Community Ment Health J DOI 10.1007/s10597-010-9289-1 ORIGINAL PAPER Reflections on Working for Senator Edward Kennedy, A Vital Ally in the Effort to Improve Mental Health Access and Care David A. Pollack Received: 23 November 2009 / Accepted: 1 January 2010 Ó Springer Science+Business Media, LLC 2010 Abstract The author worked as a health policy fellow in the most influential person in the Senate on health issues the office of Senator Edward M. Kennedy in 1999. These and had been part of most of the key health legislation of reflections on that experience provide a description of the the past 20–30 years. His role on the Labor Committee, ambience of working on health policy issues in the US as ranking member of the minority, made him the key Congress, how the author utilized his community psychiatric Democrat in organizing and collaborating with the other knowledge and skills to assist in the process of developing Democrats as well as coordinating and negotiating with the and promoting various health and mental health related Republicans on a wide variety of health issues, especially issues, and what it was like working in the Kennedy office. In those that relate to public health and private insurance the wake of his death, the Senator’s long and influential issues. career and especially his role in advancing health and mental The staff in the health office were very bright, surpris- health access and care improvement cannot be overstated. ingly seasoned (compared to the generally Gen-X nature of the staff of most other offices), and quite interested in using Keywords Mental health policy Á Government process Á congressional fellows to do a major amount of their work. History They were very supportive of me. After an initial period orienting myself to the office procedures and protocols, I was given an agenda of issues to work on, many of which The following are selections from my chronicle of working had mental health as their focus. In particular, I was to be in Senator Kennedy’s health office in 1999 (which I could involved with the reauthorization of SAMHSA (the federal have entitled ‘‘Shrink Rapped Health Policy’’). They reflect Substance Abuse and Mental Health Services Agency), as the nature and ambience of working in Senator Edward well as the mental health aspects of the medical records Kennedy’s office, but also the amazing capacities and privacy bill and the patient protection legislation. Almost qualities of this truly great and unforgettable man. immediately I was inundated with tons of background reading, began setting up various meetings to get things rolling, and consulting with others about the best ideas and February, 1999 strategies to pursue. A few words about the Kennedy Health Subcommittee I began work as a Robert Wood Johnson Health Policy office. I worked in the Minority (meaning Democratic) Fellow in the office of Senator Kennedy. He was probably Health Subcommittee Office of the Labor Committee, of which the ‘‘Senator’’ (as he was called) was the ranking member. The office had three full time legislative staff, five D. A. Pollack (&) fellows, a marvelously organized and unflappable young Departments of Psychiatry, Public Health and Preventive office manager, and an ever-rotating collection of college Medicine, Division of Management, Oregon Health interns, who were a nice consolation for not having a and Science University, Mail Code: UHN-80, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA secretary. The two main staff were terrific people, extre- e-mail: [email protected] mely bright and energetic. They directed our activities but 123 Community Ment Health J gave us each a number of issues to be primarily responsible The issues I had included the reauthorization of the for (with periodic checking in and guidance from them, Substance Abuse and Mental Health Services Administra- especially with regard to the political aspects). They took tion (SAMHSA), the agency charged with funding services the lead on the most critical and high profile issues, such as research and block grants to the states for community based managed care reform (known fondly, if not optimistically, mental health and addictions services. It was an exciting as the Patient’s Bill of Rights), Medicare reform, and the project, because it afforded opportunities to incorporate overall shepherding of our agenda. We had a list of 50–60 new initiatives into the agency’s program agenda. It was a different health issues to deal with, some related to specific challenge, both in terms of getting fully up to speed on the legislation or regulatory activities, some simply issues to issues involved with the legislation (which had been keep track of for Massachusetts constituents or to make evolving for 2–3 years and included several major nego- sure the majority did not pull a fast one on us. So, each of tiated agreements on certain provisions), to effectively us had 8–12 specific issues to be personally responsible for coordinate and lead (with sufficient attention to all the tracking. For the issues that may have legislative initiatives political ramifications) the staff from the other minority associated with them, we were often the leadership for the offices, and to relate effectively to the staff from the other Democratic offices in the committee, but more about Republican offices without revealing too much or becom- that later. ing too contentious. The office was in Hart, the newest of the three senate I also worked on a proposal to allow certain people office buildings, a big eight story box with a huge central between 55 and 64 to buy into Medicare when they lost atrium filled with a very large Alexander Calder mobile/ other coverage, the mental health aspects of the bill on stabile. The space in our office was rather cramped, with privacy and confidentiality of medical records, the mental bookshelves and desks filled with files, books, and briefing health aspects of managed care reform, and a few other binders on all the issues the office had ever dealt with. I issues that became more active later. There was no way I shared a small cramped office with two or three other could be fully informed and on top of each of these issues. fellows. Two other fellows occupied the office across the The apparent goal was to stay just enough informed on any hall. We were all over everywhere and in each other’s particular issue to deal with it sufficiently to keep others spaces all the time, partly because we collaborated on so thinking that you are on top of it and then to cram on the many issues. The pace was frenetic, but quite comfortable issues that became hot. and eerily familiar for a hypomanic refugee from an urban We also got occasional mini-research assignments to community mental health center. We jumped from one check out questions that one of our bosses tossed to us with issue to another, ran off to meetings, darted away for a minimal notice, requiring sudden attention to another new quick lunch or bathroom break, but often found ourselves issue. I became an expert on several fairly arcane aspects of working well into the evening. I got into a strange routine Medicare, indigent care for hospitals, and post traumatic of looking up from my computer and realizing that stress disorder in children who witness violence. The other (‘‘Goodness gracious! It’s 8:30 already; I guess I should go occasional activity was dealing with and making recom- home’’) I was completely absorbed by what I was doing mendations on requests to meet with the Senator or to have and not tired until it dawned on me that I should be. him attend some public event or private meeting that Since I was the only mental health person in the office, related to one of my issues. and since we were the main office dealing with health issues, So, I spent a lot of time jumping from one activity/issue/ I was handed all of the mental health issues. The other offices assignment to another, going to frequent meetings, making of members of the committee (in particular Senator Paul lots and lots of phone calls, and writing memos and letters Wellstone, who, before his tragic death, was the Democratic for the Senator. In my spare time, I read any of about 40 champion for mental health issues) were very involved in different documents that were critical to understanding my health issues, but usually in a more selective way, taking the issues. It was an exhausting way to live and work, but lead only on specific issues that they staked claims over, but exciting and interesting, and thankfully it was time-limited. not nearly as many as our office managed. It turned out that Senator Kennedy was Mister Health (and Mister Labor, Education, Judiciary, and a few other May, 1999 Misters as well) in the Senate, having been the key legis- lator on countless issues over the prior 37 years (yes, that’s The First Speech right, he was the longest sitting Democratic senator after West Virginia’s patrician, Robert Byrd). Therefore, we in One of the first requests I received in the office was from the Kennedy office were in a fairly influential position on the American Psychological Association to have the Sen- the issues that we managed. ator come to their legislative leadership banquet to receive 123 Community Ment Health J an award for his long and effective commitment to the of this sort occurs this season. However, the show has been needs of persons with mental illness. Apparently legislators renewed for a second season and we cannot guarantee what are offered all kinds of recognition and invitations to speak, will happen then.