Last week I had the honor of joining the Hogg Mental Health Policy Fellows on their whirlwind tour of Washington D.C. As a part of my HHCI fellowship in mental health policy, I had previously joined the Hogg Fellows on their tours of county mental health agencies and local criminal justice systems in the Austin and Houston regions, but this five-day intensive was an altogether new experience for thinking about community mental health on a national scale. Together we met with federal agencies involved in mental health service delivery and research, along with advocacy groups seeking to improve mental health policies at the federal level.
Our first meeting of the week was with Dr. Ron Manderscheid, a juggernaut in the field of public mental health policy. He gave us an overview of his career— from starting off as a bench scientist to later spearheading innovative programs at the National Institute of Mental Health, which led to organizational culture changes to include consumer and family members’ perspectives in advocacy and policy. A well-respected researcher and administrator, he also helped orchestrate and advocate for many other progressive mental health policies, including the national paradigm shift towards recovery-oriented services and the federal mental health parity law to mandate that private health insurers pay for mental health services as they would for physical health services. Now he serves as the executive director of the National Association of County Behavioral Health & Developmental Disability Directors (NACBHD).
Dr. Manderscheid was the first to tell us that scholarship plays only a small component in the messiness of effecting change at the Capitol. Much of his success on the Hill has been a product of luck, timing, storytelling, and perseverance. He explained, “Stories matter. Legislators respond to a gripping story.” He went on to describe his go-to “formula” for educating legislators: 1) Invite a person with lived experience of the issue at hand to speak directly about the legislative topic to be considered. Provide support— be it monetary funds, caregiving support, accompaniment, etc. to ensure the advocate has the resources to speak meaningfully and purposefully. 2) Describe the impact of the proposed legislative intervention. Ask an expert to provide a short summary of the evidence-base for the intervention. 3) Make a simple ask of 2-3 items that support incremental changes, then plan to make bigger asks to augment the items later on.
This no-frills advice was quite welcomed, and it affirmed my commitment to storytelling as a part of mental health policy creation. As a qualitative researcher (a.k.a. professional storyteller) myself, perhaps I am rather biased towards embracing his advice, and I’ve long held a sense that people’s experience of mental health systems should guide organizational design and provision of services. Following this bent, this summer I’ve worked on a research project to listen to communities’ accounts of regional infrastructure strengths and needs. Throughout the daily grind of transcribing focus group interviews to coding themes to synthesizing findings, the knowledge that community stories ultimately can make a difference in public services and resource allocation guided my process. In short, stories led to findings; in turn, this new evidence-base will be used to support community projects. In this way, community stories can lead to real shifts in the way we think of governance as a shared, iterative process.
In total, 16 speakers from federal service agencies, 7 advocates, and 4 speakers from federal research organizations shared their knowledge over the course of our week-long trip to D.C. And as I reflect on their words, I imagine that the generous advice of our presenters could best be summarized as follows: “Do the legwork to build a plan for change; start with stories; and act upon short windows of opportunity when they open up.” As the trip comes to a close, I am left to wonder when we will face another auspicious moment for mental health policy? Until that small, yet critical moment, we must continue to lay the groundwork for thoughtful, community-driven policy to gain traction at all levels of governance.
Dr. Erica Hua Fletcher
Zorich Fellow in Mental Health Policy