The Politically Divided 118^th Congress:

NBC News recently noted that more than 50 years ago, two female lawmakers led a Congressional Committee for the first time: the House of Representatives Select Committee on the Beauty Shop. This Congress, women will hold all four of the top positions on the House and Senate Appropriations Committees for the first time in our nation’s history; thus, being responsible for $1.7 trillion in federal spending annually. In the U.S. Senate, Patty Murray is the new Chair, while Susan Collins is the Ranking Member. In the U.S. House, Kay Granger is now the Chair, with Rosa DeLauro serving as the Ranking Member. This is also the first time that the Biden Administration faces a politically divided Congress.

In enacting the Fiscal Year 2022 Consolidated Appropriations Act during the last Session of Congress, then Chairperson Rosa DeLauro stated: “Hubert Humphrey held that the ‘Moral test of government is how we treat those in the dawn of life… the twilight of life… and the shadows of life.’ And I have always held that as a guiding principle. This funding helps us tackle the biggest issues facing American families. We lower the cost of living for hardworking people and the middle class by investing in child care, early learning programs, high poverty schools, students with disabilities, and by expanding access to higher education.” Her counterpart, then-Chairman of the Senate Appropriations Committee Pat Leahy, highlighted the bipartisan support for behavioral and mental health, especially when targeting the critical needs of our nation’s children. Senator Leahy has been a strong supporter of psychology for decades and a personal admirer of former APA President the late George Albee (1921-2006).

Included in this far-reaching law are a number of provisions which should be of considerable interest to those in the behavioral/mental health professions. For example, Veterans won big when the Senate attached significant pieces of legislation advanced by the House Veterans’ Affairs Committee Democratic Majority to the must-pass Appropriations Omnibus package. Then-Chairman Mark Takano’s STRONG Veterans mental health mini-omnibus, REMOVE Copays Act, and the VIPER Act—all developed and shepherded by former APA staffer Heather Kelly while on the House staff—were included in the non-appropriations “ash and trash” section of the massive bill and signed into law by President Biden soon thereafter.

In 2023, the Department of Veterans Affairs (VA) is mandated to implement the mental health, suicide prevention, and research provisions of those bills, including: comprehensive, culturally appropriate mental health outreach and suicide prevention for Native Veterans at every VA medical center; inclusion of sovereign tribes in VA’s Governors’ Challenge suicide prevention program; phased expansion of VA’s peer specialist services to all VA medical centers; elimination of copays for every Veteran’s first three outpatient mental health appointments at VA every year; the hiring of 100 new Vet Center staff, 500 new VA mental health trainees, and 50 additional mental health scholarship awardees; broadening of Vet Center eligibility; improvements to VA’s Veterans Justice Outreach Program; mandatory mental health consultations when Veterans file certain disability claims; new Office of Research and Development authorizations; and scientific studies on topics including sleep disorders, substance use, and military family well-being.

Also included in the appropriations report was language “Encouraging the Assistant Secretary of Defense for Health Affairs to revise regulations regarding employment of clinical psychologists to include those who graduate from programs accredited by the Psychological Clinical Science Accreditation System to ensure the Department has full access to qualified clinical psychologists.” This was the vision of Alan Kraut, former founding Executive Director for the Association for Psychological Science (APS) and just retired Executive Director of the Psychological Clinical Science Accreditation System (PCSAS). For those with an interest in psychology’s history, Alan, then in his role as an APA senior staff member, initiated the first APA Black Tie Dinner at our annual convention for elected officials. The inaugural guest was U.S. Senator Daniel K. Inouye.

In reviewing the accompanying House Report (H.R. #117-403), the breadth of the expressed Congressional interest and vision is quite impressive: “Mental and Behavioral Health. The COVID-19 pandemic exacerbated existing mental health and substance use disorder crises, with more people reporting increased levels of anxiety, depression, suicidal ideation, and substance use. In particular, more than a third of high school students reported experiencing poor mental health during the COVID-19 pandemic. Suicide continues to be a leading cause of death, taking more than 45,000 lives in 2020, and is the second leading cause of death among youth between the ages of 10 and 14. Drug overdose deaths have also continued to increase with CDC estimating more than 107,000 drug overdose deaths in the United States during 2021, an increase of nearly 15 percent from 2020, according to provisional data.”

APA’s Chief Advocacy Officer Katherine McGuire and her staff, along with advocacy by psychology’s state leaders, were impressive in convincing the Committee to provide additional funding specifically for psychology: “Graduate Psychology Education (GPE) – Within the total for Mental and Behavioral Health Programs, the Committee recommendation includes $25,000,000, $5,000,000 above the fiscal year 2022 enacted level, for the interprofessional GPE program to increase the number of health service psychologists trained to provide integrated services to high-need, underserved populations in rural and urban communities. The Committee recognizes the severe impact of COVID-19 on Americans’ mental and behavioral health and urges HRSA to strengthen investments in the training of health service psychologists to help meet these demands.”

“Nursing Workforce Development: Expanding Access to Nursing Education — The Committee remains concerned about workforce shortages among health care professionals, including the nursing workforce. According to the American Hospital Association, nursing vacancies increased by nearly 30 percent between 2019 and 2020, with an additional 500,000 nurses expected to retire or leave the profession by the end of this year. Recent studies suggest that an additional 1.2 million nurses will be required in the U.S. by 2030 to meet anticipated demand.”

Exploring what one might consider external and/or internal historical practice barriers:

• “The Committee bill strikes language prohibiting HRSA funds from being used to support demonstration projects to train or employ alternative dental health care providers, including dental therapists. Dental therapists are licensed providers who play a similar role in dentistry to that of physician assistants in medicine, and work under the supervision of a dentist to provide routine dental care like exams and fillings. Ending this prohibition on funding will give States flexibility to expand the oral health workforce and improve access to dental care, particularly in rural and underserved communities.”
• “Social Workers– While the Committee is aware that the behavioral health workforce is seeing shortages in all professions, the Committee encourages HRSA to ensure that social workers are receiving equitable treatment from the program given their multifaceted roles in health care settings. Additionally, the Committee encourages HRSA to ensure that program awardees are actively working to recruit a diverse field of behavioral health professionals.” And,
• “Nursing Workforce Development: Experiential Learning Opportunities– The Committee is aware that mental health is one of the most in-demand skills in nursing, but many nurse education training programs do not expose students to mental health care settings. The Committee encourages HRSA to give priority to experiential learning opportunities grantees that are partnering with behavioral and mental health hospitals to increase the pipeline of nurses into this field.”

An intriguing policy question for which the behavioral sciences might provide scientific evidence: “Active Shooter Drills – The Committee is concerned about the possible mental, emotional, and behavioral health effects on students and staff resulting from lockdowns drills and active shooter drills conducted in elementary and secondary schools. In response, the Committee provides $1,000,000 for the Department to enter into an agreement with the National Academies of Sciences, Engineering, and Medicine (National Academies) under which the National Academies will conduct a study to assess the science on the potential mental, emotional, and behavioral health effects of firearm violence prevention activities on students and staff in elementary and secondary school settings. The study and subsequent report should include an analysis of the effects of active shooter simulations, full-scale lockdowns, secured-perimeter lockouts, and other school security measures (e.g., metal detectors, visibility of police/policing on campus) and their mental, emotional and behavioral consequences. The assessment should review the potential effects on children and youth of different ages and on students with disabilities. The National Academies report should identify practices and procedures that can minimize any adverse mental, emotional, and behavioral health effects on children, youth, and staff in elementary and secondary schools resulting from the drills and make recommendations were appropriate.”

One of the pleasures of working on Capitol Hill is that upon occasion one is able to experience projects that one envisioned years ago gradually mature over time. HRSA reports that “Since 1985, our EMSC work has helped seriously ill and injured children. We make sure that–no matter where a child lives–the health systems in their area provide quality emergency care services. The goals are to improve access and quality of emergency care for children and reduce serious injury or death. The program also provides leadership in improving emergency services for children and teens both before they get to the hospital and after they arrive at the emergency department.” This year the Appropriations Committee provided $25 million, an increase of $2,666,000 above last year: “Funding is available to every State emergency medical services office to improve the quality of emergency care for children and to support research on and dissemination of best practices.” The EMSC program was originally authorized on a bipartisan basis by U.S. Senators Daniel Inouye and Orrin Hatch; HRSA pediatrician David Heppel successfully nurtured it during its early days. Mahalo.

Investing In One’s Professional Future:

The American Association of Nurse Practitioners (AANP), with a membership of more than 121,000, reported that in 2022, AANP members contributed nearly $250,000 to their AANP-PAC. They further pointed out that throughout 2022, there were other provider groups that actively opposed their efforts to remove outdated federal practice barriers on Nurse Practitioners and their patients. And, that year the other health care provider PACs raised an average of more than $600,000. “If every AANP member contributed at least $25, the AANP-PAC would raise over $3 million and become one of the largest health care provider PACs in the nation.”

Last year the Psychology PAC met its goal of raising $100,000 – over $20,000 more than the previous year and an all-time high for the PAC. For the 2021-22 election cycle, the PAC raised over $200,000. Wonderful progress; although we still have a long way to go to ensure Psychology continues to have a “seat at the table.” In comparison, the Physical Therapists’ PAC raised over $1 million in the last Congress and the Social Workers raised $363,000. If only every APA member contributed just $25, the Psychology PAC would become one of the largest health professions PAC in the nation. Will psychology learn from the AANP experiences and take their message to heart? “We still have tasks to do, so, let’s split up so we can win. Everyone is sus so let this last round begin” (Among Us in Real Life, Rebecca Zamolo). Aloha,

Pat DeLeon, former APA President – Division 29 – February, 2023

+1

0

Pat DeLeon, Ph.D.