May 7, 1999

Despite the growing national cynicism about the effect Congressional actions have on the lives of Americans, psychiatrist John Wallace, M.D., is surprised by just how substantial an impact Congress's deliberations actually have on the day-to-day lives of his fellow citizens.

Wallace is one of two young psychiatrists selected to spend six months away from their clinical duties showing federal lawmakers why the treatment and insurance needs of mentally ill Americans must not continue to fall between the legislative cracks that swallow up so many constructive proposals on Capitol Hill.

"Seeing the reality of the process in action and realizing that what goes on in discussions on the Hill is not just academic but will have a direct impact on how I practice and what options my patients have" clearly showed him how enduring Congress's actions really are, said Wallace in an interview with Psychiatric News.

Wallace and Sukhmani Gill, M.D., are APA's 1999 Daniel X. Freedman Congressional Fellows. The program, now in its fifth year, provides funds for two senior psychiatry residents interested in public policy and the legislative process to work on health-related issues from the rarified perch of the office of a U.S. senator or representative. Program funds come from the American Psychiatric Foundation, which administers the fellowship, and Eli Lilly and Company.

Wallace is spending his six months on the Hill in California Senator Dianne Feinstein's office where, he said, he has been fortunate to be allowed to work on a wide array of health issues including legislation affecting managed care, confidentiality issues, and improving medical services in underserved areas.

As soon as Wallace walked in the door back in January, he found himself detailed to a briefing on legislative proposals intended to change the way the Medicare program funds medical residencies, after which he prepared policy recommendations on this issue for Feinstein.

Characterizing his Washington experience as an "extraordinary opportunity," Wallace, still in awe after three months in the corridors of Congress, said, "In just a few months I went from seeing the pain of a mental health center laying off staff and cutting services to preparing questions for Donna Shalala, the Secretary of Human Services, about the impact of the President's budget on the health care of Americans."

Gill arranged to spend her Capitol Hill tenure in the office of New Jersey Congresswoman Marge Roukema. Gill has lent her psychiatric expertise to legislative proposals involving autism treatment and prevention, insurance parity for mental health and substance abuse care, graduate medical education, and health insurance reform, including patient protection legislation.

She told Psychiatric News that she is especially excited about the opportunity to contribute to the Mental Health and Substance Abuse Parity Act of 1999, which will be introduced by Rep. Roukema. Gill explained that the bill, which will attempt to move the insurance industry toward complete parity, "is designed to prohibit group and individual health plans from imposing treatment limitations or financial requirements on the coverage of mental health benefits, as well as substance abuse and chemical dependency benefits, unless similar limitations or requirements are imposed on medical and surgical benefits."

She noted that she also has been quite involved in legislation that would empower the Centers for Disease Control and Prevention to wage an aggressive fight against autism. It would, according to the bill's sponsors, "provide $7.5 million to establish several centers of expertise in autism in an effort to quantify the incidence and prevalence of autism, as well as develop new ways to treat and prevent it."

Observing the machinery of the legislative process firsthand has also provided a bit of enlightenment about lawmakers' motivations, Gill said. "I was surprised to learn after just a short time here that Congress exists not to make laws, but to keep bad laws from passing. The barriers to enacting legislation that frustrate so many people are intentional."

She added that she is increasingly impressed with the impact that constituents from a member's district have on legislation when they take the time to write or call their congressional representative's local or Washington office.

"If enough people write in, it really does sway opinions on the Hill. Staff members in each office keep tallies of letters and calls supporting or opposing an initiative. It just makes such a difference," Gill stressed.

Both Gill and Wallace emphasized that the representative and senator for whom they work have made excellent use of the psychiatric and health-related expertise offered by the fellows.

"They seek me out for clinical and scientific input on health issues in general and mental health issues in particular, which I really appreciate," Gill noted. "I like adding a dose of clinical reality to the words and numbers."

Wallace, who earned a law degree before entering medical school, is a psychiatry resident at the University of North Carolina Hospital in Chapel Hill. Gill is on leave from McLean Hospital, where she is a Harvard Medical School clinical fellow in psychiatry. She is also the American Academy of Child and Adolescent Psychiatry's representative to the Resident Physicians Section of the American Medical Association.

Neither plans to leave their fascination with the legislative process back in Washington once they return to their residencies at the end of June. Wallace said he intends to use his Capitol Hill experience "to do what I can to make sure legislators know how the laws they make have an impact on the people we treat. I also plan to ensure that the voices of those who may not be as equipped as we are to speak for themselves are heard by the people who make the laws."

Gill hopes to be involved in the public policy arena "for the long term" and noted that she is "open to a variety of possibilities" for the future.

The congressional fellowship is named in honor of former APA president Daniel X. Freedman, M.D., who supported the idea that psychiatrists need to be involved in the political process so they can benefit their profession and their patients. Freedman died in 1993.

Freedman's vision appears to be on its way to being realized. "It's hard to express just how valuable this experience has been," Wallace emphasized, "especially to go from seeing how legislation affects my patients to seeing how legislation is made, and even having some role in shaping it is a perspective I never thought I would gain.

"I think physicians are learning more and more that it is critical that they communicate with those who make our laws. Too often in the past, we have been put off by thinking that legislative issues are the province of 'politicians,' with all the negative connotations that go along with that term. But we do so at our own peril, because laws will be made with or without us."