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Chapter Four
Strategy: Which Powers-That-Be to Influence and How
Power
- It takes power to make change. You must sort out whether the power to bring about
change is in the public or the private sector or both. And you must identify specifically
which organizations, parts of organizations, offices, and people have power to bring
about the changes that you want to achieve.
- If this is a governmental issue, is it a federal, a state, county, or municipal issue? (In
NYC, City government provides county and municipal levels of government.)
- Is your issue a legislative, executive, or judicial issue?
- It is likely that more than one level and branch of government have power regarding your
goals.
- Because the Chief Executive usually must sign a law, making law requires cooperation of
legislative and executive branches.
- Governmental budgets are key to carrying out mental health policy and are also joint
products of the legislative and executive branches.
- Determining who has power and which of the people or organizations with power to try
to persuade to make changes is the first element of developing a strategy.
(For more information, read The Structure and Functions of Government in the USA
and Mental Health Policy Making in the United States.
Influence
- Some people have "influence" rather than power.
- Powerful people can produce change through their own decision-making, either alone or
with others.
- People with influence have access to people with power and may be able to persuade
them how to act.
- The chairman of the political party to which the Governor belongs probably has
influence. A friend or relative of the Governor may have influence, as may a recognized
and trusted expert in mental health policy. A large contributor probably has influence.
The news media certainly have influence.
- Determining who has influence is the second element of formulating an advocacy
strategy.
Know Your Elected Officials
Elected officials represent you in the federal, the state, and city governments. The most basic
step of advocacy is to know who your elected officials are.
(For listings of important federal,
state, and local elected officials, read Key Federal Elected Officials,
Key Elected Officials in New York State,
Key Elected Officials in New York City
and Key Elected Officials in Westchester County).
To find out who your elected officials are and where you can reach them call The League of
Women Voters at 212-725-3541 in New York City or 914-949-0507 in Westchester County.
Next you need to sort out which of the elected officials have power, which have influence, and
which have neither.
Know The Appointed Officials
There are public officials in the administrative branch of government who are responsible for
mental health services. They include:
- The NYC Commissioner of Health and Mental Hygiene and The Executive Deputy
Commissioner for Mental Hygiene.
- The Commissioner of Mental Health of NYS.
- At the federal level the Secretary of Health and Human Services (HHS) has the highest
level of authority for mental health.
- There are a number of agencies within HHS, which deal directly with mental health
issues including the National Institute of Mental Health (NIMH), The Center for Mental
Health Services (CMHS), and The Centers for Medicare and Medicaid among others.
To find out who your appointed officials are, read Key Federal Administrative Officials
and Key Mental Health Officials.
Motivation
Once you have identified the people with power and influence, you need to figure out what will
persuade them to help you. Like all of us, people with power or influence have mixed
motivations.
What mix of ideals, values, emotions, self-interest, and politics will help you win over the people
you need on your side?
- Better lives for people with mental illnesses.
- Having a family member or a friend with mental illness.
- The impact a change will have on voters or contributors.
- Building a political reputation of kindness and concern.
- Avoiding bad publicity.
- Doing what the boss wants.
Form Strategic Partnerships
- In advocacy greater numbers generally mean greater power, and some advocates and
advocacy groups have greater access to power than others.
- For this reason, it often makes sense to work jointly with other advocacy organizations.
- Keep in mind that some people and groups simply cannot work together and that it
sometimes takes a very long time to form strategic partnerships.
- Don't lose opportunities for action because you hope for a partnership.
- But don't give up too easily on forming partnerships. Remember "United we stand,
divided we fall!"
Effective Advocacy Depends on Good Relationships
To be effective at advocacy, you must form good working relationships with people who have
power, people who have influence and people who can be partners in action.
An Example of Advocacy Strategy: The Reinvestment Act of 1993
Towards the end of the 1980's a number of mental health advocacy organizations in New York
State became concerned that they were weakening each other's advocacy efforts by advocating
for different goals. They decided to formulate a common agenda and to advocate for it together.
They formed The Mental Health Action Network of New York State.
After a couple of years of mixed success, they decided to focus on a single theme, which they
called "reinvestment." The notion was simple. The state was closing beds in state hospitals and
was not providing adequate services for people in the community. Their position was that
savings from closing state hospital beds should be reinvested in new services in the community.
Advocacy Strategy
In order to move this agenda, they had to choose an advocacy strategy. Achieving a mandate for
reinvestment through the courts was clearly not feasible. The policy either could be adopted
voluntarily by The Governor and the Office of Mental Health, or it could be set in law by the state
legislature. The advocates decided reinvestment policy would be more stable as state law than
merely as the policy of the current state administration. So they chose a legislative strategy.
They knew that a legislative strategy would require that they get support from the chairs of the
mental health committees of the Assembly and the Senate. So they turned to them to sponsor the
legislation.
Both were impressed with the idea and with the coalition of advocates and agreed to sponsor a
bill.
The Governor proved to be more difficult, and his reservations affected not only the likelihood
that legislation would be signed but also made it less likely that the legislative house controlled
by his party would ultimately support the legislation.
Media Strategy
The Mental Health Action Network decided that it needed a media strategy and developed a basic
story about the mental health system, stressing the irrationality of closing hospital beds without
developing services and supports in the community. The story drew heavily on the fact of
homelessness and the widespread belief that there was a clear relationship between homelessness
and mental illness. The story stressed that reinvestment could result in community-based services
to prevent homelessness at no additional cost to the state. It would simply redirect money from
state psychiatric centers to community-based services. The Mental Health Action Network
carried the message to newspapers throughout New York State and ultimately got support for
reinvestment from virtually every newspaper.
The message was also carried through vigils, rallies, and letter writing campaigns on which
people with psychiatric disabilities, their families, and mental health professionals worked closely
together.
Addressing a Major Social Problem
The idea of addressing a major social problem at no additional cost to the state was politically
irresistible. Local state legislators wanted to move ahead, and their desire to pass the law as well
as consensus among the media created more and more pressure on the Governor. Eventually he
conceded, after negotiating changes to the bill that focused the bill more clearly on people who
were homeless.
This, of course, is a vastly oversimplified telling of the story. But what can we learn from it?
Lessons of the Campaign for Reinvestment
- Strategy beings with identifying who has the power to make a policy change and deciding
which of the powers-that-be to target. The Mental Health Action Network decided on a
legislative strategy.
- Carrying out a legislative strategy entails getting support from the chairs of the mental
health committees in each house, from the leadership of each house and from The
Governor.
- It is important for the most influential members of the entire mental health community—
including people with psychiatric disabilities, their families and mental health
professionals—to join forces.
- A persuasive advocacy story has to be formulated in a way that has widespread
ideological appeal.
- Media support ultimately carried the day.
Strategy
Public or Private Sector?
What Level of Government Has the Power to Change Policy?
Federal? State? County? Municipal?
What Branch of Government Has the Power to Change Policy?
Legislative? Executive? Judicial?
Which Specific Offices and People Have the Power to Change Policy?
Which elected officials? Which appointed officials? Which court?
Who Has Influence?
Respected experts? Colleagues? Party officials and contributors? Friends and family? The press?
What Will Motivate Them to Help?
Ideology? Relationships? Politics? A good story? Pressure?
Should You Form a Strategic Partnership?
With whom? Is it feasible? What compromises are required? Will it result in delay?
Have You Developed Good Working Relationships?
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