, make the ask, make sure you ask a specific question, and then stop, and there'll be an uncomfortable silence, but just stop and wait. Don't talk through your clothes. You need to persevere, accept short-term incremental change, celebrate those changes, and even if it doesn't work out with your opponent, or with your legislator, or whatever you're doing, always express gratitude because you're in this for the long haul, and try to find a way to move forward. You already use negotiation skills in your clinical work when perhaps you're working with a patient to help them understand why they need to take a medication, and you may find ways of talking to them about it. I like what our House Minority Leader said earlier this year, that negotiation really is a way of being able to agree to disagree without being disagreeable. So that's kind of the heart of negotiation. Again, I'm not going to get into this a lot, but the basics of negotiation are you want to kind of identify where you and the other person might be at odds, and clarify that conflict. Maybe with, you know, an easy example that might be accessible for people is with a child who doesn't want to go to bed, and they want another story, and so you may want to kind of say, you know, the conflict is that you need to go to bed, it's after your bedtime, but I tell you what, these are your choices. You can either have a snack, or I'll read you a story, and then you'll go to bed. And so you, you know, depending on the child, sometimes that will work. So that's just kind of a basic idea. Communication skills is actually at Yale what we spend a lot of time helping people try to develop, because there are a lot of common, actually I'll skip ahead, these are a lot of common forms of advocacy communications that are used in advocacy, and they tend to have typical structures, and so feeling comfortable with those structures, knowing what they are, allows you to better do them. And so whether it's an elevator speech, which we'll be talking about the structure a little bit later today, signing, writing a petition that someone will sign, writing a letter or an op-ed, a leave behind or a one-pagers, the term that we use when we meet with a legislative official, and we give them something, a hard copy at the end, or an email, a PDF of what we said. Again, there's lots of different ways. The rest of these are maybe education and awareness to grow grassroots through social media or regular media. But basically, you're going to want to, in all of these, know who you're speaking to, and when I say identify the audience, it really is important that you know, are you speaking to legislators? Are you speaking to the people in your district branch? Are you speaking to your colleagues at work? Is it a more general audience? And knowing who you're speaking to is really important in constructing any advocacy communication. All of these, it's really important to, you may have a hundred reasons why your advocacy issue is the best thing to move forward, but you need to hone them down to maybe three or to five concepts. We don't have enough shelf space in our short-term memory to have more than that, and sometimes if you give too long of a litany, you'll develop some new opponents who may may believe in the first three, but may take issue with the last four, and so you might lose some potential people who would otherwise be on your side. Try not to use jargon and use data, but don't overwhelm people with data. We're comfortable as physicians with data, but be careful about overdoing it. And then always, whenever you engage with somebody, never forget to ask them for the next step, whether it's sign my petition, call your legislator, and make it easy. It's hard to say just call your legislator, help them look up who their legislator is, find their contact information, maybe give them a template for how they might write an email. And basically, for all of these, you want to engage people to care enough about an issue that they'll take that specific action. Two other tips, and I'm going to be done soon, is for any advocate, you really want to make sure that you vote in every election. Elections don't take place every four years. Even with our presidential elections, 55% of the people eligible to vote in the US turn out. It's much, much lower in off years. But those local, state, and federal elections, as many people may have seen recently over the last couple of years, can really make a difference in terms of those state laws. If you're not eligible to vote in the United States, encourage people who can to do so. And kind of a tip for that is, instead of saying, oh, why don't you go and are you going to vote, and the person says yes, it's really helpful to have them imagine, especially if you only have a state where people need to do in-person voting on a specific day, what's your plan to vote? And they might say, oh, I'm going to vote at some point. Well, no, but what's your plan? Are you going to vote before you go to work, or after work, or before you drop off your children? Do you know where your polling place is? Help them create a little visual image in their mind about where they're going to vote, because research has shown that that makes it highly more likely that they will actually engage in that action. Know who your legislators are, your state, and federal, and local legislators. I'm not sure I have time to have you look up your legislators right this second, but I would encourage you to go to any website. If you just Google, look up my legislators, they'll ask you to put in your street address, and you can do so. And you'll find your state and federal officials, usually. This is a good one for openstates.org. It has state and federal officials. But most states, just if you look on the state government website, will be able to do that. And lastly, I was told I could actually have people do that. So all right, so we're going to make people do that, then. I didn't want to take up too much time, but I've been told by my panelists that I'm not. So why don't we do that? So everybody, get out your phone, openstates.org, put in find your legislator. I'm going to give you a little bit of time. All right, so who wants to just raise their hand and let me know who one of their US senators is, one of their federal senators? Just raise your hand or shout it out. Excellent. Great. And back in the room? Yep. So California and Colorado. Who wants to say who their US congressperson is? And I can't recall in this particular website. Sometimes it can be confusing. But upper house means Senate for both the federal and state, if that's how it's indicated. And lower house means Congress. So anybody want to share who their congressperson is? Actually, I'm going to go ahead and just Congressperson is? Excellent. Great. And anybody else? Great. OK, good. Now we're going to move to something a little more challenging, state legislators. In every state but Nebraska, there are people that have state senators and state representatives. In Nebraska, it's a unicameral legislature. Anybody from Nebraska? No? OK. So anybody want to share who their state senator is? And if for, yes, go ahead. And those are upper and lower. Great. Anybody else? Go ahead. And that's your state senator. Do you have your state representative listed there as well? Great. Great. Anybody else? Anybody had any difficulty doing this? Everybody found everybody. OK, great. So now that you know who they are, that's really the first step. And it's really important to, you know, also it's important to understand some people get confused about state and federal legislators. So now that you understand that, actually before we move, well, I'll say something after this. But it's really helpful, especially for your state senators and your house members. It's pretty easy to go to your state website. Usually you can put in, you know, their name, or you could put in your state and government. But take the time, and they should all have websites or have social media accounts, but find out a little bit about them. Like, what committees do they sit on? It'd be really interesting if they sat on the public health committee in your state or insurance. Are they in leadership? And what that means is for most state houses, the party that is in the majority, let's say you in Connecticut, I'll just say in both of our state senate and our state house, the Democrats have the majority. And so what that means for them is that they are able to decide which bills get brought to the floor, which bills get heard in a public hearing. So it really does confer a lot of power. In other states, it may be a mix or a different party. But find out, if they're in leadership and you're their constituent, you can really have a powerful voice in telling them, please don't bring this to the floor or please bring this to the floor. Because especially at the state legislative level, so much legislation is introduced, but it dies in committee or it is never brought to a vote. And so the leadership has that power. And so they will listen to constituents. Find out what their signature issues are. Do you have any personal connection? And then once you do that, the next step is meet them. All legislators, both federal and state officials, are going to be coming into their districts. They want to meet with constituents. A lot of times, they'll hold coffee houses at libraries or other kinds of opportunities to meet people. Go to that. Introduce yourself. They love to be followed on social media. So if you're on social media, follow them. And then the next step, really, and this is for state officials, most state officials have a bare bones staff. They might not even have a full legislative aid. And so they have to vote on hundreds of bills every year. And so if they know that they have a trusted, reliable source of information in you as a constituent, as a psychiatrist, we have a public mental health crisis, as a physician, we just had a pandemic, you could actually develop into a go-to resource for them. I can't tell you how many people have a texting relationship with their state legislator. And so you can actually have a lot of impact on not just the issues you care about, but on the issues that may impact more broadly our patients and populations on social determinants of mental health issues and so on. So before I finish this and we move on to the incredible stories from our panelists, are there any questions about what I've presented today or anything? OK. So seeing none, I'm really excited to have, I will introduce Dr. Dionne Hart, who is, she's actually a distinguished fellow here at the APA and a fellow in addiction medicine, and board certified in psychiatry and addiction medicine. And she practices in Illinois and Minnesota. And is an adjunct assistant professor of psychiatry at the Mayo Clinic. In 2014, she was the Minnesota Psychiatrist of the Year. And in 2017, she received NAMI's Exemplary Psychiatrist Award. She holds local, state, and national positions in organized medicine. And I can tell you, if you get an email from her, her signature is like 10 lines long. I just don't know how she does it. She was the inaugural chair of the AMA's Minority Affairs section. And she is on the assembly here at the APA, a member of the Minnesota Medical Association Board of Trustees, president of the Minnesota Association of African-American Physicians, chairperson of National Medical Association's Region 4, and the AMA liaison to the National Commission on Correctional Health Care Board of Representatives. And in 2020, Minnesota Physician Journal named her one of the best physicians in the country. And Minnesota Physician Journal named her one of the 100 most influential health care leaders in Minnesota. And she was recently recognized by the Minnesota African American Heritage Calendar Committee as an honoree for the class of 2023. So I can't wait to hear her story. Dr. Dionne Hart. Thank you. And before I begin, I want to, if we can, thank Dr. Kennedy for sharing her experience and her pearls of wisdom. So thank you again for joining us. I don't have slides. I just wanted to really talk about my experience. And really, this is going to be like my, I'm going to be the humbled person here. I'm going to talk about a failure. Because I think a lot of people don't get started in advocacy because they worry, what will I do if it doesn't work? And how I will cope? And how will I keep staying engaged in advocacy? So I'm going to ask you, how many people know about the uprising that started in 2020 with the murder of George Floyd? Just know anything, just know. OK. So as was mentioned, I practice in Minnesota. So we were ground zero for that. How many people are aware of organizations, companies, individuals, pledging that they were going to be anti-racist, that they were going to do a lot of corrective actions to make changes? OK. All right. So how many people think that all of those companies and organizations, individuals, followed through? Probably had good intentions, but OK. And how many people think that they suddenly knew the right thing to do overnight? So I'm going to tell you about an experience that I recently had. And I can tell you that when I was thinking about having this conversation, I was like, which failure? So we fail a lot. We have great wins, but we also have some setbacks. So I'm a Michael Jordan fan, and a fan of the real bulls, not the ones today that don't win championships. So Michael Jordan said, I succeed because I failed 1,000 times. So you keep trying, and you stay engaged, even though you may not always win. So because of a lot of drive and momentum to really take an anti-racism stand, some organizations, some individuals have not been able to really measure what that means. So one of my hats is being very involved in the National Medical Association. And I sometimes sit on different boards where I'm still a black woman, still concerned about health disparities, but I'm there to support a different organization. So maybe their policies don't always align, so sometimes I'll just kind of listen. So we were in a meeting of our medical society, maybe just a month ago. And we learned that the commissioners had said, we were going to take a stance, but we decided not to, because we feel it would injure black people. It's like, oh, well, don't do that. Don't injure black people. What are you going to do? And the stance was, we are not going to eliminate menthol cigarettes, because more black people smoke cigarettes, and that would be a racist thing to do. They need to have access to cigarettes. So it just links one of those things where you're kind of curious. So how many people are familiar with the campaign for menthol cigarettes? OK, so kind of a little familiar. So in the 1950s, only 10% of black people smoked menthol cigarettes, right? Menthol cigarettes can be more addictive. You take a larger breath, so you can take a larger breath, so you get more of the smoke and the nicotine in your lungs, which also means more of the chemicals. But the companies really targeted black communities. So today, about 85% of black people smoke menthol cigarettes. When growing up, when magazines like Jet, Ebony, Essence, every other page was like Newport, people being really cool with their cigarettes. They sponsored events at schools and sports and stadiums. They were everywhere. It was cool. All the people did it, right? They were targeted. They were targeted. It was a strategic marketing campaign to get more African-Americans, more black Americans addicted to smoking. It is the number one cause of preventive death. Smoking claims 45,000 black lives every year. Black people die at higher rates of cancer, heart disease, and stroke. So eliminating menthol cigarettes could save up to 654,000 lives and about 255,000 black lives over the next 40 years or so. So it's a big deal. So I'm in this call. And the medical society, the legislative committee, they're talking. And one of my counterparts said, oh, I'm so glad we're not going to do that. Because we have to stand with black people. We have to make sure that they have access to their cigarettes. This would be so racist to do this. And we really shouldn't get involved in doing this. So I'm on the phone. And I'm like, well, I'm just going to speak as a black person and as a leader in the black physician community, that we have actual policy towards working to ban menthol cigarettes and eliminate them. We're in the middle of a campaign. So I think that's concerning that we are taking a stance when we call ourselves part of a public health organization to support the commissioners who are trying to make sure black people have access so they don't look racist. And one of my colleagues said to me, well, we really can't do this without talking to black people to see what the community says. Can you not see me? I'm literally right here. And I'm telling you that the community and black physicians do not support this ongoing public health threat, that we do not see people who eliminate ways of people being harmed as racist. But they're very focused on making sure they don't do anything that appears racist. So it's like, OK. So I get approached by the American Lung Association and others. And they say, Dr. Hark, we understood what you were saying. And we think that you're more on our side than what the consensus was to just not do anything and let the commissioners have their stance. Will you help us? And I said, well, I was there in my other hat. So let me reach out to them, because I'm going to be doing something that's not consistent with their stance. And I want to make sure that I'm very public about that before I partner with you. So I sent an email. And I said, listen, I was on the call. I understand your perspective. We don't have to agree. But as a black physician, as a black woman, I have to take a public stance that eliminating menthol cigarettes is going to save lives. That's how you show Black Lives Matter. So I wrote an op ed that was published in a local paper. I reached out to the commissioners. I didn't get a respond. I asked for a meeting. In the meantime, I'm also a leader in the National Medical Association who had an ongoing campaign for banning menthol cigarettes. In fact, the last past Sunday was No More Menthol Sunday. So I started tagging the commissioners and tagging the local newspaper. And the American Lung Association would retweet it. We just started a social media campaign. We still haven't heard back from the commissioners. They haven't changed their stance. But we continue to tweet about what it means to support black lives, what it means to take an anti-racist stance at ground zero of the uprising, and what it means to collaborate. And it doesn't always mean that you necessarily collaborate with people that you have reached out to in the past. I'm a psychiatrist. I never thought about reaching out to the American Lung Association. That never occurred to me. But I also practice addiction medicine and probably should have. So now I'm a part of a coalition. And we're really working to eliminate menthol cigarettes. But also, if they are eliminated, make sure it's not criminalized. So you don't have a situation where somebody has them. And suddenly, they end up not getting treatment but are part of a criminal justice system. So I think you can do both. You can address the public health threat, but also address making sure that we don't have further harm. So also, asking to make sure that when you address people not smoking, that you give them ways to quit, right? So you take away one, but you also say, this is how you can stop smoking. This is how we can help youth not start. So you do both. You don't take one stand and say, thank you. I'm very proud of myself. I'm anti-racist. No, you have to be very thoughtful, and you have to engage others. So I don't know what the outcome will be, because the story continues. But I'm saying that it's a current failure that I hope will change, but also to kind of remind ourselves. Like, I went into the meeting thinking I was going to hear one thing, and thinking everybody would be on the same page because we're physicians. And literally hearing the opposite, but also realizing that they didn't see me fully as a black physician when I was in this space, and not. So it was just kind of like a very odd thing to be in a room where people are talking about black physicians, but then saying, oh, I'm sorry, I forgot you were black. It's not a part of my bio. Don't put it there. But I'm a black woman always, and anybody who knows me knows that I will advocate for underrepresented people in Madison, underrepresented communities. So I know that I still have work to do, so that my colleagues understand when there's an issue like this, consult me, consult others. Engage in the collaboration from the beginning, and not after you've made a decision, after you've taken a stance. So that is part of my failure, and that will be part of my journey to continue to reach out to people, even people that I wouldn't have thought of as partners in advocacy. So I thank you for your attention. Thank you. I'm going to pass the baton to Dr. Chatwell. Good morning, everybody. I party too much at the APA, so I have this voice. If it becomes really problematic to you, just raise your hand, and I'll step back. But my friend who's a singer gave me some tips on how to project my voice, without harming my vocal cords further. And I also want to say it's quite a funny thing, because my last two social media posts have been about how my voice matters. And so really, this morning when I couldn't speak, I'm like, hmm, I think the world is telling you something. You're relying too much on your voice. Today, my hope is to talk a little bit about some of the points that Dr. Kennedy made, around how to get from that outrage to outreach. And some of the skills that we were talking about. So the three big skills are collaboration, negotiation, communication. And I think we would expect that all of those will be in play every time we advocate. But we might realize that some skills are being used a little bit more than others. So when it comes to collaboration, it's really about figuring out who the stakeholders are when you're considering any issue. For me personally, I think one of the first advocacy issues I participated in around 2019-2020 was mental health parity. So in the state of Arizona, we're pretty purple now. We have Republican House, Republican Senate. But back in the day, we also had a Republican governor. Currently, we have a Democratic governor. So we're in a very interesting landscape in Arizona. But at that point, we were really trying to make the case pre-pandemic for mental health parity. And like Dr. Hart said, sometimes even in the House of Medicine, we're a different voice. People don't know our issues. I'm currently doing a certification as a physician executive. And some of the assignments that they have just don't apply to behavioral health. The metrics that they talk about are not things that overlap. So what we started finding in the mental health parity discussion is that we had to really struggle to figure out who our collaborators were going to be. So we worked with our interprofessional behavioral health group, which had social workers, counselors, psychologists, and then also tried to involve the hospital associations. But at the end, we ended up having some of our strongest collaborators being nonprofits. And one of them was run by parents who had lost their 15-year-old son to suicide. And their story and their voice was the thing that got that entire coalition together. And we were able to collaborate with all these different groups, some of whom we typically didn't work with. But at this point, that one coalition has served us for so many other issues. Because having banded together and spoken from so many different angles during the mental health parity discussion, we started to notice that we had a lot more commonalities when it came to access to care, being able to really allow quality care to get to the patients in various parts of the state. And so that type of collaboration or developing a coalition can really become a skill that we have to develop over time. So it can be sitting together with some of your people in your psychiatric association or your workplace and saying, OK, who else do you think we need to invite to this conversation? And being able to know that they won't see the issue exactly like you do. So for us as physicians, we obviously want to get paid well. We do think that being paid fairly by insurance companies is important. But when it came to the parents who'd lost their child, they don't care about the kind of money we make. For them, we as physicians already get paid so much better than the average person. So you have to make sure that the way you're bringing the issue forward really centers others and centers our patients, centers our communities. And if we can have some additional benefit to our profession from that, great. But we can't say, oh, you know what? I want to get paid better. I want to do this in a really different way. Or I want to make my life as a physician easier. And so in collaboration, you're always trying to center somebody else's point of view. You're trying to better understand what are the things that motivate them in that issue. The second skill is negotiation. Negotiation is more challenging than most skills because it really means giving up some of the things that we might hold dear and being able to sometimes agree to disagree or also being able to figure out what are some commonalities we might have. One of the things that I think about where I use my negotiation skill was in changing physician licensing applications in Arizona. So there is the Federation of State Medical Boards that has issued some pretty nice guidance that says what physician licensing boards should be doing so as to support physicians not only be healthy, get care, and be able to do all the things they need to do, but also balance what their core goal is, which is patient and community safety. So when you go speak with the physician medical boards, their biggest issue is making sure that the public is safe from any type of physician who's not practicing to the standard of care. So in describing to them my concerns around the licensing application, which asked about if physicians had mental, emotional, psychological issues, and they asked that question in about five different ways, both in the initial licensing as well as the re-licensing application. So as a physician peer support person in our state, I was hearing from physicians during and after kind of peri-pandemic that they were not seeking help when they were really distressed because they were worried that when they went up for re-licensing, they were going to have to say, yes, I got mental health care. And so we had to work with the physician medical board to negotiate with them as to why changing this language was going to be important to serve the physicians and also help them see how that was not antithetical to their goals. Because they kept on asking me, they're like, well, Dr. Chotwal, what if a physician is impaired? What if they're drinking on the job? What do we do? And so we had to constantly educate them and let them know that they needed to focus on behaviors of physicians in the workplace, right? If somebody came into work and appeared impaired, yes, take action. But there's no reason to ask probing health questions about physicians. You don't need to know that I have diabetes. You don't need to know that I may have skin cancer. And why do you need to know if I have depression? Why do you need to know if I struggle with some sort of mental health issue? And so starting to give them some examples and helping them see how the change we were requesting them to make was not going to impede their job and somehow might make their job a little bit easier because people will get help in a timely way and there'll be less impaired physicians overall. Another part where we found negotiation to be more challenging was around scope of practice legislation this year. So in Arizona, we had a psychologist prescribing legislation and the oddest part about that negotiation was that the senator who introduced our collaborative care expansion bill was also the same senator who introduced this scope of practice bill. So here we were thanking him for introducing our bill but then on the other hand, having to step up in committee and oppose this other bill that he had introduced. And so that put us at a really interesting crossroads with him where we had to constantly try and let him know how we were not opposed to what he was hoping to do which was improve access to care but that we did not agree with the method with which that was being attempted which was RxB legislation or psychologist prescribing legislation. And we have one of our residents here in the audience and then my husband who's also a psychiatrist in our state and all of us, about five of us went up to the legislature to try and testify on collaborative care and that same day, we tried to go ahead and educate the legislators in the House Health Committee just sort of catching them outside the committee room or talking to them casually in the committee to try and help them understand why one bill was going to be helpful in expanding care and also put patient safety in the center but then on the other hand, also having to educate them on that other thing and negotiate their votes like that. And so those are some of the ways in which I think things that have been said by my co-panelists are important. We have to elevate our arguments, we have to really share the details about our concerns without making it personal, without devolving to blaming or shaming other groups and really always realize that a lot of people are coming to these conversations because they do want to make things better but it may be that they don't have a broad enough view of what the situation is and don't see the unintended consequences of what they're trying to do. And then finally, the last skill, I'm gonna see if I can make it through. The last skill I want to talk about is communication. Communication really ends up being what we do day-to-day as physicians. We're communicating with our patients. As psychiatrists, we are better equipped to communicate, hopefully, than most other groups. We're doing that every day. We're trying to communicate with folks who are having mental health struggles and may be very neurotic because of their condition or may be disorganized and so we're really very good at communicating as compared to the average person. And so some of the ways that in our state, the way that we've communicated is not just educating legislators about topics. So think about scope of practice, think about parity. Those are very complex issues and it's hard to break it down into bite-sized things. And so sometimes what you decide is pick one or two major points, educate on that, and then slowly build your case for what you're asking for. One of the fun and kind of interesting communication examples I have from my advocacy is that one day we started hearing from our medical, our GME group, our Graduate Medical Education Group in Arizona, that one of the organizations that the GME was run under was planning to cut primary care spots in Tucson, Arizona. And I remember hearing that from colleagues who were in GME and becoming so enraged. I'm also the person who very quickly moves to anger when things come up. So then I had to say, okay, I'm so outraged by this, what can I do? Because this is an organization that's a multi-billion dollar organization. They have thousands of spots and they're only really trying to cut GME spots in primary care. So as I'm raging and walking and being really pissed, I started to think about who else would care about this. So I said, okay, well, our local legislator would care because if we don't have GME spots, we're not gonna have primary care physicians staying in our communities and we're already struggling with access to care. So I ended up calling my legislator and I am one of those people who has a texting relationship with her, and she met me for drinks at like a local bar. We sit down, we start talking, I describe the situation to her, and she also got outraged. So it was good, that communication helped. And then she went and let our house health chair know, we reached out to another legislator who we thought would be affected by this, and he further reached out to the senate health chair. Next thing we know, in under a week, we had both the health chairs, the governor's policy person, myself, one of these legislators, all of us gathering in a meeting where we called the lobbyist of this organization in, and all they said to each other is, oh, we're all friends, you know, we're hearing something about GME, what's going on? And this person's like, oh, no, no, nothing at all, we always wanna expand GME. And I'm sitting there on the Zoom call feeling frustrated. I'm like, why aren't they calling him out? Why aren't they saying, why are you cutting GME spots? Why aren't they really calling this person to the carpet? They were all just very kind with each other, they're just letting him know that they're really, they think GME is very important, they're worried about Southern Arizona. And I left that meeting feeling confused. So I called the legislator and I said, oh, man, this was not a good conversation. What do you think we're gonna do? I don't think we achieved anything. And he started laughing on the other side. He's like, Jasleen, you don't understand. This is how politics works. They communicated that they're looking. And they know that something, if anything happens, they know who to call. And literally the next morning, we got communication from our GME group that they had heard that they were no longer going to be cutting those spots. So. And I think that those are some of the things which got me so hooked on legislative advocacy. I was like, oh my God. Like here I can be frustrated, we're thinking of writing a white paper, we're thinking of starting a petition. And just having these relationships and being able to communicate to the right people made such a huge impact to our community. And so again, starting to think about who are the people we build relationships with becomes one of the most important things when it comes to advocacy. Because having a broad-based coalition in your community with non-profit leaders, there's NAMI, there's American Foundation of Suicide Prevention, there may be local non-profits in your area, there may be family and peer coalitions. Having relationships with the hospital organizations, with the medical association, all of those things will come in handy at different times. So really utilizing our social skills and our relationship-building skills that we as psychiatrists hopefully have in droves is really one of the greatest ways to advocacy. And thank you so much for hearing my raspy voice. I'll pass it on to Dr. Pannell. So, I've been doing advocacy for several years, but I've really gotten into legislative advocacy for the past five years. I love it. I get really excited about it. So, if I talk too fast, just raise your hand and I'll try to slow down, but really, I love it. It excites me. But advocacy can be very frustrating. You get angry, you get frustrated, and it's okay to step back and take a break, recoup, and then it just makes you stronger to keep on fighting. I'm going to tell about my most recent advocacy effort because it literally took every advocacy skill I had, and it's a neat story because it goes from the very beginning, and then I have an end to the story. Four takeaways from my recent advocacy efforts. Relationships matter. Find your champions. Get creative and be ready to pivot, and don't give up. So, a mentor told me many years ago that relationships matter, and he was very right. So, when I got into legislative advocacy, I made building relationships a major part of my advocacy. I made an effort not only to get to know my local lawmakers, but also other state lawmakers on both sides of the aisle. I was at community events, fundraisers, dinners, conferences, wherever I could be to talk with lawmakers about things that were important to me. Now, because I've formed these relationships, anytime there's mental health legislations, they either call or text me questions, or they even invite me to testify. So, this past session, I was asked to testify. My major efforts right now in advocacy are based on fentanyl legislation, and this last session I was asked to testify twice on fentanyl test strips. I testified on substance use education and the 9-8-8 system, and it was because of those relationships that I have with lawmakers. They don't, most of our lawmakers are not physicians, they're not in health care, so they don't really have the background knowledge, and when they're looking to find how they should vote or not vote on something, they're going to look towards the experts, and if you have a relationship with them and you're involved, they're going to look to you, and you're going to be able to guide them on how they should vote on that legislation. So, this session for me, again, was really about getting legislation to decriminalize fentanyl test strips. I live in Mississippi, and before this past session, fentanyl test strips were considered drug paraphernalia. So, if you were caught with fentanyl test strips, you could go to jail. And there had been legislation in the past several years to decriminalize fentanyl test strips, but it always died. So, first of all, I started looking into things and tried to figure out, you know, why was this legislation dying? And I noticed that it was definitely a unipartisan effort. I noticed that none of the medical associations were even involved in any of the past fights during the session, which baffled me, but it was because none of the associations had policy. So, to the very begin with, I had to make sure that the medical associations had policy so that they could actually go out and fight for it. I mean, it's not that they didn't support it, but it wasn't on their agenda of things to do because we didn't have policy. So, I wrote a resolution, and I took it to our state medical house of delegates. It passed unanimously, so now we have policy to decriminalize fentanyl test strips. So, that also gave us so much more manpower. We had the lobbyists of our state medical association, the state psychiatric association, family physicians jumped in. I mean, every association pretty much within the state was ready to lend help with their political action teams. So, once we had policy, I had to go out and find the champions. You have to find people on both sides of the aisle that are willing to fight with you, and that's when you really start to kind of look at those relationships and see if you can find somebody that has a personal connection. Well, the first person I contacted was the House representative that was on the Democrat side that had authored the legislation in years past, and of course, he was willing to do it again. So, that was wonderful. We had a champion in the House, but I wanted to find another champion in the House that was also on the Republican side, and I had a very close relationship with a representative from New Albany, Mississippi. I know that doesn't mean anything to you, but we had a relationship because his mother suffered from schizophrenia, so he was our mental health champion, and when I went to speak with him about the legislation and told him the issues we were having, that people were dying and nothing was working, yes, education is going to work, but it's going to take time. We have to find something now that's going to save lives. He was totally sold, ready to fight, and the good thing about that is he was also a committee chair for drug policy. So, not only did he want to support, but he was like, let's do a hearing. So, he scheduled a hearing, and of course, because of that relationship, he asked me to testify on how harm reduction fentanyl test strips can save lives, so that was huge. So, then I had to look to the Senate side, and I'm very thankful I have a very close relationship with my local state senator, and she had actually recently, one of her friends had lost a son to fentanyl overdose, so she immediately was like, I'll author it, I'll fight for it, let's go. So, I had my champions in place, they authored the bills, the bills dropped. We testified, so now it really became all about education, so I talked to as many lawmakers as I could. I had a relationship with the state radio station in Mississippi. I had come on the radio a couple times to talk about other things, like when it was mental health month, and so I reached out to their producer, and I said, hey, I would really love to come and talk about fentanyl test strips. So, she was like, sure, come on, so I went on, I talked about fentanyl test strips. This is also the radio station where all the lawmakers, they listen to it every morning on their way to the capitol, so it's a huge reach to many lawmakers. So I did that, and it kind of spiraled into this like common, like I would go, and every time the legislation moved, I would come and give an update, so I was on the radio constantly. I'm also very big on Twitter, so I was constantly tweeting things, articles in support of harm reduction methods and fentanyl test strips and tagging those lawmakers, because lawmakers love Twitter. That is their social media platform, they love Twitter. So after that, I kind of had to look and see, okay, so what are the reasons why these lawmakers are not supportive of this legislation? And I found that the common reason was that they felt like fentanyl test strips enabled addiction. Well, of course, we know that that's not the case, and any time they said that, like it was just all I could do, just like throw my hands up, but you can't get angry, you can't walk away. I had to come and find an argument that would actually reach them. You know, some of them I was able to convince that fentanyl test strips do not enable addiction, they enable recovery, they save lives, as Dr. Kennedy said, those personal stories are huge. I was able to tell a personal story, my father suffers from bipolar and addiction issues, and when he was struggling, you know, fentanyl wasn't as big of a deal, but I just kind of explained to them, you know, it took him multiple tries to recover and get sober, and had he, you know, used pills when one was laced with fentanyl and died, he wouldn't have had those chances. He wanted to keep people alive so that they could eventually get into recovery, and it took my father many chances, but he was able to do it, and we just can't give up on these people, and so that was an argument that some of them were able to get, and they were able to change their mind, but still some of them were hard and fast that, you know, no, this enables addiction. So then I decided, you know, I've got to figure out something that's going to actually really resonate with them, so these lawmakers were really big about supporting law enforcement, which is great, so I went to them, I said, you know, I love your passion about law enforcement and supporting our law enforcement in Mississippi, and I will tell you that Mississippi overwhelmingly supports fentanyl test strips, and let me tell you why. Because they want to get fentanyl off the streets, and so if someone goes and they go to their dealer and they get their product, and they have these test strips, they'll place it on their pill, and they'll realize, holy cow, this has fentanyl, I'm not going back to that dealer. He has, he laces his product, he has bad product, he could have killed me, I'm not going back to him, and then that person is going through their entire circle and saying, hey, he's a bad guy, you don't want to get your product from him, and you're essentially putting these drug dealers out of business, and you're getting fentanyl off the streets, and it was like a literal light bulb moment for some of these legislators. They were able to wrap their minds around that, and that was the reason why they were sold and they were going to get this legislation passed. So bills dropped, unfortunately the bills were double referred, not only in the House and the Senate, which if anybody follows, being double referred is basically the kiss of death. It is a signal from the leadership in the House and Senate that they don't like this legislation, and they have no motivation to move this legislation. So again, the education continued, those arguments continued, I got more and more people on my side, and so we fought through committee on the House side, sailed through both committees unanimously, went to the House floor, passed unanimously on the House floor. However the Senate side was much more difficult. We passed through one Senate committee, and then we had another Senate committee, and the Senator, we went and talked to him, he was like, oh no, I wasn't planning on getting this passed. In fact, I was going to put a reverse repealer on it, and we were like, no, no, no, no, no, you can't do that. We just came out of the other committee unanimously, why would you do that? And he was like, I just don't think people support this. I was like, I think you're wrong, I do think more people support this than you think, and he said, you know what, fine, you get all the votes, you tell me if I have the votes in committee, and I'll bring it up for you. So immediately me and my colleagues got on our cell phones, we printed out the entire committee, and we were calling, texting, do we have your support on this? If they were like, well, I'm on the fence, I picked up the phone, I talked to him, I provided those arguments, got all the votes, text the Senator, the Chair, we got them, let's go, pass out that committee unanimously. So we're feeling good. Next up is the Lieutenant Governor, who would have to bring the bill to the floor. Went to his office, his Chief of Staff said, no, we just don't support this, we feel like it enables addiction. So again, I'm back to that. I give the other argument of the law enforcement doesn't go anywhere. So at this point, it's pretty bleak. If he's not going to bring any bills to the floor, we're going to die and we're going to fail again this year. So I thought, I said, you know, this is where you got to put it all on the table. You know, if this is going to fail, I want it to fail knowing that I have done absolutely everything I could do. So I talked to the Chief of Staff, and again, she said, you know, we're not in the mindset that we want to do this, we're not supportive, and she looked at me and she said, and don't go tweet about this conversation. And I thought immediately, they're following my at, Lieutenant Governor. They are watching, so they are seeing me. And so what I immediately did, of course, I didn't tweet the conversation, was I bombarded with tweets about how fentanyl test strips enable recovery, that how they save lives, and I add our Lieutenant Governor on everything. This was on a Friday, the next week was the deadline week. So Friday, I said, what else can I do, and this is another place where we were talking about op-eds. I authored an op-ed that said, fentanyl test strips do not enable addiction, they enable recovery. I went to my state medical, they pushed it to every single outlet. So many outlets were gracious and pushed it out there. I made the point in the article that, fine, if you don't support fentanyl test strips because you think it enables addiction, the other side of thinking about that is that you're okay with people dying. And I don't know if that was the reason why our Lieutenant Governor changed his mind, but that Monday, his Chief of Staff texted me, we're on the same page now, we're good to go. It passed off the Senate floor with only one nay, and then went to the Governor and signed, and now Mississippi has decriminalized fentanyl test strips. And that's where the last point is, just don't ever give up. The legislative group, they're such a fickle bunch. I mean, you can think that your bill is dead, and then you get this last, like, saving grace, and just don't give up. Even when you think things are dead, you'll be surprised, keep fighting, you can turn things around. Thank you. So, so inspiring. We have about 15 minutes left and so I'm going to just introduce you to the idea of the elevator speech just for a few minutes and then we'll be able to have some time for questions. So again, I think we've heard from these three panelists how being able to communicate effectively op-eds, written testimony, meeting with legislators is so important. And really one of the basic ones is the elevator speech. I'd like everyone to just reflect, I'm not going to take a whole minute of our time, but just I'd like you to have in your mind an issue that you really care about that you might want to advocate for. So I'm just going to give you about 15 seconds to think about that. All right. We're going to just move quickly into my explaining what an elevator speech is, as you keep in mind whatever that issue is. Again, you have to be passionate about your advocacy issue. So the definition of an elevator speech or an elevator pitch is that it basically is around or no more than 27 words that you can say within 9 seconds and you make only 3 points. And it should make your audience, whoever that is, want to learn more. And so I'm going to show right now, let's see, I'm wondering, this should have an embedded, I may not be able to show this. So here we are with, I don't see the link, unfortunately, because this is a really great little video that I, oh, is it going? Okay, it's going. The elevator pitch is your first step towards becoming a networking god. I don't think we can see you. Good to see you, buddy. Good to see you. Reuben, right? Yes, yeah, yeah. Good things about you. Nice, nice. So what is it that you're doing exactly? Well, you know, I like merge all my talents together and just give it out to the world, like all my stuff inside me. It's like a mixture of stuff, like I'm a creative god, people's person, obviously. Okay, do you want to, it's not even coming out of here, it's coming out of that. You know what, we, in the interest of time, I think we will just move on. So that was, I think, a really effective, I think it, it's not advancing. sssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss Let's try that again, shall we? Hey, Mr. CEO. Good to see you, sir. Good to see you. Hi, Reuben, right? Yes, yeah. Oh, I've heard a lot of good things about you. Okay, nice. So, what is it you do then, actually? I'm a presenter and a comic. I host live events and I make online comedy videos. And I'm also co-founder of Individualism.co.uk, which is the UK's leading men's style blog. Oh, excellent. I've got a few events coming up that we could do with your services. Have you got a card? I do. Yes, I do. There you go. Well, I'll be in touch. Thank you. Thank you. Have a nice day, mate. See? Preparation, it got me some potential work with the CEO of this whole company. Oh, yeah. Did you say a men's style in- Remember, guys, your elevated pitch should be- short and to the point. Even if you do, you need to know exactly what you do. You do not want to give people the wrong idea. And I think, let's see, I'll try to start it. Okay. So sorry about the volume, but we're not going to actually do this in the workshop. Everyone should have a copy of the slides because we did submit them in advance. So you can look at this formula, which is basically the idea that you had in mind. This is kind of a basic formula where you might say, my name is Dr. Kiki Kennedy. I am a physician. I want to help people who are undocumented gain access to our state Medicaid. And we need you to call your legislator in order to get them to vote for this bill. And so if you think about that, basically you can go through the steps of briefly condensing whatever your issue is into the issue, the consequences, giving your listener an easy next step. We're not going to do this part of the workshop. But you can refer to these slides in order to be able to do that. Because what I'd like to do is put up this last slide, which has a lot of our information and also some hashtags. And I'd like to have the last 10 minutes open for questions and conversation. And this is being recorded. So if you have a question or would like to make a comment, please come up to the microphone. And before we take questions, I think Dr. Dionne Hart, you wanted to mention the handout that we have. So also included in the website app is the handout that we compiled that, let's see, But it's in the website, it's a handout that we all created with our own pearls and tips to help you to move from being outreached to outreach. In addition, if you go to this psychiatry.org website, you will find the congressional advocacy link so you can get information about ways where you can advocate. We wanted this to be an introduction to advocacy, but there are lots of resources on the website so that you can learn some skills in order to be able to collaborate, negotiate and communicate with your legislators. And again, if you have any questions, please feel free to move to the mic so that our future audience can participate. Hey there, my name is Jake Cross, I'm a psychiatry resident in Chicago, third year. Thank you so much for this amazing talk, it was really inspirational. My question is about anger or rage. I'm very curious about everyone on the panel, their relationship with anger and how it has been either helping or hurting your advocacy career. I'm going to see, okay. For me, I think I had shared in my presentation, I definitely find that I go to anger very quickly when something is happening that's inequitable. And I consider equity sort of like my core value, so there's other values, but equity sort of being in the center. And what I've discovered is that anger can move me to action, but I need to figure out always in the moment, okay, if I'm really pissed about this, what will I do? Or what element can I really solve in this? Because I think staying with anger too long can make you bitter, can cause health problems, you know, really is traumatizing to your psyche and further to your body. So figuring out how you can move from that anger to the next step is really important. And then also to know how you come across when you feel that way. For me, I feel like I try to always move that anger towards energy, and energy to do something more, you know, work harder at the thing than anybody else will type of attitude, rather than staying with the negative emotion of anger, because I think there's a lot of really solid research that if you stick with anger just as the emotion, it's corrosive, and it actually makes you less effective and makes it that you just become the person that people are like, oh, gosh, like this person doesn't shut up, doesn't really have good points, and is pissing other people off. And I will just say, I'm very cautious of stereotypes. So if I have an emotional response, I don't want to show it. So my thing is you raise your argument, not your voice. So even if you feel outraged, you feel anger on the inside, you want to stay composed. Because if you have too much of an emotional response where you go past passionate, then you again may turn off the exact people you're trying to reach. Did you want to say something? No, I mean, I'll just echo that, but also that's, again, where taking a break from it also helps. I mean, legislative advocacy is exhausting, and there's so many emotional highs and lows, but you're no good to anybody if you're spouting off an anger, take a break. It just, and then again, it just turns that anger into energy. But yeah, you got to step back every now and then. I mean, there's other people that are fighting the same cause. They'll take your spot while you take that break. So. Great. Thank you. Next question. Thank you for a wonderful panel, really, and for the wins that you've already accomplished, and yay. Continue. I'm Cynthia Myers Morrison, and I want to practice my elevator speech. I'm a food addiction professional and family health person, and I want to help preconception parents achieve optimal weight and well-being to end the litany of negative outcomes for them and their offspring for five generations, intergenerationally, of mental and physical carnage by supporting children and teens to eat real food and care for their bodies and minds and to encourage parents to do the same. Awesome. That's great. Does that work? Wow. I don't know how you put that together in the two minutes, but really. Thank you. Really impressive. Thank you so much. Please join me. Great. We have another question. My name is Faisal. I'm a first-year charged psychiatry fellow at University of Colorado, Denver. Firstly, a plug to APA Fellowship programs. They've been a great exposure for me personally to learn more about advocacy. I do want to be more involved in the advocacy space, and I feel I haven't, obviously, I don't have the experience you all have, but the times I've gone and spoken to state legislators or federal legislators, I've often been met by the question of, what's the budget? I feel like my medical training lacks the knowledge to answer that question. In your experience, how do we speak the language of your legislators, and how do you be an effective communicator? Just real quickly, if you don't know, that's a huge thing to say too. If you don't know the answer to something, don't just make it up. You could all, once you, if a lawmaker knows that you don't know, and you basically just essentially lie, your relationship is done. It's okay to tell a lawmaker, you know what, I don't have the answer to that question, but I will get it for you, and I'll come back to you with that answer. I would also say, I think, knowing what the resource is in the legislature is important. A lot of legislatures will have analysts who actually do the one-pager or two-pager breakdown of any laws that are being introduced, but if it's not a legislation, and they're asking you budgetary questions, or what's the impact, you can always say, like Dr. Panel said, hey, let me go find out the answer, and there are other people in the healthcare space who likely can help you figure that question or that answer out. Gotcha. Is there, I mean, I do want to get more involved in this, and I feel like a major barrier would be finances. I feel, at least, I don't know of any institutions that would fund my desire to pursue this, at least 50% or more, and from that perspective, do you all suggest, like, because I'm considering like doing either a forensics fellowship to understand more of the law versus doing a master's in public policy or an MPA, and what are your thoughts on that? I think both the avenues you're describing could be very helpful. Forensic definitely helps you understand more of that interface, but there's also a Gene Spurlock Fellowship through APA that you could do in which you are at the Hill in Washington D.C. for about 10 months, and you get paid, I think, somewhere between $75,000 to $100,000 to live and sort of work and do that. Yeah. Unfortunately, I'm ineligible for that because I'm on a visa, but that's a great opportunity. Yeah. Happy to talk to you after. I'm an IMG, so I had to learn how to become an advocate while not having a vote, not having a green card, all of that, and happy to help navigate any challenges you're facing. Thank you. The last thing I will add, if you offer to follow up, make sure you do because you don't want to say it and then never do it. Thank you. All right. We have time barely for one more question. Please go ahead. Thank you. Hi. My name is Nima. I'm from the University of Arizona. I'm a resident there. Firstly, thank you all for the work you've done. It's been very inspiring being here. One theme I caught onto was the power of attendance alone, and I wanted to ask from the panel what your thoughts are on the most important first step to attending, especially in collaborating with important people in governmental roles. What is that essential first step, or what was it for you all? I will say you have an amazing attending, but also that your first step is really the introduction to outreach. I think just kind of breaking the barrier and reaching out and saying hello, and like Dr. Kennedy said, hey, you may not have an issue that I'm passionate about now, but I'm here as a resource, and just start the conversation. I feel like my situation may be a little ... I'm from a tiny town in Mississippi, so we don't have ... I mean, you know everybody, so I already knew this person, and then church and with semen restaurants, so just when I really started to get into advocacy, I just basically saw her one day and was like, hey, I would love to take you to lunch and talk to you about some things that I'm passionate about, something that maybe you were willing to work with me on. It was the Alzheimer's Caregiver Program, and that's what I did. We went to lunch. We talked about it, and she was good and ready to author it, too, so I'm very lucky that I'm from a small town, and I already knew mine, so I have a little bit of a different story. Before we wrap up, I just want to kind of add that one question we've gotten is, what if your legislator is a party that's different from yours? How do you start a conversation? I want to emphasize that those are probably the relationships that are most important to initiate, foster, and grow, because any kind of legislation, whether it's the state or federal level, really needs to be passed in a bipartisan way. So many people don't really want to talk to someone who has differing opinions or views or perspectives, but with your stories, with your data, with your voice, a lot of times you'd be surprised at how effectively you can persuade someone of the other party to vote a different way than they would have, and it can be the most important relationship to get legislation passed. So before we end, I also want to just underscore what Dr. Hart had mentioned about resources at the APA. We have an APA website. Look at advocacy. You can sign up for alerts. You can sign up for the Congressional Advocacy Network. There's lots of different things. You can email any of the staff on the Division of Government Relations. They would love to hear from you, your questions, what to do. So I really encourage you to do that. Reach out to us if you need anything else. We'll take questions up here, but otherwise, thank you for being a wonderful audience on our very last day here and hanging in with us. Thank you so much. Thank you.

advocacy

psychiatry

Dr. Dionne Hart

systemic issues

policy change

structural oppression

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legislators

mental health parity

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bipartisan relationships

burnout prevention

healthcare systems