New Freedom Commission Report: The Campaign for Mental Health Reform: A New Advocacy Partnership

The work of the President's New Freedom Commission on Mental Health may bring many changes in the mental health landscape. Commission Chair Michael Hogan and others are pointing the way to some of these changes in their articles in this special section. On one front, however, there has already been significant movement, and it is worth noting both why this has happened and what it portends.

Soon after President Bush created the Commission, the chief executive officers of four nationally prominent Washington-based mental health advocacy organizations began, from their very different perspectives, to think about how they could take advantage of the once-in-a-generation opportunity that the Commission's work would present. They reasoned that if the mental health community could mobilize its advocacy resources around a set of policy objectives designed to move toward the goals outlined in the Commission's report, it could, in turn, help public mental health systems to become more streamlined, user friendly, and truly focused on fostering recovery and resilience among those whom they are charged to serve.

The four organizations initiating this discussion—the National Alliance for the Mentally Ill (NAMI), the Bazelon Center for Mental Health Law, the National Mental Health Association (NMHA), and the National Association of State Mental Health Program Directors (NASMHPD)—examined their own priorities and matched them with what they heard emanating from the Commission. They agreed that it would be important to present a unified response to the Commission's report and to find new ways to demonstrate to the decision makers who help shape America's public mental health policy both the urgency of need and the promise of effective services.

During the public comment session at the January 2003 Commission meeting, the potential strength of a united advocacy approach became evident. Chris Koyanagi of the Bazelon Center presented a series of legislative proposals to the Commission on behalf of nine Washington-based public mental health policy organizations. Specifically, these groups had achieved consensus on proposals concerning employment and disability benefits, child and adolescent service system issues, co-occurring mental health and substance use disorders, the intersection of the criminal and juvenile justice systems and mental health systems, evidence-based practice and research, housing, workforce development, Medicaid, and Medicare.

What was extraordinary about this presentation was not just that the organizations had reached agreement, but that they had done so in policy areas that are complex and have historically been prone to factionalized approaches. The significance of this unified presentation was not lost on Commission Chair Hogan and the other commissioners who were present. They enthusiastically suggested that such an approach was needed in the follow-up to their work.

The unity of the advocates at that point in time was important, but there was no guarantee that it would last, as skeptics were quick to point out. The advocates pondered the idea of creating a more formal mechanism to help move forward with the Commission's recommendations. Although they were looking for a vehicle to demonstrate the common commitment of a number of organizations, they felt strongly that the last thing the field needs is simply another coalition. For this effort to succeed, it needed not only to credibly represent disparate organizations but also to be able to act quickly. It needed to be strategic and at the same time opportunistic.

Other fields provided examples and inspiration. For instance, the Campaign for Tobacco Free Kids is the effort of a very different advocacy community to convert a largely ignored policy issue into a national public health priority. There was much for the mental health advocates to learn—or borrow—from this and similar initiatives, including the notion of a "campaign." This was the idea they seized on. As the release date for the Commission's report neared, the Campaign for Mental Health Reform began to take shape.

The campaign was created by the four organizations noted above—NAMI, the Bazelon Center, NMHA, and NASMHPD. However, it was understood from the outset that the campaign should be a partnership of a wider group of public mental health policy organizations. Organizations that have joined the campaign include those representing consumers (the National Mental Health Consumers Self-Help Clearinghouse, the National Empowerment Center, the Consumer Organization and Networking Technical Assistance Center [CONTAC], and the Depression and Bipolar Support Alliance), providers (the National Council for Community Behavioral Healthcare, the National Association of County Behavioral Health Directors, and the International Association of Psychosocial Rehabilitation Services), and the guilds (the American Psychiatric Association and the American Psychological Association), along with several organizations with special interests (Children and Adults With Attention-Deficit/Hyperactivity Disorder [CHADD], the Federation of Families for Children's Mental Health, and the Suicide Prevention Action Network). This list may well have expanded by the time this article goes to press. As the campaign grows larger, it will face the challenge of ensuring that all viewpoints are taken into consideration while maintaining its ability to act quickly on specific fast-breaking legislative and administrative issues.

The campaign was created to focus on federal policy. Its plan is to identify recommendations of the Commission on which traction can be achieved inside the Beltway and then to put the weight of the mental health advocacy community behind them. Issues on which the campaign can weigh in include the reauthorization of the Substance Abuse and Mental Health Services Administration (SAMHSA), funding for the Mental Health Block Grant, Medicaid, Medicare, reauthorization of the Rehabilitation Act, and funding for housing programs.

If the Commission's report is to be an effective catalyst for making mental health a national priority, a central goal of the campaign must be to show the rest of the policy-making world that the mental health field stands behind the Commission's recommendations. Many of the policies and much of the funding that affect adults with mental illnesses and children with serious emotional disturbances now come from government agencies whose primary focus is not on mental illness. It is important for these agencies and for the members of Congress who oversee and fund them to understand that the mental health field is in agreement on the need for appropriate policies on education, employment, prisoner reentry, and housing. Much as the Commission's report focuses on all agencies and programs that have an impact on the lives of people with mental illnesses, so too will the campaign focus on the broad array of issues and programs relevant to people with mental illnesses, including Medicaid, criminal justice, education, housing, and vocational rehabilitation.

Some thought has also been given to the appropriate role of the campaign in addressing state and local issues, because many of the Commission's recommendations are ultimately aimed at the state and local levels. The advocacy terrain differs noticeably from state to state, and campaign leaders concluded that the model of collaboration and the principles on which campaign policies rest are the most useful tools they can make available to advocates in state and local jurisdictions. The founding organizations have also made a commitment to use their technical assistance capabilities to help state-based advocates in policy development and other activities that will lead to implementation of the Commission's recommendations.

So, what will the Campaign for Mental Health Reform achieve? And how does it plan to do it? Before the campaign began to work out its policies, it adopted underlying principles to act as anchors for all the work to come. These principles are based in large measure on a preliminary understanding of what the Commission's report would say. They are specific, yet simple and indisputable—at least among the campaign partners.

The campaign insists that mental illnesses be treated with the same urgency as all other medical illnesses; it has adopted the Commission's message that mental health is fundamental to health. The campaign calls for national leadership and will promote specific policies to align now-fragmented systems and achieve markedly improved quality in service delivery. The campaign's immediate purpose is to address specifically what the federal government should do to ensure that public systems close gaps and support comprehensive approaches that cross many current systems.

These policy initiatives will be based on themes that incorporate shared priorities: equal access to mental health care, promotion of recovery and full community participation of consumers and family members in all systems of care, the need for a strong safety net, strengthened quality of care, and accountability of funders, administrators, and providers.

The campaign's leaders are realistic about what it will take to bring about dramatic shifts in policy. Simply announcing that the mental health field has decided to come together is not going to accomplish much. Concerted opinion research will be vital, as will communication strategies that target key decision makers in Congress and the Administration. The campaign will engage strategists and use poll results to convey important messages. If mental health is to become a national priority, the field has to use all the tools at its disposal.

The campaign has been driven from the start by the assumption that little would happen to the Commission's recommendations without a major push from the advocacy community. This is not to diminish the central role that will be played by SAMHSA in coordinating federal initiatives based on the Commission's recommendations. Rather, it reflects growing sophistication about what it takes to "transform" a system. The transformation envisioned by the Commission is a multilayered process involving consumers, family members, practitioners, bureaucrats, and many others who share a vision of recovery and resilience. Advocates, too, have a critical role in the transformative process. The Campaign for Mental Health Reform is the advocates' attempt to put the lessons they have learned into practice to help achieve the goals of the President's Commission. If the campaign can produce results, mental health advocacy—and the system itself—may truly be transformed.