Capitol Mental Health Day: Advocacy in Residency Education

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Commentary — April 2015

Tex Med. 2015;111(4):15-16.

By Aparna Atluru, MD

Capitol Mental Health Day occurs once every legislative session and allows mental health advocates, family members, and psychiatrists to put on a united front in visiting with the Texas Legislature in support of policies that better mental health care for Texans. When the opportunity to attend Capitol Day on Feb. 19 presented itself, I was eager to participate. The 84th Texas Legislature's priority and dedicated "theme" for this year's Capitol Day was "Treatment Works," an effort to improve health care workforce recruitment.

My participation in this advocacy day was markedly dissimilar to any other conference I've attended as a medical professional or student. I started the day off boarding a chartered bus in Dallas. I was the sole psychiatrist on a bus that carried various mental health advocates, most of whom had suffered from mental illness or had family members who have. As a resident physician with a background in journalism, I appreciated the embedded feel of this mode of transport. 

During the ride to Austin, I met an academically gifted young woman who had been diagnosed with an anxiety disorder, recovered with treatment, and had taken the day off from a very hectic job to spend it doing advocacy work at the Capitol. I conversed with two other women who had lost family members to suicide and who vowed to prevent that from happening to anyone else. 

Later on, we received lists with assignments detailing which state senator or representative each individual or team would meet. As the assignments came about, many people started rehearsing their stories, neatly packaged into 2- to 3-minute sound bites aimed at quickly conveying their personal struggles with and triumphs over mental illness. The bus soon bellowed with the soft boom of 50 tales of mental illness all waiting to be heard. Some stories melded in the air, which grew humid with emotion. 

After a lunch at First United Methodist Church across from the Capitol, an organized rally of more than 300 people took place on the front steps of the Capitol. Impassioned speeches were delivered about lives lost to mental illness. Others talked about indigent populations and their lack of access to mental health care. The preponderance of cowboy boots paired with pinstriped suits made sure everyone knew we were indeed in Texas. 

Afterwards, the advocates headed off to the various legislative offices to meet with senators and representatives. As a resident physician, I had little knowledge of much of the legislation before becoming involved with Capitol Day. Two other physicians from The University of Texas Southwestern Medical Center, my residency training institution, had accompanied me to Capitol Day. Our main objective was to make our support known for several Senate bills aimed at increasing mental health access in Texas. 

Mental health in Texas is not, on average, a very popular proposition. Texans are stereotypically about barbecue and football and pulling yourself up by your (cowboy) boot straps. Thus, we anticipated resistance to our proposals. We pressed on in support of three bills: Senate bills 2, 239, and 18. SB 2 would increase funding for graduate medical education (GME) by $60 million over the biennium. SB 239 (by Sen. Charles Schwertner, a physician and state senator from Georgetown) would offer student loan repayment assistance for psychiatrists, psychologists, psychiatric mental health advanced practice nurses, and others working in mental health care who agree to provide direct care to underserved Texans. SB 18 creates a new program at the Higher Education Coordinating Board to incentivize teaching hospitals to create and maintain residency programs, including those in psychiatry, for physicians in high demand across the state. 

During our meetings, one particular legislator seemed to address our plea in support of the three bills with incredulity, as if to say, "Don't we have bigger fish to fry?" Call him a straight shooter, or a skeptic, or whatever you'd like. As an educational experience, his resistant behavior helped sharpen my acumen about how a legislative transaction transpires as opposed to a medical one. The experience was an unusual conglomerate of working with teams of other mental health advocates, many of whom themselves had dealt with psychiatric illness, and simultaneously dealing with legislators, some of whom laughed at the thought of increasing the mental health budget. 

The experience required catering, though minimally, to different personality types, party affiliations, and regional politics. Though some may view two-stepping with such "negative forces" a waste of educational time, Capitol Day was definitely a step in the right direction for physician involvement in the political process. Getting resident physicians involved in the legislative process while in training would likely increase their likelihood of staying involved later in their careers. Like the state of Texas itself, an exemplary residency education ought to be broad in depth and breadth.

Dr. Atluru is a second-year psychiatry resident at The University of Texas Southwestern Medical Center in Dallas.

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May 13, 2016

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