Authors:
- Jennifer Piel, she/her, Associate Professor without Tenure, Psychiatry and Behavioral Sciences, University of Washington, Seattle campus
- Edward Goldenberg, Clinical Professor, Psychiatry and Behavioral Sciences, University of Washington, Seattle campus
Project Description
The project focuses on participation in legislative advocacy as a way to learn about healthcare advocacy and broader concepts at the interface of psychiatry and the law. Although advocacy is recognized as an important topic for medical education, educational programs and experiences in advocacy are often limited. Legislative advocacy focuses on measures to introduce, implement, or change laws through the legislative process. We developed a course with a legislative advocacy track. The course includes didactic and experiential learning. As part of this project, psychiatry learners were surveyed about their learning activities and involvement in the 2023 legislative session. Results revealed that, collectively, program participants reviewed over 100 bills relevant to behavioral health. Survey results shed light on ways that participation in legislative advocacy can improve skills and empower participation in policy activities.
Project Question
Although advocacy is recognized as an important skill for health professionals, educational programs struggle with finding meaningful ways for learners to participate in advocacy efforts beyond the patient-clinician relationship. This program aimed to provide an educational environment for learners to gain skills and experience in legislative advocacy. The program sought to increase knowledge in basic legal concepts, how bills are made, statutory interpretation, and the influence of law on psychiatric practice, as well as hands-on skills for working with policymakers and stakeholders.
Context
We created a curriculum in legislative advocacy in psychiatry. The curriculum provides learners with experiences and skills to increase awareness of the relevance of legislative advocacy in psychiatry. The curriculum includes didactic and experiential learning. The training exposes learners to the legal system, statutory interpretation, organized medicine, serving in a consultant/teaching role, testifying, and ethics in advocacy. Learners complete individual projects with mentored guidance.
The curriculum initially originated as a track for BSCI-525 (Psychiatry and Law), an interdisciplinary course for learners interested in the intersection of mental health and the law. The course combines weekly didactic with a dedicated mentored project, in this case a project related to legislative advocacy. To make it available to more learners and those who cannot participate in a traditional course format, the curriculum has been adapted to offer a one-month immersion rotation for psychiatry residents during the state legislative session. The curriculum includes readings, resources on bills currently before the legislature, cannons of statutory interpretation, and practical skills related to talking with policymakers, testimony before the legislature, policy briefings, and working with other stakeholders.
The curriculum includes readings, resources on bills currently before the legislature, cannons of statutory interpretation, and practical skills related to contacting and talking with policymakers, how to sign-in to provide one’s position on a bill, testimony before the legislature, policy briefings, working with lobbyists, and working with other stakeholders. Learners are introduced to lobbyists and organizations with interest in the relevant bills. Bills of interest to the learner are discussed in mentored sessions.
Methods
The project included a survey of psychiatry participants to better understand their experiences with the legislative process, knowledge and skills, and attitudes toward continued participation in health advocacy on a population scale. In addition, the course requires students to complete an individual advocacy project under mentorship. We are able to track activities and reported skills acquired by the learners after completion of the course. Among outcomes, learners have used their projects as a means to communicate with policymakers, testify before the legislature, develop position statements, write op-eds, and work with relevant stakeholders to better appraise specific legislative proposals.
Impact/Assessment
As part of the project, a survey was administered to better understand the impact on learning and attitudes towards health advocacy and, more broadly, the intersection of psychiatry and law. The results revealed that, collectively, participants reviewed over 100 bills relevant to clinicians or consumers of behavioral health in the 2023 legislative session. The results revealed a strong interest in advocacy by learners. The results indicated that participants, following their training, had improved understanding of the U.S. legal system, sources of law, reading bills, cannons of statutory interpretation, and testifying. All participants responded that their participation improved their understanding of how laws impact behavioral health clinicians, consumers, and/or services. Regarding skills, respondents overwhelmingly indicated that they feel more confident in reading bills or statutes; feel more confident testifying before the state legislature or similar body; and feel more confident in discussing behavioral health topics with policymakers. Many respondents reported that they now have an increased appreciation and interest in how psychiatry and law intersect.
Application
Although advocacy has been identified as an important skill for psychiatrists, there are limited opportunities to include this in the general training program. The course is a component of an elective rotation, meaning that only a portion of psychiatry trainees are able to participate. There are additional challenges, such as proximity to the state capital and the timeframe for the legislative session. One of the most significant barriers is identifying faculty members versed in legislative advocacy. These challenges can be overcome. We incorporate the use of small mentorship teams with a faculty advisor and multiple trainees to foster feedback and participation. This allows learners to gain helpful perspectives from others and additional feedback on the implications of policy on various stakeholders. The faculty advisor and mentorship teams also provide learners with useful feedback about future directions to promote their work and acquired expertise in the policy topic(s). The goals and outcomes of this project should not be limited to psychiatry. Although the survey component was directed at psychiatry trainees, the course has included learners from social work, psychology, law, and other departments. The current course focuses on mental health-related advocacy; a similar course could be developed around other areas of healthcare, academic discipline, or industry.