Much
of the news we report here comes from Beth Powell of the American Mental Health Counselors
Association. Beth is as well informed regarding the national
issues that effect our profession and we appreciate her alerts!
www.amhca.org;
800-326-2642, x105; bpowell@amhca.org
FIND
AND CONTACT YOUR U.S. AND STATE SENATORS AND REPRESENTATIVES BY CLICKING
HERE
IMPORTANT!!!
The
Senate is about to vote on broad tax relief extension legislation which
includes mental health and addictive disorder parity provisions!
The parity provisions are the result of long, careful negotiations and the
passage by both the House and Senate of landmark parity bills (H.R. 1424 /
S. 558) earlier this Congress. A vote is expected either today
(Thursday, 9/18) or tomorrow.
ACTION
NEEDED:
Call your Senators to ask them to VOTE FOR the tax extenders legislation,
including the mental health parity provisions.
SUGGESTED
MESSAGE:
“I’m calling to ask the Senator to vote for the tax relief extension
legislation, and the important mental health parity provisions included in
the legislation. American with private health insurance deserve the
same parity of insurance coverage for mental and addictive disorders that
members of Congress and all other federal employees get.”
As
always, be sure to leave your name and postal address with the Senator’s
staff person, and feel free to share your individual concerns regarding
the lack of health insurance parity for coverage of mental health
services. All Senate offices can be reached by calling the U.S.
Capitol Switchboard at 202-225-3121, and asking for a particular
Senator’s office. To find out who your Senators are, go to http://capwiz.com/counseling,
and enter your zip code in the space provided.
Mental
Health Services Should Be More Accessible in Primary Care Settings
A
multi-agency report released on
July 23, 2008
, proposes strategies to overcome barriers associated with the
reimbursement of mental health services provided in primary care settings,
and recommends that non-physician practitioners under Medicare and
Medicaid be reimbursed, particularly in underserved and urban areas.
The
report was issued by the Substance Abuse and Mental Health Services
Administration (SAMHSA), the Health Resources and Services Administration
(HRSA), and the Centers for Medicare & Medicaid Services (CMS), three
agencies within the Department of Health and Human Services.
“The
actions identified in this study are practical as well as achievable,”
said Terry Cline, Ph.D., administrator of the Substance Abuse and Mental
Health Services Administration (SAMHSA). “Improving access to timely and
targeted mental health services in primary care settings can improve
patient health and compliance with treatment.”
Mental
health service consumers, practitioners, providers, researchers and
government officials have identified seven barriers and made suggestions
for action aimed at alleviating the barriers to the reimbursement of
mental health services in the primary care setting.
The
main priorities and actions recommended in the conclusions of the report,
Reimbursement of Mental Health Services in Primary Care, include the
following:
·
Increase leadership collaboration at the federal and state
levels among government policymakers in Medicare, Medicaid, primary care,
and mental health to ensure clarity in policies, rules, and procedures,
and to promote the provision and reimbursement of mental health services
in primary care settings;
·
Broadly disseminate clarified policies and procedures to
patients, payers, practitioners, providers, and managers of care;
·
Provide technical assistance and education to states,
practitioners, providers, and managed care organizations;
·
Encourage flexibility in state Medicaid benefit designs to
cover mental health services in primary care settings, modeling changes
based on best practices achieved through existing state Medicaid waivers;
·
Increase payment for professional services by non-physician
practitioners under Medicare and Medicaid, particularly in underserved
rural and urban areas;*
·
Implement policies at the state level for appropriate
reimbursement of telemedicine services; and,
·
Provide reimbursement for mental health prevention and
screening services.
*The
report provides information about the reimbursement status of professional
counselors under Medicare and the report recommends that non-physician
practitioners under Medicare and Medicaid be reimbursed, particularly in
underserved and urban areas.
The
full report is available on the Web at http://download.ncadi.samhsa.gov/ken/pdf/SMA08-4324/SMA08-4324.pdf.
Calls
Needed on Mental Health Parity
The American Mental
Health Counselors Association (AMHCA) and the American Counseling
Association (ACA) have for years been working with Congress to require
health plans to cover mental health disorders and drug and alcohol
addiction on par with physical illnesses.
AMHCA and ACA invite
their members to call their Senators and Representatives about mental
health parity legislation.
AMHCA,
ACA, and other mental health advocates have been pushing hard since 2001
to enact full mental health parity, and victory is finally within reach.
Following the Senate’s historic passage of S.
558 by unanimous consent in September, and House passage
of H.R.
1424 on March 5, informal negotiations commenced.
Mental health providers across
America
should contact their
Representative and Senators NOW to urge their support for successfully
concluding this process. Senate
and House leaders must continue to work together to reconcile differences
between the versions and produce a bill that can pass both chambers before
the end of the year.
Background:
With
suicide claiming some 30,000 lives each year in this country, health
benefit barriers still block millions of Americans from getting needed
mental health and substance-use treatment. Given the critical need for
Congress to lift those discriminatory barriers, and a limited number of
legislative days to do so, there is profound urgency to forge a compromise
on mental health parity legislation that will not only yield strong
protections but will also pass both chambers. We applaud initial steps to
reach that compromise, and call on Senate and House leaders to move
quickly to ensure enactment of a strong mental health parity law this
year.
Failure
to pass a parity bill in 2008 would further delay relief for millions of
American families who face discrimination now.
It would also place the issue directly in the path of a potential
health care policy tornado in 2009 – health care reform – with no
assurance that our issue would receive the attention it needs.
Targets:
All Members of the House of Representatives and Senate.
Action:
All
AMHCA and ACA members, and others interested in this issue, are urged to
call your Representative and Senators by using the
toll-free Parity
Hotline, 1-866-PARITY-4 (1-866-727-4894). (The Parity Hotline
reaches the Capitol switchboard, which can connect callers to their
Members of Congress). Please be sure to leave your name and address
with the staff member to make it clear that you are a constituent.
Message:
 | Tell
the staff member that you are calling as a constituent and a Licensed
Professional Counselor (or your specific state title).
 | Ask
[Representative/Senator]
________________ to urge the Leadership to
help conclude negotiations on mental health parity legislation.
 | Both
chambers must be able to agree on the legislation.
 | Legislation
must be passed before the end of the year; relief from health
benefit discrimination against mental and substance use disorders must
wait no longer.
|
| | |
The
Legislation: Both S.
558 and H.R. 1424 expand the Mental Health Parity Act of 1996 by
prohibiting group health plans from imposing treatment or financial
limitations on mental health benefits that are different from those
applied to medical/surgical services. The legislation applies only to
group health plans already providing mental health benefits and exempts
plans sponsored by small businesses of 50 or fewer employees.
E-News
from Washington
Vol.
08-08
February
13, 2008
Congress
to begin work on Medicare in the coming months
This
past December Congress passed and the President signed S. 2499,
legislation that extends the State Children's Health Insurance Program (SCHIP)
through March 2009 and delays impending pay cuts to Medicare physicians
through June 2008.
After
the House passed substantial Medicare reform legislation (H.R. 3162—the
CHAMP Act) in August, the Senate began work on similar legislation.
Unfortunately, as the end of 2007 approached, the Senate ran out of time
to pass any significant reforms to the program and, instead, was forced to
pass "bare-bones" legislation (S. 2499) to do little more than
delay looming physician pay cuts, which, due to limited available funding
and time, will only last for six months.
The
short-term nature of S. 2499 means that Congress will have to pass further
Medicare legislation before the June 30, 2008 or face the possibility that
many physicians will stop accepting Medicare patients.
Staff
for the Senate Finance Committee have been engaged in informal discussions
on future Medicare legislation for the past few weeks, and are expected to
begin addressing specific provisions in March after the Congressional
Budget Office announces its new funding baselines for 2009. An
aide to Senator Blanche Lincoln (D-AR), sponsor of S. 921, believes that a
bill will be introduced sometime in April, noting that the Senator Max
Baucus (D-MT), Chair of the Finance Committee, is dedicated to taking
significant action on Medicare this year.
Continuing
work on Medicare legislation means that Congress will have another chance
to expand Medicare's provider base by including professional counselors in
the program. Representatives from AMHCA and ACA will
be visiting Senate offices in the next few months to ask Senators to
co-sponsor S. 921 and work to include Medicare reimbursement of counselors
in any broad Medicare legislation.
Counselors
are encouraged to write/call/email their legislators and ask them to do
the same. All Senate offices can be reached by calling
202-224-3121 and asking for your Senator's office. In
your message to the Senator, please consider including the following
points:
 | Professional
counselors are licensed in 49 states and the District of Columbia, and
their education and training credentials are nearly identical to those
of clinical social workers.
 | There
are over 103,000 professional counselors in the United States who
could be helping to address the needs of Medicare recipients.
 | Virtually
all of the rural counties in this country have a shortage of Medicare
mental health providers and about 50% of rural counties have no
practicing psychologist or clinical social worker.
 | Seniors
are the demographic group most likely to commit suicide, and
typically, older Americans who kill themselves had seen a physician
within a month of doing so. Clearly, the pool of covered providers
needs to be expanded to provide better access to mental health care. |
| | |
Members
of the Finance Committee will be influential in drafting this legislation,
so counselors in Montana, West Virginia, North Dakota, New Mexico,
Massachusetts, Arkansas, Oregon, New York, Michigan, Washington, Colorado,
Iowa, Utah, New Hampshire, Maine, Arizona, Kentucky, Idaho, Kansas, and
Nevada are especially encouraged to call and may be receiving a second
email specifically tailored to these Senators.
Below
you will find a list of Senators who have already co-sponsored S. 921;
counselors should call and thank them for their support.
Sen
Barrasso, John [WY]
Sen
Boxer, Barbara [CA]
Sen
Brown, Sherrod [OH]
Sen
Durbin, Richard [IL]
Sen
Johnson, Tim [SD]
Sen
Landrieu, Mary L. [LA]
Sen
Lieberman, Joseph I. [CT]
Sen
Lincoln, Blanche L. [AR]
If
you have any questions or comments, please contact Beth
Powell, American Mental Health
Counselors Association, 800-326-2642 x105 (bpowell@amhca.org)
or Peter Atlee, American Counseling Association, at 800-347-6647 x242 (patlee@counseling.org).
E-News from Washington
Vol. 08-04
January 24, 2008
House
Passes Inmates' Mental Health Bill
On Wednesday, January 23, 2008, the U.S.
House of Representatives passed, by voice vote, H.R. 3992, the Mentally
Ill Offender Treatment and Crime Reduction Reauthorization and Improvement
Act, legislation to improve mental health services for inmates and improve
training for law enforcement officers.
In addition to expanding existing grants
available under the Mentally Ill Offender Treatment and Crime Reduction
grant program created in 2004, H.R. 3992 authorizes an additional $35
million annually in fiscal years 2008-2013 for four new grant programs
focusing on the treatment of female prisoners who are mentally ill,
coordination of the treatment of mentally ill prisoners, screening,
identification and assessment of mentally ill inmates, and coordination of
post-release services.
The purpose of the legislation is to
encourage mental health and criminal justice systems to work together in
devising new, more effective ways to assist the mentally ill. Demands for
grants available through this program have far exceeded their
availability. In 2006, for example, only 27 (11%) received funding out of
250 submitted grant applications from states and communities.
The Senate has not acted on a companion
measure (S 2304) introduced in November of 2007.
If you have any questions, please feel free
to contact Beth Powell
of AMHCA at 1-800-326-2642, ext. 105 or by e-mail at bpowell@amhca.org.
E-News
from Washington
Vol.
08-08
February
13, 2008
Congress
to begin work on Medicare in the coming months
This
past December Congress passed and the President signed S. 2499,
legislation that extends the State Children's Health Insurance Program (SCHIP)
through March 2009 and delays impending pay cuts to Medicare physicians
through June 2008.
After
the House passed substantial Medicare reform legislation (H.R. 3162—the
CHAMP Act) in August, the Senate began work on similar legislation.
Unfortunately, as the end of 2007 approached, the Senate ran out of time
to pass any significant reforms to the program and, instead, was forced to
pass "bare-bones" legislation (S. 2499) to do little more than
delay looming physician pay cuts, which, due to limited available funding
and time, will only last for six months.
The
short-term nature of S. 2499 means that Congress will have to pass further
Medicare legislation before the June 30, 2008 or face the possibility that
many physicians will stop accepting Medicare patients.
Staff
for the Senate Finance Committee have been engaged in informal discussions
on future Medicare legislation for the past few weeks, and are expected to
begin addressing specific provisions in March after the Congressional
Budget Office announces its new funding baselines for 2009. An
aide to Senator Blanche Lincoln (D-AR), sponsor of S. 921, believes that a
bill will be introduced sometime in April, noting that the Senator Max
Baucus (D-MT), Chair of the Finance Committee, is dedicated to taking
significant action on Medicare this year.
Continuing
work on Medicare legislation means that Congress will have another chance
to expand Medicare's provider base by including professional counselors in
the program. Representatives from AMHCA and ACA will
be visiting Senate offices in the next few months to ask Senators to
co-sponsor S. 921 and work to include Medicare reimbursement of counselors
in any broad Medicare legislation.
Counselors
are encouraged to write/call/email their legislators and ask them to do
the same. All Senate offices can be reached by calling
202-224-3121 and asking for your Senator's office. In
your message to the Senator, please consider including the following
points:
 | Professional
counselors are licensed in 49 states and the District of Columbia, and
their education and training credentials are nearly identical to those
of clinical social workers.
 | There
are over 103,000 professional counselors in the United States who
could be helping to address the needs of Medicare recipients.
 | Virtually
all of the rural counties in this country have a shortage of Medicare
mental health providers and about 50% of rural counties have no
practicing psychologist or clinical social worker.
 | Seniors
are the demographic group most likely to commit suicide, and
typically, older Americans who kill themselves had seen a physician
within a month of doing so. Clearly, the pool of covered providers
needs to be expanded to provide better access to mental health care. |
| | |
Members
of the Finance Committee will be influential in drafting this legislation,
so counselors in Montana, West Virginia, North Dakota, New Mexico,
Massachusetts, Arkansas, Oregon, New York, Michigan, Washington, Colorado,
Iowa, Utah, New Hampshire, Maine, Arizona, Kentucky, Idaho, Kansas, and
Nevada are especially encouraged to call and may be receiving a second
email specifically tailored to these Senators.
Below
you will find a list of Senators who have already co-sponsored S. 921;
counselors should call and thank them for their support.
Sen
Barrasso, John [WY]
Sen
Boxer, Barbara [CA]
Sen
Brown, Sherrod [OH]
Sen
Durbin, Richard [IL]
Sen
Johnson, Tim [SD]
Sen
Landrieu, Mary L. [LA]
Sen
Lieberman, Joseph I. [CT]
Sen
Lincoln, Blanche L. [AR]
E-News from Washington
Vol. 08-04
January 24, 2008
House
Passes Inmates' Mental Health Bill
On Wednesday, January 23, 2008, the U.S.
House of Representatives passed, by voice vote, H.R. 3992, the Mentally
Ill Offender Treatment and Crime Reduction Reauthorization and Improvement
Act, legislation to improve mental health services for inmates and improve
training for law enforcement officers.
In addition to expanding existing grants
available under the Mentally Ill Offender Treatment and Crime Reduction
grant program created in 2004, H.R. 3992 authorizes an additional $35
million annually in fiscal years 2008-2013 for four new grant programs
focusing on the treatment of female prisoners who are mentally ill,
coordination of the treatment of mentally ill prisoners, screening,
identification and assessment of mentally ill inmates, and coordination of
post-release services.
The purpose of the legislation is to
encourage mental health and criminal justice systems to work together in
devising new, more effective ways to assist the mentally ill. Demands for
grants available through this program have far exceeded their
availability. In 2006, for example, only 27 (11%) received funding out of
250 submitted grant applications from states and communities.
The Senate has not acted on a companion
measure (S 2304) introduced in November of 2007.
If you have any questions, please feel free
to contact Beth Powell
of AMHCA at 1-800-326-2642, ext. 105 or by e-mail at bpowell@amhca.org.
E-News
from
Washington
Vol.
08-12
March 6, 2008
House
Passes Historic Parity Legislation!
On March 5th
the House of Representatives passed comprehensive legislation requiring
private health insurance plans to use the same treatment limitations and
financial requirements for mental health and addictive disorder coverage
as is used for substantially all other covered services. H.R. 1424, the
“Paul Wellstone Mental Health and Addiction Equity Act of 2007,”
introduced by Representatives Patrick Kennedy (D-RI) and Jim Ramstad
(R-MN), was passed with strong bipartisan support by a vote of 268-148.
(House members’ votes are listed online at http://clerk.house.gov/evs/2008/roll101.xml.)
The legislation is named for the late Senator Paul Wellstone of
Minnesota
, a tireless advocate for Americans with mental illness.
House passage of H.R.
1424 is an historic step forward for mental health and addiction treatment
advocates, and comes after years of hard work by the mental health and
addictive disorder advocacy community. Although similar in many respects
to legislation passed last year by the Senate, H.R. 1424 provides more
consumer protections by requiring plans covering mental and addictive
disorder treatments to cover the full range of disorders recognized in the
Diagnostic and Statistical Manual of Mental Disorders (DSM)—the same
range of disorders as is covered for members of Congress and all other
federal employees under long-standing requirements for Federal Employee
Health Benefits Program (FEHBP) policies. Unlike the Senate’s bill, H.R.
1424 also stipulates that health plan covering out-of-network services for
medical and surgical benefits must also offer out-of-network coverage for
mental health and addictive disorder benefits. This requirement applies
for both outpatient and inpatient care.
AMHCA and ACA applaud
Representatives Patrick Kennedy (D-RI) and Jim Ramstad (R-MN) for their
long, hard, heroic work in gaining House passage of H.R. 1424. During
floor debate, both Kennedy and Ramstad spoke about their own personal
battles with mental and addictive disorders, their treatment, and how
their treatment has enabled them to lead productive lives. AMHCA and ACA
also thank those counselors who took the time to contact their
representative on this issue.
Attention now shifts to
House-Senate negotiations to reconcile their chambers’ versions of the
parity legislation. Like the business community, the Bush administration
argued in favor of the weaker Senate version, issuing a statement of
policy expressing opposition to H.R. 1424. Despite this, AMHCA, ACA and
other mental health and addictive disorder advocates are now working to
build upon the strong bipartisan support for H.R. 1424 and the unanimous
passage last year of the Senate’s bill, to encourage the development and
enactment of parity legislation that provides consumer protections that
are as strong as possible.
For more information on
this issue—or to find out how you can help—contact Beth Powell with
the American Mental Health Counselors Association at 703-548-6002 x105, or
at bpowell@amhca.org
or Scott Barstow with ACA at 800-347-6647 x234, or at sbarstow@counseling.org.
Why
Legislative Advocacy is Key to the Future of Mental Health Counseling
Legislative
activities at the federal, state and local levels affect all aspects of
the mental health counseling profession. In the most fundamental terms,
lack of support from policymakers may mean that mental health counselors
are not included in state and federal programs. Conversely, strong support
can mean the inclusion of mental health counselors in federal health
programs, such as Medicare and Medicaid.
Why
get involved in the legislative process? Because the profession’s future
depends on the advocacy efforts of mental health counselors like you.
Everyone – each mental health counselor – must play an active role in
the legislative arena to improve federal policy regarding mental health
counselors.
In
Washington
, groups such as the American Mental Health Counselors Association (AMHCA)
derive part of its influence from the fact that it represents
concentrations of voters, also known as constituents. Constituent pressure
is a very effective tool. Legislators listen to what their constituents
have to say, especially if they are visible and persistent in
communicating their cause. They listen to what you have to say. Your
grassroots advocacy effort can make key difference in future legislative
decisions.
One of the most
important actions you can take in support of your profession is to develop
a good relationship with a legislator and his or her staff. Getting to
know each other and helping legislators understand the role that mental
health counselors play in the mental health field are the most effective
ways to influence the legislative process.
Communicating
with your Legislators
As a mental health counselor, you need to develop an ongoing relationship
with your member of Congress in which there is two-way communication.
Members
of Congress want and need to hear from their constituents. Each legislator
must consider a vast number of issues. These issues are divided among
staff that is responsible for following legislative activity and
constituent support for each of their assigned issues. A staff member may
be responsible for 20 or more broad issues and is seldom an expert in all
of them. Staff members rely on a multitude of resources to keep them
knowledgeable on these issues, including groups like
AMHCA
and experts like you.
Mental
health counselors must be proactive and offer to serve as a resource to
members and their staff. You are in an excellent position to provide them
with information about your profession and the role that you play in your
community. Once you have developed a working relationship with the member
and his or her staff, they will look to you more often and ask for your
input as these issues come forward. By establishing yourself as a reliable
source of information, you are improving your access to the member.
Mental
health counselors typically are effective communicators. This is important
in working with clients as well as influencing policy makers. There are
many options available for communicating with policy makers: letters,
faxes, telephone calls, personal visits and e-mail. Logic dictates that if
you are trying to influence something that is going to happen immediately,
faxes and phone calls are the best option. E-mail is an option as well,
especially when communicating with staff members. If you need to provide
detailed information and have a longer period of time in which to work, a
personal letter is more likely to get the legislator’s attention.
Keep
in mind that as our issues come before Congress, it
is much easier to ask a friend for something than it is to ask a stranger!
Guidelines for Communication
Whether
you write, call, e-mail or visit your legislator, some basic guidelines
are applicable to all methods of contact. They are:
<Identify
Yourself.
Identify yourself as a constituent by providing your address and
congressional district. Identify yourself as a mental health counselor and
give your area of expertise. In addition, identify yourself as a member of
AMHCA
and your state mental health counselors association. This will further
enhance your credibility and effectiveness by linking you to a broader
advocacy effort.
<Be
Prepared.
Know your issue. Know the legislation you support and the impact it will
have on your profession, organization or local community, and, if
appropriate, on the nation as a whole. Know and use statistics and facts
whenever possible. In this age of accountability, numbers matter! Keep
abreast of issues through the Advocate
and AMHCA’s E-News from
Washington and contact us if you have any questions. Contact your
state chapter for state-level advocacy assistance.
<Be
Specific.
Be specific and state the action you want the legislator to take, such
as: vote in a certain manner; introduce legislation or co-sponsor a bill.
If the member expresses support for your position, hold him or her to that
commitment. Whenever possible, refer to a specific piece of legislation by
its number.
<Be
Concise.
Be concise in your written or verbal communications. Legislators and
their staff have limited time to devote to any one issue. A one- or
two-page fact sheet can summarize your points and is more likely to be
read and filed for future reference than a 10-page document. In
face-to-face meetings, highlight key issues and leave behind a fact sheet
as a reminder of essential points you want the legislator to have on hand.
<Be
Constructive.
Be pleasant, polite and use a “soft-sell” approach even if a
legislator does not agree to support you in a specific instance. Do not
threaten or make negative comments. You are looking for a continuing
relationship and very likely will need the legislator’s support on
issues in the future. In the meantime, feel confident that you have shared
your information in a positive manner.
<Follow
Up.
Follow legislation throughout the legislative process and be prepared to
contact your legislator several times on one issue. You can contact the
legislator prior to a committee vote, before a floor vote or when there is
a lot of press activity on the issue. Keep the pressure on him or her
through your continued contact on the issue.
<Continue
the Connection.
It is important to continue developing ties with your legislator and his
or her staff. In addition to contacting them about specific legislation or
issues, also:
¨
Congratulate them on honors received or elections won. Thank them for a
positive vote on your issue or on actions taken that are important to the
community.
¨
Legislators appreciate, but seldom receive, thank you letters for actions
taken. Be among those who show appreciation for their support and you will
be remembered!
¨
Sharing news with your legislator is an ideal way to promote your issues
and to highlight the impact it has made on his or her constituents. This
is an easy way to continue to develop and establish rapport with the
legislator. You are also giving them information they can use to justify
their support of your issue.
<Update
AMHCA
.
Be
sure to share information regarding contacts with your federal legislators
with the
AMHCA
Public Policy and Professional Issues staff. It is important for us to
hear about your legislator’s support or opposition to
issues affecting mental health counselors.
Everyone
has a different comfort level and level of experience in advocacy and
different amounts of time to commit to these important efforts. Regardless
of your specific circumstances, there is a great need for you to
participate and there are a variety of ways to get involved. Please
contact
Beth Powell
, AMHCA’s Director of Public Policy and Professional Issues, by e-mail
at bpowell@amhca.org or by phone at
800-326-2642, ext. 105 for more information about how to get involved in
our advocacy efforts. If you aren’t yet a member of AMHCA, please join.
And, please take the next step in advocating for your profession. TAKE
ACTION.
ALMHCA
still supporting FACT - Fair Access Coalition on Testing
ALMHCA has become a member of FACT because of ongoing
activities regarding various state psychology boards who have been
attempting to pass legislation that would greatly limit access to most
quality assessment instruments from Professional Licensed Counselors and
all other mental health professionals other than licensed psychologists
and psychiatrists. Read
more...


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