Creating a social movement for mental health

Three questions we need to start asking ourselves as well as a framework for success

I shared in my last post how I was planning to tee up – though it probably makes more sense to say “lay up” – my grand rounds presentation at Stanford School of Medicine for the Department of Psychiatry and Behavioral Sciences.

Probably to the surprise of many of you, I talked about basketball. March Madness was a minor point (my bracket was a mess this year), as the real reason for the reference was to use Wilt Chamberlain’s free throw shooting experience as a metaphor for the state of mental health in this country. Wilt was horrible at free throw shooting, and even though he was shown, with success, a better way, he opted not to stick with it for fear of what others might think – the culture that surrounded him making him not want to do something different no matter how much better it was!

Shooting underhanded like Rick Barry worked really well for Wilt. But it wasn’t the norm, it didn’t fit with the NBA’s culture, and so no one else – aside from Rick Barry’s one son, Canyon – really adopted the “granny style.”

Mindsets needs to shift before there’s a more widespread embrace of this free throw shooting approach. And similarly, mindsets need to shift so we see change in the mental health field, too.

Social movements have been known to do this. And despite mental health being something we all have – a foundational aspect of our health – too few people are pushing for structural reform that challenges the status quo AND reforming the policies that enable that system. It’s clear that mental health needs a social movement of its own, which is exactly why that was the focus of my grand rounds presentation. It’s why Well Being Trust partnered with Public Affairs group Civitas (who in turn created Inseparable, a new mental health advocacy organization), and also why our respective organizations believe that tapping into the social movement energy can be a game changer for mental health.

HOW DO YOU START A SOCIAL MOVEMENT?

Social movement principles have been written about extensively. And if you read enough about them, there are three main ingredients that stand out:

  1. Vision and framing. You have to appeal to hearts and minds. As Civitas has taught me, marriage equality started out as several hundred policies that needed to be changed, but ultimately what won people over was when the message was simplified to be about love. People understood love over playing offense or defense on policy.

  2. A constituency. You have to have people. Starting with friends, family and community members, eventually, a successful social movement means that clinicians and leaders at every level of society get on board as well.

  3. A long-term commitment. You need to know that social movements are not episodic – they are all about long-term perspective and investing in building relationships and training those future leaders who can keep the work going.

But for fun, if you want to see a movement in real time and the importance of leadership in advancing the movement, this video is a classic and one of my favorites:

MENTAL HEALTH & … MARRIAGE?

I want to focus a bit more on that first ingredient, Vision and Framing, because there’s a lot that can be learned from that marriage example. Patrick Guerriero and Bill Smith, co-founders of  Civitas, have both spoken and written beautifully about marriage equality and social movements. In the Stanford Social Innovation Review, Patrick wrote about the three questions that transformed the marriage equality movement. And with only a slight modification to the third, Patrick’s questions about stalled social movements in that context apply the mental health field as well. When it comes to mental health, we need to ask ourselves:

1)    Have we moved out of our comfort zone and become political enough to build real power?

2)    Have we asked philanthropic leaders to join together to fund robust, coordinated education and advocacy campaigns designed to win?

3)    Have we done the right research with people outside mental health to find out what moved the most people?

OUR NEXT BIG CHALLENGE

Honestly, from my vantage point, the answers to the above questions aren’t all that great.

Have we moved out of our comfort zone and become political enough to build real power?

Sadly, no. I recently shared how lobbying and special interest groups can have a huge influence on policymaking because of funding, and noted that mental health doesn’t have its own special interest group, per se. As a result, mental health historically hasn’t had a ton of federal attention. That’s actually, in part, why Well Being Trust partnered with Civitas to create Inseparable. We didn’t see that there was the policy muscle necessary to get some of the work done, and though we have seen notable successes brought forward by this effort, there’s still a long way to go that can be made much shorter with more political involvement.

Have we asked philanthropic leaders to join together to fund robust, coordinated education and advocacy campaigns designed to win?

Again, I think the answer is no.

Social campaigns have worked to increase awareness, but we haven’t had any major wins for our field in the policy space for some time – the amount of money that went into mental health during the first $2 trillion stimulus bill is evidence of that. 

Fortunately, we are getting better. Now, under the Biden administration, close to $4 billion of the $2 trillion America Rescue Plan was set aside for mental health. Specifically, the law allocates $3.5 billion for block grants addressing MH/SUD and several million more for other programs and workforce issues. 

This is a win on paper, but it’s worth noting – and I will explain this in greater detail in the future – that block grants are not always the ideal mechanism for scaling up innovation in the mental health space and discretionary funding without policy change or structural reform does little to change the system. Policy wins have occurred at the state level, but we need our foundation and philanthropic community to come together in service to advance more robust and meaningful goals for federal policy – we don’t need them to uphold the status quo (a topic I will write about in detail in the future).

Have we done the right research with people outside mental health to find out what moved the most people?

Same answer as above, but at least the takeaway here is clear.

There’s a brilliant author Jane McAlevey who writes about the difference between organizing and mobilizing (and her podcast with Ezra Klein is simply divine!). She posits that a lot of organizations that think they are organizing are just in fact mobilizing. Here’s the difference: Organizing is knocking on the doors of the people who don’t know that mental health is their issue, and mobilizing is taking those people – those you have brought in – and directing them to do something.

Most mental health advocacy organizations mobilize quite well – the action alerts, the Hill days, etc. – but we need to convince more people to organize. We need to get new data; new research on what these people think. Knocking on the doors of people who don’t know mental health is their issue too is our next big challenge. What are the messages that will move this new constituency? And with all the mental health challenges our nation has had to confront during the pandemic, now is the time to start knocking, start listening, and start taking action!