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,
But, surprisingly, even though more cuts to OHP are likely, the state
legislature restored the lost mental health and substance abuse benefits as of
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.
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
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 (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
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
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
Kimball said, "We organized the tasks so that members would have
three things to do each week during the critical time for the
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
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
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
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. ▪