Lisa Spurlock, M.D., and Cynthia Vitko, M.D., have taken an unusual detour on their way to a psychiatric career. The two senior residents are spending a year on Capitol Hill sharing their medical and mental health expertise with senators and Senate staff members as they try to legislate improvements in the nation’s health care system.

Their Hill experiences are made possible by the American Psychiatric Foundation’s Daniel X. Freedman Congressional Fellowship, which each year pays the living expenses for two senior psychiatry residents interested in public policy issues to work in the office of a House or Senate member or on the staff of a health-related committee in Congress.

The 12-month fellowship, now in its sixth year, provides each of the fellows with a $20,000 stipend in addition to covering their expenses for moving to Washington, D.C. Funding is provided by the American Psychiatric Foundation and Eli Lilly and Company.

Vitko is working in the health office of Senator Edward Kennedy (D-Mass.), and Spurlock is on the staff of the Senate Finance Committee’s minority—that is, Democratic—side, where she works for Senator Daniel Patrick Moynihan of New York.

While all of the fellows have been involved to some extent with policymaking, the law, or the political system, either locally or nationally, the federal legislative process rarely fails to offer some eye-opening lessons.

It did not, for example, take Vitko long to discover one of Capitol Hill’s oft-proven truisms—that knowledge may be important in crafting legislation, but the cliché about squeaky wheels is a way of life on the Hill.

"Squeaky wheels do get greased," Vitko told Psychiatric News. That situation doesn’t mean, however, that advocates armed with data and a good cause can’t be effective as well, she noted, even without the deep pockets and cadre of lobbyists that some special interests can use to influence legislation.

Another lesson that Vitko said is brought home repeatedly is that "legislators are reactive, not proactive. They react to the latest news story." She likened this to the medical field, "which has emphasized the disease model rather than prevention."

Spurlock and Vitko have been able to contribute their specialized knowledge to a broad array of health-related legislation in the making.

Spurlock, who is a third-year resident in psychiatry at Wayne State University School of Medicine, said she has worked on Medicare-reform proposals, patients-rights legislation, and maternal-child health issues.

She has been tracking the progress of and briefing Moynihan and his staff on congressional proposals to reduce medical errors and the effect the proposals will have on the way physicians practice. Spurlock has also met with several medical, insurance, and health advocacy groups on this topic.

The consequences of the movement to deinstitutionalize people with mental illness is a particular concern of Moynihan’s, Spurlock pointed out, and she is supervising a study that is assessing the effects of deinstitutionalization on how the severely mentally ill are treated, the ability of community mental health centers to meet the needs of this population, and the link between federal health policies and increases in the number of homeless mentally ill people.

Soon after arriving on the Hill, which coincided with the release of the Surgeon General’s report on mental health, Vitko volunteered to help draft mental health legislation, an initiative that Kennedy and Senator Pete Domenici (R-N.M.) were planning to introduce. The bill, she told Psychiatric News, will attempt "to address some of the more serious consequences of untreated or undertreated mental illness and is also a partial response to the Surgeon General’s report." In particular, Vitko said, she has been researching the report’s finding that there is a shortage of child and adolescent psychiatrists. The bill will also likely call on the Secretary of Health and Human Services to launch an antistigma campaign.

Vitko also is Kennedy’s point person on issues concerning the federal Substance Abuse and Mental Health Services Administration (SAMHSA), which has recently involved developing the senator’s request for SAMHSA’s Fiscal 2001 appropriations request.

In addition to mental health and substance abuse issues, Vitko noted that she has worked on proposals to reduce needle-stick injuries, to allow Americans aged 55 to 64 to buy into Medicare, and to "promote prevention and the use of ‘best practices’ in the care of Medicare beneficiaries." She said she has also been detailed to work on improvements to the Pain Relief Promotion Act, "which despite its name, is likely to chill aggressive and appropriate pain control and is actually intended to nullify Oregon’s physician-assisted suicide law." Kennedy does not support this legislation, she added.

Vitko and Spurlock diverge on how well they feel their Capitol Hill colleagues have used their psychiatric and mental health expertise. Spurlock said that since the Senate Finance Committee has not introduced any legislation specifically related to mental health concerns, her specialized knowledge "has not been fully utilized." She added, however, that committee staffers have asked her opinion when a mental health issue does arise.

Vitko’s experience has been somewhat different. "I work on issues for the Committee on Health, Education, Labor, and Pensions, of which Senator Kennedy is the ranking minority member," she said. "My medical skills and knowledge are constantly used in this position, as are my research skills. I am immersed in medicine. Senator Kennedy is notable for his work in health," she added, "and his interest in health matters keeps this office very busy."

Both Spurlock and Vitko had advice and some reflections for future Freedman fellows. Vitko enthusiastically urged her colleagues to apply for the fellowship. "It is a unique opportunity to be part of the political process at the Congressional level and allows you to meet many wonderful and interesting people," she said.

"But before interviewing for the fellowship and certainly before interviewing in a congressional office," she advised, "carefully determine whether you can work for someone whose politics differ from yours. You are likely to be asked the question at some point in the process."

She also cautioned her colleagues to examine "goodness of fit" before they interview for a position. "Fellows should examine their work style to consider how much supervision they require and what physical conditions they can tolerate."

Working on the minority side, she noted, means that space is much less generous than that enjoyed by the majority party’s offices.

Spurlock suggested that future Freedman fellows also decide before their Capitol Hill tenure begins whether they would find it more rewarding to work on a single issue in depth or be involved in several issues. Also come with a concept, she urged, of how important having access to the senator or representative is for the applicant. Working in a member’s personal office will allow considerably more access to him or her than will assisting in a committee office.

Spurlock intends to remain involved with mental health legislation and policymaking once she leaves the Hill, but on the local or state level. Thanks to her congressional experience, she said she will now be able "to function more effectively in the political arena and better advocate for meaningful changes in health policy."

Vitko, who is also an attorney, plans to head to Georgia, where she will begin a fellowship in forensic psychiatry at Emory University. "I’ll never be a politician," she added, "but I do enjoy being behind the scenes. I suspect I’ll participate in the state or local government process in some capacity."

The late Daniel X. Freedman, M.D., the former APA president for whom the fellowship is named, was an outspoken advocate for the idea that psychiatrists must be involved in the political process for the benefit of their patients and their profession.