The seemingly unstoppable political alliance made up of NAMI, the American Psychiatric Association (which represents 24,000 psychiatrists), the financial lobbying power of the corporate drug industry, and a chorus of fear-mongering politicians, achieved a great political victory this week when president Obama signed the Medicaid DocFix legislation into law.
Federal law now sanctions -and now will provide $60 million dollars to help fund – the forced community psychiatric treatment that is legally carried out in 45 states.
This week the House will have hearings on the Murphy legislation, that in part aims to purge SAMSHA, will also reflect the political agenda of the same NAMI-led alliance that I identified above.
Despite the valiant decades-long daily efforts to stop forced treatment by the National Empowerment Center, MindFreedom, the Bazelon Center for Mental Health Law, PsychRights, the ACLU, and countless dedicated consumer/survivor/peer human rights activists plus the efforts of the National Coalition For Mental Health Recovery, and a recent position by the UN equating forced treatment with torture, we are still now seeing this legislation supporting forced treatment as part of the national political landscape.
To me this disaster confirms my long-held belief that the mental health reform movement, often voiced here on MIA, needs a more robust political ground game. One that can compete with the NAMI-led coalition in ways not frequently done before.
Based on almost 35 years opposing the NAMI-led political machine operating in California, I believe there is a need for an enhanced strategy that can challenge, and in time defeat the brilliantly orchestrated political alliance that has systematically lobbied for and succeeded in passing forced treatment laws at the state level and secured this week’s national legislative victory.
I wanted to share a specific idea here about forming strong mental health coalitions that could help tip the scales politically. I hope this blog essay contributes to a discussion where more ideas about needed political strategy will emerge.
I would start by saying that In every town, city, county and state there needs to exist a level of comparable grass roots, industrial-strength political presence that relentlessly lobbies every city council member, every mayor, every county-elected supervisor, every local health service and mental health administrator, every Faith-based organization, state legislator, state senator, governor, US Congressperson US Senator and media outlet.
Because that’s exactly the ground game NAMI and the coalition it leads has executed every day of every year for decades.
They consistently win the political power struggle over forced treatment because they go to where every lever of political power resides and they pull the levers. They never stop pushing their agenda.
Their demonstrated immense political power is built on the solid foundation of an incrementally grown grass roots political base that radiates up through every level of the political hierarchy. The mental health reform movement painfully lacks such a grass-roots based foundation of comprehensive political power in my opinion.
But it is possible to organize and form political coalitions from the grass roots up, to develop reform oriented coalitions that can compete with the NAMI led juggernaut, that can begin to make serious inroads on the political turf they now so clearly own.
My years serving as a therapist/activist/peer with lived experience in a public mental health system, was spent trying to do just that. Creating and sustaining viable coalitions does require a long term commitment to tirelessly work to organize allies and secure political support, while at the same time often struggling against overwhelming opposition and odds.
Ironically, the NAMI led coalition has also practiced – and have perfected – what is actually a Marxist strategy called “The long march through the institutions.”
That labor-intensive, long-term strategy seeks out the so-called switch points of social power. No stone is left unturned. No elected official is left out. If you are a first-time candidate for city council, for instance, you are going to be contacted by NAMI requesting a meeting with you. You are going to be told you will share responsibility for the lack of mental health services in your area if you are elected. You will be told how many NAMI-registered voters reside in your city! You will be told that involuntary outpatient commitment saves lives.
An almost evangelical revolutionary zeal is clearly at work. Many mental health system psychiatrists publicly endorse the NAMI political work. This overt psychiatric backing adds great credibility to the political agenda NAMI works towards.
This laborious grass roots political process aims at transforming a social institution like the mental health system both from the inside-out and from the outside-in.
I witnessed how every public and private person with any bit of political influence or power that could be a useful ally, or be convinced, cajoled, or pressured to support the national and local NAMI coalition’s agenda, was identified and personally engaged for their support over and over again.
The broad-based stakeholder coalition I led doggedly tried to do the same thing. Part of our political power base was the mental health workers’ independent labor union that had also mastered the long march through the institutions. As a result we often were successful in building the necessary political network that was effective in preserving and creating more humane, peer-led and -staffed services. We walked precincts for politicians at every level of government for example and contributed money to their campaigns. Our mental health coalition’s strength was in our diversity and the common ground we all had a vested interest in preserving – that is what kept us united.
The same pragmatic political principles that dictate the winners and losers in any political contest are at work in the struggle over which vision of mental health care will take place in the United States.
I hope this tragic, federally-funded forced treatment victory and the Murphy legislation that threatens to destroy SAMHSA, may prompt us to examine additional and new political strategies. Lives and much avoidable human suffering is at stake. I believe it is possible to reverse the political gains made by the daunting alliance of NAMI, psychiatry, pharma and fear-mongering or apathetic politicians.