Sound Message, Persistence Get Results in Oregon

Mental health advocates in Oregon learned that triumphs can be gained in the most unlikely circumstances.

Approximately 100,000 members of the Oregon Health Plan (OHP) lost mental health and substance abuse benefits in March 2003. State officials also added premiums and copayment requirements that resulted in a decrease of more than 50 percent in the number of people in the program (Psychiatric News, July 16).

But, surprisingly, even though more cuts to OHP are likely, the state legislature restored the lost mental health and substance abuse benefits as of August 1.

David Pollack, M.D., medical director of the Office of Mental Health and Addiction Services in the Oregon Department of Human Services, said,“ Providers, advocates, and consumers made very persuasive arguments to the state legislature that the cuts were clearly inadvisable and in the long term would lead to greater costs in the form of hospitalization, incarceration, and lost productivity.”

Pollack and John McCulley, executive director of the Oregon Psychiatric Association, credited Angela Kimball, director of public policy for the National Alliance for the Mentally Ill (NAMI) of Oregon, for her skillful and tireless work in bringing about the victory.

How did she do it?

Kimball told Psychiatric News that the effort began when the Oregon House of Representatives appointed a committee in early spring 2003 to deliberate the future of the OHP. In summer 2003, she and other advocates focused on the attempt within the legislature to bring about tax reform.

“I was in the capitol every day, listening to what was going on and trying to gauge the sentiments of the legislators,” she said, “so I was ready when they announced hearings.”

Kimball emphasized the importance of public testimony at the hearings, and this was coupled with and supported by phone calls to legislators from NAMI members and others.

She believes that “riveting public testimony” is important in making a case for funding services, and she has some deceptively simple ideas about how to present that testimony.

“Clarity of message is critical,” she said. “You have three minutes to make a case. You can make three points, and you must appeal to the intellect and the emotions. Don't ramble, and don't be overly emotional.”

The best approach, Kimball believes, is to tell a personal story. Her own story, which she presented in written and oral testimony, captures the struggles of a family coping with serious mental illness and emphasizes the hope that effective mental health services can offer (Original article: see box).

In fact, she believes that advocates sometimes place too much emphasis on what the mental health system fails to accomplish.

Kimball suggested a different message. “We used to call our representatives to complain about services. The implicit message was, `We have services, but they don't work well.' Now, we say that `services work, and we want them funded.'”

What kind of evidence do the legislators want? Kimball thinks it's a mistake to believe “you have to prove everything. It's clear that without services many people with mental illness would be homeless, dead, or in jail.”

She developed and nurtured a network of NAMI members and other advocates by offering them the tools they needed to talk to legislators and by making their tasks manageable.

Via e-mail, advocates received “quick facts” and examples to use in phone calls to legislators to convey the general message that“ taxpayers would pay in the long run with higher hospitalizations and incarcerations” for cuts in substance abuse and mental health treatment.

Kimball said, “We organized the tasks so that members would have three things to do each week during the critical time for the legislation.”

For example, during the first week in July, when hearings were being held on tax reform, supporters were asked to make three phone calls to selected members of the state legislature with the message: “Individuals with serious mental illness need a reliable system of support that is maintained by adequate and stable funding.”

Advocates also called to say “thank you” to those responsible for initiating efforts at tax reform.

Kimball identified potential allies. The Oregon Hospital Association supported the effort to restore benefits because of the likelihood that hospital emergency rooms would be inundated with people with severe psychiatric emergencies.

State Sen. Jackie Winters (R), co-chair of the Special Committee on the Oregon Health Plan and chair of the Joint Ways and Means Committee, told Psychiatric News that NAMI representatives had done a “very good job talking to legislators.”

Winters, who has cared for a family member with serious mental illness, said, “I tell the other legislators, `If this were a broken arm or leg you'd want it to be treated. Mental illness should be viewed in the same way.'”

She also believes it is important to demonstrate the impact of untreated mental illness on the correctional system.

“Jail is not an appropriate placement,” Winters said. She arranged a hearing at which representatives from the courts and correctional facilities testified about how untreated mental illness affects functioning.

At Winters' request, Gov. Ted Kulongoski issued an executive order establishing a legislative task force that will examine the fragmentation of the state's mental health system and make recommendations.

“It is my hope that Oregon will lead the nation in providing positive outcomes for the mentally ill,” she said. ▪