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Advocacy > Be An Advocate
> Speak Out! Home Page
Chapter One
What is Mental Health Advocacy?
Who Is This Handbook For?
This handbook is designed for people who care about mental health and about people who have
mental illnesses or psychiatric disabilities, including children, adolescents, and adults of all ages.
I will use a number of different terms to refer to this population--most often "people with mental
illnesses", "people with psychiatric disabilities", and "children and adolescents with serious
emotional disturbances", but also "people with mental health problems", "consumers",
"recipients", "people with serious and persistent mental illnesses", "person diagnosed with mental
illness", etc. Some of the language I use may be controversial. I apologize in advance to anyone
who is insulted by my choice of language.
The Value of Speaking Out
People who care about mental health can be and have been powerful forces in moving the mental
health system in progressive directions.
- This includes people with histories in the mental health system—both people with mental
illnesses and their families.
- It includes concerned citizens.
- It includes mental health professionals.
- It includes professional mental health advocates.
- All people who care about mental health have important stories to tell and information to
provide to policy makers.
- Public officials—especially elected officials—like to hear directly from the people their
decisions will affect.
Advocacy Regarding Mental Health Policy
This handbook is about advocacy for changes in the mental health system. This handbook is not
about how to advocate for individuals on a case-by-case basis.
Advocacy for individuals is very important work, but is an art of its own. It focuses on helping
people get what they need and want from systems as they are currently structured.
Systems advocacy is based on the realization that some people cannot get what they need from
systems as they are currently structured and that helping them therefore requires working for
changes in public policy.
You and the organizations you are part of need to decide what changes you think are important.
Better access to better treatment, better places to live, more opportunities to work, more peer-run
programs, greater respect for people's rights, equal health insurance coverage for mental health,
etc. Mental health advocates have identified many needed changes in the mental health system.
Trying to persuade government or the private sector to make changes in mental health policy so
as to help achieve these goals is the kind of advocacy that this handbook is about.
What Is Mental Health Policy?
Mental health policy consists of laws, regulations, plans, program models, licensing standards,
budgets, financing models, organizational policies and procedures, etc.
These elements of policy are derived from broad visions of the role of society in helping people
with mental health problems. For example until the mid-20th century, public mental health policy
was institution-based. For the past 50 years, it has been based on a vision of people with mental
illnesses leading free and satisfying lives in the community.
Who Makes Mental Health Policy?
Public mental health policy is made by legislatures, by elected chief executives such as the
President, governors, and mayors, by their appointees such as commissioners, and by the courts.
Some mental health policy is made by the private sector. For example, in the U.S., most people’s
health benefits are provided by their employers, who decide whether—and to what extent—to
provide mental health coverage.
Why Change Mental Health Policy?
Most people who are familiar with the mental health system believe that it is inadequate in some
important ways. Even people who believe that NYS's mental health system is one of the best in
the United States realize that it could be better. In recent years the greatest concerns have related
to:
- The failure to reach people diagnosed with mental illnesses who reject traditional treatment
- Iinadequate services for children and adolescents with serious emotional disturbances
- Lack of readiness for the elder boom
- Lack of adequate housing
- Obstacles to work
- Issues of coercion
- Access to treatment and medication
- Mental health insurance coverage
There are, of course, many other issues.
How To Change Mental Health Policy: The Framework for This Handbook
- You need to work in advocacy groups to be effective.
- Effective advocacy requires planning.
- A sound advocacy plan rests on a good assessment of need, policy, history, cost, and
politics.
- A sound advocacy plan has three parts: an agenda, a strategy, and tactics.
- The agenda consists of your advocacy goals. Perhaps what you think is important is
better access to better treatment, decent housing, family support, access to work for
people with psychiatric disabilities, and adequate insurance coverage for mental health
treatment. Your “agenda” would include those goals. These are just examples, of course.
You may think that other goals are equally important or more important.
- The strategy identifies what private or public organizations and officials you are going to
try to reach in order to bring about the changes that you want to achieve. It is based on
an analysis of who has the power to achieve your goals, of who can influence those with
power, and of what will persuade them to do what you want them to. Usually there is
more than one person or organization with the power to do what you want. Your strategy
is your selection of which point(s) of power to focus your efforts on, your sense of what
will motivate them to change policy, and your selection of advocacy partners.
- Tactics are the methods that you use to carry out your strategy and to achieve your goals.
Once you know what you want to achieve and decide which powers-that-be you want to
reach and what you think will motivate them, you need to develop a detailed plan about
how to carry out your strategy. Will you organize a letter writing campaign? Will you
seek a face-to-face meeting? Will you demonstrate? Will you try to get headlines?
These specific actions constitute your “tactics.”
- Planning must lead to action, and sometimes action cannot wait for a refined plan.
Advocacy is Action
What Can You Do?
- Register to vote and vote.
- Contact your elected and appointed officials.
- Join an advocacy or an advisory group.
- Make a financial contribution to an advocacy group.
- Participate in actions organized by an advocacy group such as letter writing or
attending lobby days.
- Work and provide leadership for an advocacy group.
Advocacy Planning
Assessment
What is the need? The problem? What is the current policy? What is the history of the
policy and of advocacy to change it? What is the political context? How much will the
desired change cost?
Agenda
What are your goals?
Strategy
Who has power? Who has influence? What will motivate them to change policy? Who
can be good advocacy partners?
Tactics
How will you persuade the powers-that-be to change policy? Lobbying? Public
education? Demonstrations? Social Defiance?
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