If You Don't Do It, Who Will?
When I'm out and about visiting with rural mental health providers, family members, or consumers in my state, they often have very legitimate concerns about access, funding, regulation, and other matters of state policy. Many of them are very passionate and articulate about what folks in the State Capitol do not understand. Since I'm there, they are willing to spend an hour or two "cluing me in." While I appreciate this, it is sort of like preaching to the choir. Implicit in their discussion is the expectation that I go back and change things. And, I do make every effort to represent their concerns whenever the opportunity presents itself. BUT, it's just NOT very effective.
The people with the real credibility in advocacy for rural mental health are the people who are "living" the problems they are concerned about. These are the folks who can speak form direct experience. Listen to almost any politician talk about what's wrong with government and it will give you an idea about how much influence and credibility public employees are likely to have with elected officials. In fact, in many states, state employees are expected/required to represent the Governor's policy position with the legislature. State bureaucrats, however, can be very helpful to consumers, family members, and local providers in assisting advocates in translating their wishes and concerns into concrete and practical recommendations. So, in short, don't ignore state bureaucrats but don't make the mistake of thinking that they can carry the ball for you. It really is up to you.
Sometimes I think that "local" folks simply do not realize how much influence they can have. If anything, besides big money, will move elected officials, it is the voices of people they represent who have direct experience with a particular problem. In this sense, consumers and their families are the most effective spokespersons for rural mental health. They have the most direct, lived experience with mental illness and the problems of accessing treatment. Rural mental health providers and practitioners also have real credibility stemming from their day-to-day work experience. Obviously, a mutually supportive coalition of consumers, family members, and providers is the most effective voice for rural mental health at any level of government. In the 1980s, a small coalition of individuals concerned about the mental health needs stemming from the Farm Crisis formed a group called the "Rural Families Issues Coalition." This group, consisting of less than 40 members at its height, took its case to Congress. Being a "grass roots" effort that did not represent professional organizations or associations, we were welcomed in almost every congressional office we visited. And, the group was successful in getting money from the Farm Bill directed to provide direct mental health services. That made a believer out of me that folks from the front-line can have a big impact without large numbers or a big budget.
There is a lot that can be done at the state level to improve rural mental health and its up to local folks to make it happen.
Some Dos and Don'ts About Advocacy
I've come to a number of conclusions over the years about working with elected officials. These ideas come from my own mistakes or watching others either fail or succeed. So, for what its worth, here is my top twenty list (remember David Letterman's Home Office is in Wahoo, Nebraska) of dos and don'ts about advocacy. I have focused my discussion on state legislators but many of these "rules" apply equally well when working with public officials or your national representatives. And, please remember, there are exceptions to every rule. I have grouped these recommendations into three areas: The Proposal, Working Together, and Advocating.
The Proposal
(1) Be Specific: Knowing exactly what you want done and how it can be done is a big help. Going in and just talking about needs without specific recommendations often doesn't go anywhere. Having examples of what other states have done is sometimes helpful.
(2) Frame Needs In Terms Of Benefits To Consumers: Advocating for staff and/or program needs is not nearly as effective as talking about what needs to be done to improve services to clients. Keeping the consumer as the focus of your argument avoids the appearance of vested interest and reminds the legislator that their actions will benefit real people with real needs.
(3) Be Succinct: You can not make legislators or their staff experts in rural mental health. Remember the "three points" rule. Decide on the three most important points you want to make and stick to doing that. They won't remember any more and you are likely to confuse them or lose them if you try for more. This goes for both written and oral communication.
(4) Be Unique: While there will be times when your message is that rural mental health is the same as X and shouldn't be treated different, most of the time you will want to be unique. The reason for this is that legislators do not want to be placed in the position of doing something that others will be able to legitimately argue should be done for them too. For example, it is usually a mistake to ask for money to cover inflationary costs such as increased health insurance rates or other operating costs. Not that these are not valid issues, it is just that everybody faces the same issues and if the legislature funds one area for such cost increases they open themselves up to having to fund everybody. So your task is to be unique enough so the legislature can support what you want without feeling they have to do the same for others.
(5) Don't Build Your Case On Cheaper: New programs and initiatives are rarely cheaper and trying to selling them as such can get you into trouble. It is better to focus on meeting needs. Then if you do save money you're a hero and, if you don't it won't come back to haunt you.
(6) Don't Ask For Lawn Mowers: Laundry lists of needs are very difficult to market. Asking for a bunch of "small things" is not often successful. First of all there is an assumption that "good managers" should be able to cover such expenses within existing budgets. Second, it is hard for legislators to justify spending money on lawn mowers, computers, furniture, etc. when there are many pressing human needs that are going unmet. If you have a number of "small ticket" items it is better to try to roll them up into themes or include them as part of the budget for a bigger program request. For example, needs related upgrading computer systems might be packaged as developing a new system of results-based accountability where computers and software upgrades are simply the infrastructure needed to implement the program.
(7) Do A One-Pager: Take the time to write-up a one-page summary that clearly articulates what you want. Be sure to include what you want done, why it is needed, why it must be done now, and the anticipated benefits. Don't forget to include the name, address, fax, phone, and e-mail for a contact person. Leave one of these with whomever you visit and send one to whomever you contact by phone.
Working Together
(8) Build Coalitions: It is often helpful to build coalitions of different organizations and associations in order to have a bigger voice. The key here is to focus on common ground and agree to disagree on other matters. Don't spend a lot of time trying to resolve differences. Just find areas in which you can work together and move forward. The important caveat to this, especially when working with bigger and more powerful groups, is to know when to walk away. At some point what they are asking you to give up or in to may be more detrimental than your going it alone. Know where you can compromise and where you can't.
(9) Look For Friends In Unlikely Places: Remember that some of your strongest allies may come from outside the mental health community. Many of the traditional "rural advocacy" groups such as farm organizations may share your interests and concerns. Don't forget the primary care, rural health and public health communities. And if you have a separate substance abuse community, be sure to involve them. Other groups that advocate for special populations such as children and families or the elderly may also be supportive.
(10) Get Everybody To Sing The Same Song (or to be quiet): Nothing kills a bill quicker than the appearance of disagreement among the people who "should" be for the bill. It is very important that everybody who is advocating say essentially the SAME thing without qualifications. Death to any bill is to have someone testify saying: "Yes, I support this BUT..."
(11) Don't Try To Redirect A Money Train: One of the classic mistakes in lobbying is to try redirect money that is already on its way. The way this works is some mental health group or organization has convinced key legislators that more money is needed for X. A bill is moving through the legislature that will make money available for X. X doesn't directly benefit rural mental health so you try to get some or all of this money redirected to what you want. Nine times out of ten this will either: (1) ruin it for everyone and no new money will be made available (the mostly likely scenario) or (2) it won't make any difference and they will go ahead with what is already planned. In any case, you're not likely to be successful, you could prevent need monies going to a good cause, and you'll very likely make enemies. Better to meet with the group pushing the legislation and see if you can win some concessions (e.g., they'll help you out next year or add some changes that would benefit rural mental health) for your support.
(12) Don't Bad Mouth Others: Inevitably you will be in competition for scarce resources. Others may attack you and/or your proposal. Some legislators or their staff may try to get you to lure you into criticizing other proposals. Resist the temptation to say "bad" things about other people, programs, or proposals. Stay positive. Stay focused on the needs your proposal addresses and the benefits it will have. "Bad Mouthing" other programs or providers or making light of other needs makes you seem untrustworthy and unprofessional. It will likely come back to haunt you.
Advocating
(13) Tell Stories AND Have Hard Data: Personal stories and compelling examples are what get the attention and interest of legislators and their staff. Gathering these stories and rounding up people who are willing to tell their stories is important. But stories are not enough; sooner or later elected officials are going to want data in order to feel comfortable about taking action. NARMH may be able to help here in directing you to literature, research, national data, or experts that can help you support your cause. Give us a call.
(14) Create The Impression Of Urgency: Legislators are always overwhelmed with requests and there is never enough money to go around. So, if they can put something off until the next legislative session, they will. Your challenge is to convince them that what you're proposing can't wait.
(15) Have Something For Everybody: If you have 300 members in your state legislature, there are probably 300 different reasons why a particular piece of legislation passes. Tuning into and speaking to the different interests of particular legislators is important. They may have very different reasons for why they think your bill should pass. Try to show them how what you want to do addresses things they are interested in and concerned about.
(16) Relate It To Each Legislator's Home District: Whatever you're proposing, make the extra effort to show each legislator how it will benefit folks in his/her home district.
(17) Cultivate and Support Interested Legislative Staff: Legislative staffers can be some of your most important allies. They are often more accessible than legislators themselves. Finding staffers who are receptive to your concerns can make a BIG difference. Sometimes your best ally is not the staffer who deals with mental health issues. A staffer who hails from a rural area or who is responsible for rural or agricultural issues may be more sympathetic. Once you got a staffer "on board" don't forget to support them. Get them the information and personal contacts they need to successfully advocate for your cause. Volunteer to help.
(18) Keep Checking In: A single visit or contact is not sufficient, you need to keep in touch with folks. Legislative sessions are very hectic times and it is easy for things to fall through the cracks or get forgotten. Regular check-ins with key people are necessary to keep your concern on the front burner, to make sure they have all they need to be successful, and to counter anything the opposition may have said to them.
(19) Take The Long View: While it is possible to meet with success in a single legislative session, it often takes two or more. You may have to go back two and three times and it may take two or more years. If you don't get what you want right away, do NOT give up. If it's a good idea and the right thing to do, you'll succeed eventually. Persistence pays off.
(20) Don't Bang Your Head Against A Brick Wall: If you encounter a legislator or staffer who is particularly uninterested or hostile to what you're advocating for, go on to someone else. Don't waste your limited time and energy. If this person is absolutely critical to what you want to accomplish, find a colleague of theirs that they respect and try to influence that person's opinion.
I hope the above is helpful and that you will put it to good use. In some ways, there is greater potential for enhancing rural mental health through advocacy at the state level than there is through advocacy at the national level. Please remember, however, to contact members of your U.S. Congressional delegation when there are national issues that affect rural mental health in your state. And, please keep NARMH informed of any national policy issues that you believe could either help or hurt rural mental health in your state.