“There's a man goin' ‘round takin' names”*
By Patrick H. DeLeon, PhD
With the convening of the 114th Congress (2015-16), and the Republicans controlling both the U.S. House of Representatives and U.S. Senate for the first time since 2006, public service colleagues should expect somewhat different legislative agendas and federal budgetary priorities to evolve. The newly elected Senate majority leader has proclaimed: “It's time for a new direction. We can have real change in Washington, and that's just what I intend to deliver.” It is too early to predict with any sense of certainty what specifically will evolve. However, change is definitely in the air. Accordingly, this might be a good time to reflect upon several developments that were occurring right around election time.
Evolving Treatment Programs
One of the foundations of President Obama's Patient Protection and Affordable Care Act (ACA) is the development of interprofessional (i.e., interdisciplinary) integrated systems of data-driven primary care which will provide a priority for preventive care and wellness, while eliminating historical barriers for receiving mental health/behavioral health services. The ACA invested heavily in expanding the Federally Qualified Community Health Centers initiative, which was established under President Lyndon Johnson's Great Society era. Bob McGrath, director of Integrated Care for the Underserved of Northeastern New Jersey at Fairleigh Dickinson University and their clinical psychopharmacology program: “Thanks to the efforts of APA to improve funding for the Graduate Psychology Education program, in July this year I unexpectedly received funding for a grant that had been recommended but not funded in 2013. The grant was to create a clinical training site in the primary care services of a local federally qualified health center called North Hudson Community Action Center. We got the notice a week before the grant start date, so since then has been a whirlwind of creating a program from scratch, including finding students, hiring supervisors, creating protocols, developing a training program, establishing a legal relationship between the university and the site, and developing a personal relationship with staff. The many months of work finally paid off, and in early December we began offering behavioral health services on an as-needed basis within the women's health and internal medicine services. The population is overwhelmingly poor and Hispanic. Few have ever had contact with mental health services before. In just two days, we've seen people (including several staff members) suffering with chronic pain, overwhelming life stress, suicidality and depression, family problems. It's remarkable how great the need is, and how limited the resources are. It's exhausting work – I don't know how the staff keeps up this pace day after day – but it feels like we're finally connecting with people in real need who can benefit from what we have to offer. I'm excited, and I know my students are already being reshaped as clinicians by what we've created.”
Bob's visionary efforts to move psychology into the future are most timely. I recently participated in a conference call for a HRSA national advisory committee during which it was noted: “Mental health disorders rank in the top five chronic illnesses in the U.S. An estimated 25 percent of U.S. adults currently suffer from mental illness and nearly half of all U.S. adults will develop at least one mental illness in their lifetime. In 2007, over 80 percent of individuals seen in the emergency room had mental disorders diagnosed as mood, anxiety and alcohol-related disorders.”
The Advent of Social Media – Congressional Management Foundation (CMF) Findings
Advocacy groups have relied heavily on constituent email communications for years, and yet a recent CMF survey of Capitol Hill communications directors, legislative directors, and legislative assistants found that three quarters of senior Hill staff report that between one and 30 comments on social media platforms like Facebook and Twitter would get their attention on an issue. Thirty-five percent indicated that even fewer than 10 comments were sufficient. Social media interactions are viewed as authentic communications and its influence was perceived as rising. Seeing an issue pop up in tweets or comments in just one instance is generally not enough to get congressional attention. Similarly, when numerous advocates tweet a prearranged message at an account all at once (i.e., thunderclaps), these are not viewed as authentic communications. However, if tweets and comments on an issue appear over the course of many days on social media accounts, they are definitely noticed. To be effective, these repeated interactions have to be viewed as having a human element expressing a genuine concern. Because many staffers have grown up with social media, they are adept at separating out constructive comments on Facebook and Twitter from the noise.
As is the case with email, the tone and level of influence a sender has will boost the likelihood of a message being heard. It is particularly effective when constituents interact with the specific content Hill staff have posted on the member's Facebook. Genuine conversations are valued. When asked which constituent types were most influential with Congress when commenting on social media, the CMF survey found that 77 percent cited multiple constituents commenting within a group; 75 percent cited leaders of a group or organization; 69 percent cited a single constituent self-identifying with a group; and 58 percent cited a single constituent on his or her own. While email is still the dominant form of communication, social media is expected to increase over emails and individual phone calls during the next five to 10 years. Hill staff reported that social media is often seen as a barometer of public opinion. APA is well ahead of the curve. Rhea Farberman reports that APA's main website averages 3 million visitors per month and that 282,000 people follow APA's Facebook page. Most impressive.
Substantive Change Takes Time – Often Far Longer Than One Might Imagine
In 2004, when the Republicans were in the majority, the Senate HELP Committee recommended adoption of the Act for Elder Justice [S2940], which would amend the Older Americans Act to create the Office of Elder Abuse Prevention and Services. The accompanying Senate report: “The proportion of the United States population age 60 years or older will drastically increase in the next 30 years as 77,000,000 baby boomers approach retirement and old age. Each year, anywhere between 500,000 and 5,000,000 elders in the United States are abused, neglected, or exploited. This variance reflects the unfortunate fact that there is a general lack of comprehensive data on such abuse, with 500,000 reflecting the number being reported and a significantly higher number of cases that go unreported. Elder abuse, neglect, and exploitation have no boundaries, and cross all racial, social class, gender, and geographic lines. Victims of elder abuse, neglect, and exploitation are not only subject to injury from maltreatment and neglect, they are also 3.1 times more likely to die at an earlier age than expected than elders who were not victims of such maltreatment.
“For over 20 years, Congress has been presented with facts and testimony calling for a coordinated federal effort to combat elder abuse, neglect, and exploitation. The federal government has been slow to respond to the needs of the victims or to undertake prevention efforts. No federal law has been enacted that comprehensively addresses the issues of elder abuse, neglect, and exploitation and there are limited resources available to those in the field directly dealing with these issues” (Senate report #108-391). Enacted as a provision of the ACA on March 23, 2010, this was the first legislation authorizing specific federal funding addressing elder abuse.
“Listen to the words long written down, When the man comes around.”*
“The Man Comes Around,” by Johnny Cash