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Psychology Prescribing: A Lesson in Advocacy
Martha Leatherman, MD, Federation Vice Chairman for Public Policy
and TSPP Chairman, Government Affairs Committee
 The evolution of psychiatric legislative advocacy over the past ten years has
been fascinating and informative. When I first became involved with organized
Texas psychiatry, each legislative session was marked by harrowing battles
during which we fought to preserve the rights of Texans to receive ECT when
necessary. At the time, we were forced to advocate from a defensive position,
few psychiatrists were involved, and we spent hours before legislative
committees testifying while the Citizens Commission on Human Rights spread
slanderous misinformation about us to the public and to the legislators.
Tireless work by John Bush, Debbie Sundberg, and wonderful TSPP presidents have
allowed us to enjoy the past 3 legislative sessions without anti-ECT bills.
Although, we have, for the present, neutralized the threat to ECT, psychiatrists
nationwide have been beleaguered by a certain faction of well-funded,
well-organized psychologists who are doggedly seeking to assume the privilege of
practicing medicine without earning a medical degree. Louisiana and New Mexico
have fallen against the onslaught of these misguided psychologists, increasing
the threat of an eventual psychologist victory in Texas. The psychologists filed
their prescribing bill in Texas during the 2001 and 2003 Legislative sessions.
On both occasions, we prevailed in defeating them. Recent victories by
psychologists in New Mexico and Louisiana, however, energized the Texas
Psychological Association in its quest to achieve prescribing privileges from
the Texas Legislature in 2005. We have worked hard over the past two years to
prepare for their expected onslaught in the 2005 Legislative Session. However,
on March 11, the final day to file bills for the current session, a psychologist
prescribing bill failed to emerge. Although their bill was not filed, we will
continue to be vigilant to ensure that their legislative initiative does not
appear as an amendment to a bill that has been filed. The Session is not over.
But for the effective efforts of organized psychiatry in Texas, psychologists
would have already won prescribing privileges by legislative fiat.
There are a few reasons I think we have prevailed and I think the study of our
legislative efforts over the last ten years on these two major fronts is
instructive and will help us in the inevitable battles to come. Here are the
lessons I have learned:
Lesson One: Build Relationships
During the height of the campaign by the Church of Scientology to isolate us and
paint us as monsters, we understandably were dispirited and a little frightened.
After all, if legislatures could restrict lifesaving treatments based on a
propaganda of hate, how could we possibly prevail using logic and science? What
chance did our patients, many of whom live on the fringes of society, have to
advocate for themselves? How could we fight the battle against Scientology
slander while we and our patients were crippled by the pervasive stigma
surrounding the mentally ill and those of us who care for them? After much
reflection, I believe that the Scientologists were stopped by John Bush and
Debbie Sundberg. I know they won’t like me to say this, but we psychiatrists
were suffering from substantial “issues with self-esteem.” Our very character as
a profession, and by extension, as individual human beings was under attack. It
was difficult for us physicians to heal ourselves when we were so dispirited.
John and Debbie saw the good in us and helped us to rise above our hurt and
fear. They relentlessly prodded and encouraged us and helped strengthen us for
the fight. We discovered that we really had gone into medicine “to help people,”
and with dawning gratitude and hope, we began to recognize that those people—our
patients—knew it. The development of our ongoing Advocacy Coalition in those ECT
years has proved invaluable as we have struggled with other threats: funding
cuts, drug formularies, and renegade psychologists. That was our first lesson:
build relationships.
Lesson Two: Build Relationships
Although the various TSPP presidents have focused on a number of different
issues during their terms, all have had to deal with legislative realities. This
legislative continuity has led our leaders to create programs which have
strengthened our ability to effectively influence the legislature. The Political
Action Task Force program developed in 1998 has served as a vehicle for Texas
psychiatry to work with local legislators. The relationships built as a result
of the Political Action Task Force program, executed at the grassroots level
through TSPPs 18 Chapters, were key in defeating the psychology prescribing
bills introduced in 2001 and 2003. I believe that those relationships have
prevented a psychology prescribing bill from even being filed (thus far) this
year. The psychiatric leadership in Hawaii credited their recent victory, in
part, to their hosting of an annual legislative reception. Our ongoing work in
building a Key Legislative Contacts Database has facilitated liaisons with
legislators that are not restricted to the legislative session, but which
operate year round. I believe that it’s because of these contacts, nurtured
outside of the legislative arena in Austin that we have not yet had to endure a
tense floor vote on a psychology prescribing bill such as the one Hawaii
narrowly won by a 12-12 tie.
Lesson Three: Build Relationships
Five years ago, TSPP forged a new relationship with our extraordinary lobbyist,
Steve Bresnen. The major factor in our choosing Steve to represent our interests
was his clear commitment to ethical representation for his clients. He works
with groups in whom he believes and his faith in us has enabled us to forge a
true bond with him that transcends that of employer/employee. During internal
struggles as well as struggles with the APA, Steve Bresnen has been patient, and
has continued to fight for our interests even when we were distracted. He
supported us during hard times with sage advice and unflagging confidence in our
causes. Steve has worked heroically to learn our issues and has developed a real
understanding of the complexity of psychiatric practice as well as mental
illness. In contrast, the psychologists have depended on short-term alliances
with expensive lobbyists. The money they have thrown at the efforts at
prescribing have failed while our honest and ongoing relationships have
continued to work for us. In discussions with legislators, not one of them ever
fails to speak highly of Steve. They know they can trust him, and we are proud
to say he represents us.
Lesson Four: Build Relationships
Over the past few years, we have been extremely fortunate in developing an
ongoing relationship with Joel Roberts, a nationally renowned media consultant.
On the personal side, we have seen him through the difficult rehabilitation
following a bicycle accident and were able to congratulate him on his recent
marriage. Joel has committed to an ongoing campaign to help dispel the stigma
surrounding mental illness, the mentally ill, and those of us who care for them.
He has worked with us in media training as well as helping us hone our message
for legislative purposes. He has offered to be available, on call, to any one of
us who has a media opportunity and would like preparatory help. Perhaps most
valuable, he has also worked with our partners in the Mental Illness Awareness
Coalition established by TSPP in 1995 (NAMI Texas, Depression and Bipolar
Support Alliance, Mental Health Association, Texas Mental Health Consumers, and
the Texas Medical Association). That work, which we were able to facilitate,
provided our coalition partners a level of sophistication in their media and
legislative relationships that will serve them well in years to come. The fact
that we made that possible further strengthens our relationships with members of
the Coalition.
Lesson Five: Build Relationships
As part of our ongoing Capitol Day events, conducted at the beginning of each
Legislative Session since 1995, we have reached out to include psychiatric
residents in our legislative efforts. Residents have been able to join other
TSPP members, Coalition partners, and Joel Roberts in the media training and
legislative visits. During that process, these trainees were given the
opportunity to work closely with Joel and to accompany senior TSPP members as we
went door-to-door educating legislators. I’m thrilled to report that these
trainees quickly became proficient enough that they needed no supervision in
their legislative work. Ultimately, they taught us a number of things about
effective advocacy because of their fresh view of the process. Their empowerment
in Austin has infused our efforts with renewed vigor and we have been so
grateful for the relationships we have developed with these impressive young
physicians.
Lesson Six: Build Relationships
Texas organized psychiatry has always striven to forge a strong and effective
relationship with the Texas Medical Association and with our colleagues in other
medical specialty organizations. The relationship we enjoy with the House of
Medicine has been helpful to us in many legislative battles, and conversely, we
have contributed to successful legislative outcomes for other branches of
medicine. These informal relationships were formalized this year with the
establishment of the PatientsFIRST Coalition, organized to work on scope of
practice issues impacting each medical specialty. The PatientsFIRST Coalition,
representing over 41,000 Texas physicians, includes the Texas Association of
Obstetrics/Gynecology, the Texas College of Emergency Physicians, the Texas
Ophthoalmological Association, the Texas Osteopathic Medical Association, the
Texas Pediatric Society, the Texas Society of Anesthesiologists, the Texas
Society of Plastic Surgeons, the Texas Medical Association and the Federation of
Texas Psychiatry. Not only are our colleagues in other specialty organizations
educating legislators about the threats to patient safety and patient care by
psychologists prescribing of medications, Texas organized psychiatry is actively
helping with scope of practice issues involving podiatrists, optometrists, CRNAs,
and other allied health professionals. The relationship with organized medicine
is vital to our success.
Lesson Seven: Build Relationships
One of the more subtle lessons I’ve learned from these past years is that the
art of organizational compromise and agreement is essential to success. Perhaps
part of the reason the psychologists have failed to gain prescribing privileges
legislatively is that the psychologists themselves are divided on the issue. In
fact, a determined and articulate psychologist joined us on Capitol Day and
provided insight into the issue. We proved that we are grateful for the
opportunity to work with psychology in taking care of patients, but are not
willing to compromise patient safety in order to appease the strident group who
aims to practice medicine without a license. It is probably clear to the
legislature that psychology can’t agree on its own agenda and, of course, that
hurts their cause.
Lesson Eight: Build Relationships
At the risk of being effusive, out of the ashes of the realization that our
vision of how best to represent Texas psychiatrists has sprung what promises to
be an important organizational model: the Federation of Texas Psychiatry. Under
the aegis of the Federation, TSPP, the Academy of Texas Psychiatry and the Texas
Society of Child and Adolescent Psychiatry have united to present one strong
voice for our profession here in Texas. The Federation has allowed us to
reconnect with the child and adolescent psychiatrists and offer them
representation. We have welcomed psychiatrists not previously involved in
organized psychiatry into the growing voice of our profession here in Texas. In
short, the Federation of Texas Psychiatry is rapidly forging relationships
within our own profession. With increasing numbers, we will be more effective
legislatively, a benefit to our profession and to our patients.
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FEDERATION
OF TEXAS PSYCHIATRY