Last month, long-time colleagues and friends Daisy Bassen, M.D., and Michael Wolfe, M.D., took two days off from their demanding clinical jobs – but not to go on vacation. They stepped away because they felt their oath as psychiatrists demanded their presence elsewhere: Washington, D.C.
On May 5-6, Wolfe and Bassen joined hundreds of child psychiatrists from across the nation for the annual American Academy of Child and Adolescent Psychiatry (AACAP) Legislative Conference (“LegCon,” to regulars like Wolfe and Bassen). The conference trains attendees to meet with Congressional lawmakers and their aides to advocate for children’s mental health.
“Children with mental health issues are pretty much the most marginalized population,” said Bassen, medical director and child psychiatrist at Thrive Behavioral Health and a clinical assistant professor of psychiatry and human behavior. “They’re not voters. These are people who effectively have no voice in government.”
Wolfe, a psychiatrist with Brown Counseling and Psychological Services and Hartselle and Associates, learned to be an advocate early in his training as a child psychiatrist.
“Psychiatry is unique in that we have more interaction with insurance companies than other specialties might,” said Wolfe, a clinical assistant professor of psychiatry and human behavior. “I've been on many phone calls with insurance reviewers feeling as if I was fighting for the care my patients need. That puts a fire in you. You have to learn how to fight for your kids."
Typically, the AACAP Legislative Conference prepares its members to advocate for particular mental health legislation. This year, amidst proposed budget cuts, the mission was more singular: Save Medicaid.
Children are the single largest beneficiary group for Medicaid, making up some 40 percent of enrollees. Cuts to Medicaid, Wolfe said, would not only jeopardize direct care for children and families, but also destabilize the wider medical system that supports their care.
“The way we were trained was in hospital systems,” said Wolfe, who first met Bassen two decades ago in their training through Brown. “Hospital systems are mainly funded through Medicare and Medicaid. If they don’t have that funding, hospital systems fall apart. Residency training, medical student education, fellowship training – it all falls apart.”
As it happens, a fourth-year medical student, Emily Tovar, joined Wolfe and Bassen to form the conference’s Rhode Island delegation. The three met in an initial online training session, then practiced talking points at the conference’s preparatory meeting in Washington, D.C., on May 5.
The next day, Wolfe, Bassen, and Tovar fanned out across Capitol Hill in lanyard IDs and neon green stickers (“Children’s mental health matters”), toting folders, brochures, and maps. In legislative offices and impromptu hallway meetings, they talked with Rhode Island lawmakers and their staffers about the importance of children’s mental health and the potential impact of cuts to Medicaid.
They even “off-roaded” to the offices of senators from West Virginia, Wolfe’s home state, to drop off folders of information.
“In West Virginia, there’s excessive need and not many child psychiatrists,” Wolfe said. “Daisy and I were lucky enough to be able to take the days off. A lot of people can’t do that.”
Bassen emphasized that there are many ways to make a meaningful impact that don’t require traveling to Washington, D.C. In fact, she considers Rhode Island an ideal place to get started in local advocacy.
“Rhode Island is such a small place,” Bassen said. “I’ve learned that if I call elected state officials, it’s usually them who will answer the phone.”
In addition to contacting legislators, she suggests tracking healthcare legislation, writing op-eds, attending rallies and support walks, even testifying at school committee meetings.
“You don’t have to figure it out on your own,” Bassen said, adding that many professional organizations, such as the Rhode Island Council of Child and Adolescent Psychiatry (RICCAP), provide helpful advocacy resources. “There’s a whole community of other people doing it who would be overjoyed to help you.”
She traces that ethos of collective advocacy to an important lesson she learned as a resident on her first night on call: “The senior resident said, ‘The first rule of medicine is: Do no harm. The second rule is: Never worry alone.’”