As I prepare for this year’s Practice Leadership Conference in Washington, D.C., I am struck by how connected all of our work is. In my day-to-day practice at a University Counseling Center, I do not have to bill insurance, but it is clear to me that advocacy for improved insurance reimbursement and parity of mental health and physical health coverage are essential to my work. At most University Counseling Centers now, we have a population approach to mental health and try to provide for the needs of all students at the school. Of course, we cannot provide for all needs of all students and so offer an array of services like crisis walk-in sessions, group therapy, psychiatry, case management, workshops, after-hours crisis phone counseling, and individual therapy. The individual therapy is short-term so that we can maintain quick access to services. As a result, we rely on being able to refer out students with longer-term needs or more specialized needs (e.g., eating disorder or substance dependence treatment). When students don’t have insurance or their insurance has such high deductibles and co-pays that they cannot afford to use it, we are confronted with the barriers people experience in accessing care. With our new clinical case manager, we can sometimes get students access to care through Medicaid, but the process of signing up for Medicaid is daunting. When students have severe symptoms, feel ambivalent about getting more treatment, and have tight schedules with work and school, it can seem nearly impossible to help them access needed care.
This issue of access to care is the main topic of our Capitol Hill visit this year in D.C. On Tuesday, March 12, hundreds of psychologists from across the country will be on the Hill to visit with our Senators and Representatives (or their very sharp aides). APA staff members will prepare us to advocate (1) for telehealth to be covered by insurance (the Mental Health Telemedicine Expansion Act), (2) for psychologists to be able to provide services without physician approval under Medicare (Mental Health Access Act or “Physician Definition Act”), and (3) for general support of health care coverage. In addition, we may organize our Ohio delegation to speak intelligently about the issue of families being separated during the initial immigration process here. APA has already advocated for change in this practice, and we may be able to speak personally with our Congress people about our concerns.
Then at a black-tie dinner organized by APA’s Political Action Committee or PAC, I will have a chance to talk with Senator Bill Cassidy, Republican from Louisiana. Previously, he founded a free clinic in Baton Rouge and worked as a gastroenterologist. In the House of Representatives and now in the Senate, he has been a champion for mental health care and coverage. Last year, he fought to maintain Medicare payment for psychological testing. I am inspired by his approach to improve access to care for people most in need and by the fact that we come from different political parties but share a passion for access to mental health care.
At APA and perhaps in OPA as well, there has been a distinction at times between advocacy for issues that are considered “practice” issues vs. those considered “social justice” issues. My participation in meetings this month has encouraged me to begin to challenge this dichotomy. In the February OPA Board meeting, the Insurance Committee joined us and shared the work they have been doing and how their work helps psychologists offer adequate care. Several of the committee members and board members framed their work as social justice work which allows clients to have access to care. For instance, insurance companies may take actions that seem to discourage more than a 45-minute therapy session, but for many clients, that length of session may be inadequate. We know from research that conducting a brief measure of symptoms (e.g., OQ-45 or CCAPS) before treatment and periodically throughout treatment improves outcomes and may reduce the number of sessions needed; however, insurance tends to barely reimburse or not reimburse these brief measures. The work of understanding and advocating for changes here can seem quite technical and specific to practice that relies on insurance billing. However, from a broader viewpoint, it is clear that clients relying on insurance (which is most of us) may not have access to all the care we need without this advocacy. Those with fewer resources are perhaps the most impacted by these barriers to care, and thus, advocating for “practice issues” is social justice work.
At a webinar with APA staff who were preparing delegates to address a “social justice” issue of our choosing on Capitol Hill, participants spoke passionately about their practice being inherently social justice oriented. One participant shared that the majority of his clients are from the LGBTQ community; thus, the distinction between practice and social justice issues is not a real one in his lived experience as a psychologist. Anyone working with underserved clients or those with fewer resources may feel the same.
I wonder how we might continue to break down this dichotomy in our work at OPA. Where we have both Republicans and Democrats, agnostics and Christians, liberals and conservatives in our association, can we see how our practice advocacy improves access for all and thus advances social equality? My guess is that we may have many differences in worldview across our members, but we all value the health and well-being of all people, whether it be LGBTQ clients or children just immigrating to the U.S. with their families.