Stangler, who is a consultant on the APA's Joint Commission on Public Affairs, points to the success of other groups in achieving the kinds of results she wishes psychiatrists could manage.
"Looking at the conservative wing of the Republican Party and their aggressiveness and tenacity in Clinton's impeachment matter, I think we have something to learn from some of their procedural and operating styles," Stangler said. "The tenacity and the focus are absolute requirements. We have to be everywhere, and we have to be everywhere all the time."
As an example, Stangler pointed to the National Alliance for the Mentally Ill (NAMI) and the way it has built a base of support in Congress over time.
"I look at a group like NAMI, that has really become a powerful force in public policy-making and this has to do with it being a group that has managed to coalesce disadvantaged and neglected people into a powerful force," Stangler said. "They are organized. They are omnipresent. They are clear about their agenda."
Meanwhile, their ability to affect public opinion also impresses Stangler. "When I read front-page stories in national newspapers about health policy, psychiatric, psychological or mental health issues, inevitably someone from NAMI is cited, quoted or consulted. While the public affairs arm of the APA is aspiring to have a far greater national presence, I think they recognize we've got a ways to go."
Whether the distance can be covered in the short time remaining before Congress takes up health policy reform measures is an open question for some, but not for the APA's Mirin, who said that the throes of internal restructuring shouldn't interfere with lobbying efforts. Once efforts to formalize the integration of certain government relations and public affairs functions are finally in place this spring, Mirin is confident the APA will be ready to take on Congress and public opinion.
"The APA needs to have its activities much more integrated than heretofore, because that's a much more effective way of doing business," he said. "We have lots of very talented people, but if they only function within their own silos, they won't be maximally effective. That's what I've been trying to accomplish here."
Mirin added that building a strong grassroots network is an important goal, but that it takes more than an e-mail listserve. "In any organization of 40,000 members, particularly when the specialty it represents is under siege, inevitably there will be people who feel the organization isn't moving fast enough to represent their interests," said Mirin. "Talk and e-mail messages are easy. Delivery of the passage of legislation; delivery of actual changes in federal legislation that have a direct impact on the reimbursements for psychiatric care; delivery on changes on how we view the confidentiality of medical records-that doesn't get done through a listserve. It gets done by nose-to-nose negotiations and activity at the state and federal level."
Jay Cutler, J.D., the APA director of government relations, agrees. The most effective strategy at this stage is to "continue to do what we have done in the past, while at the same time expanding our activities by having someone in-house assist us with media relations," he said, alluding to the coming integration of government relations and public affairs functions. But he conceded that, without proper teamwork, people could end up "stepping on each other's toes or forming a circle to shoot each other."
Nevertheless, achieving consensus over the coming months will remain an elusive goal. Unless APA insiders can harmonize divergent views on how to approach relations with legislators, some of the energy better directed at issues could be diverted to resolving internecine organizational battles. Ultimately, APA officers, staff and members will need to decide whether advocacy and lobbying efforts should continue to emanate from the top down, or shift to more closely embrace contributions from members outside Washington, D.C., in an expanded grassroots effort.
Mirin acknowledges that members should demand results that protect the profession of psychiatry and the patients it serves. "I'm not interested in rah, rah cheerleading," he said. "I'm interested in results-results for the patient and results for the profession."
Promising to streamline and enhance the APA's government relations and public affairs functions, while maintaining the ability to influence Congress, Mirin added, "I wouldn't have disrupted my entire life to come down here merely to be a cheerleader for psychiatry. The profession and its values and the welfare of patients are at stake here."