Political Advocacy, "In" Groups, Marketing, and Political Distance

Within the last decade, Vermont's mental health professions have increased in number. In the 1970's psychiatry reigned as the sole licensed mental health profession. Today that profession has been joined by clinical social work, clinical mental health counseling, psychiatric nursing, psychology, psychoanalysis, and substance abuse counseling. As their legitimacy has occurred, the professions have formed collaborative agreements, political affiliation and influence have been enhanced. For example, in the Legislative session just ended, it was apparent that Vermont's mental health professions enjoy political credibility far greater than that imagined possible a decade ago.

However, with increased credibility and enhanced political affiliation, there is a encouragement and risk for the mental health professions to abandon social responsibility and advocacy-for-citizens expectations which cannot be ignored. Sociologists and other students of human nature have long understood the tendency of humans to affiliate with "in groups" and lose touch with the needs of their groups of origin and needs thereof. One does not have to look far for evidence of this trait. Children and teens are notorious for their fickle social movements from one affinity group to another. Adults are not necessarily different. Typically, this movement by some away from groups of origin to higher status and/or new groups means that someone gets left behind; cannot be involved in the "higher order process." Texts have been written about this process, and C. Wright Mills made the term "social elites" a buzz word. Saul Alinsky capitalized on the term with his "social action and social movement" concepts.

Over the decade since the 1970's, Vermont's mental health professions have more and more allied themselves with citizen advocacy organizations and political/legislative bodies and authority in striving for increased credibility within the political process. Professional opinions are sought, consultation and deliberation occurs at the highest levels of the health care change process, decisions are made and announced, credit for jobs well done is displayed and shared at the highest levels of interchange; accomplishments by members of this "in group" are described in newsletters to members and others.

With specific regard for health care issues, there is another force operant in the health care change environment - a force with increasingly large amounts of money to influence political decision-making and to sway public opinion. There should no longer be any doubt among mental health professionals about the significant influence corporate managed health (budget) care entities has in the health industry and political environment. Moreover, there is probably no doubt that this influence is backed by highly skilled marketing experts with more available funding than our professions have available. One aspect which might not be so apparent to mental health professionals, per se, is that corporate entities have an automatic cost/tax write off when they spend money to influence the health care industry and legislative/regulatory process attending to health care concerns - that is a "cost of doing business." Most practitioners and professions are not able to write off our political activities in behalf of health care concerns as we attempt to counter the influence of corporate managed care.

But, my concern here is not to attack managed care; it is to point out the risk of "over-affiliation" with the Legislative process. It is a concern about leaving our professional responsibility for social education as well as our natural constituents - our clients - outside the political process within which we have become competent, gained acceptance, and where we have made new allies. It is a concern that identifies the human tendency to affiliate into groups of relative exclusivity at the expense of those who helped get us there.

In my 1998 Legislative campaign, I heard several themes, and one remains clearly in the forefront of contemporary events as I head into a second campaign: citizens, as a universal group, experience and feel an increasing isolation from the political processes which affect our lives. They perceive government as a group of influential, powerful, insensitive, and generally unresponsive special interest groups with little or no accountability to the folks who elevate them into office. More, they view the sub-groups (and lobbyists) which (who) influence political decisions as barriers and manipulators between voters, legislative and political leaders, and governmental planners and decision-makers. They feel left out and disenfranchised.

I am concerned that our professions, with our need for political influence and reinforcement of that need by acquisitive and grateful politicians, may lose sight of our clients - those who we have an ethical responsibility to advocate in behalf of - to the extent that we exclude them from participating with us in the health care political dialogue and process.

Coupled with that concern is one which respects the skills and tools of marketing which have so well focussed blame for health care problems onto citizens, providers, and institutions and away from managed care corporations and their subsets. At the same time, I lament that our professions continue to allow those marketing successes to hold us and our clients captive as the "blamed" perpetrators of the health care dilemma. While managed care corporations successfully mount extensive, focussed marketing campaigns explaining their concerns and positions, we spend much of our energy within the legitimate political process influencing legislation and regulation, allied with one of the groups (government) most maligned by managed care marketing experts. And, we don't fight back in the arena where we are consistantly absent - the media.

Are there solutions? You bet! Are they too complex? No! They are simple. However, solutions I recommend here, will require us to remove our client-centered clinical hats and glasses, and replace them with advocacy and political organization apparati. Our colleagues must learn to become comfortable writing and speaking critically and publicly in popular, non-professional media about corporate greed, the health care industry, managed care problems and solutions, describing what else is "wrong" about health care in the U.S. We must engage our clientele in ethical, meaningful discussions about issues which affect their health care beyond the therapeutic room; we must encourage responsible and visible political collaboration between helper and client; we must begin to view our clients as political colleagues and join with them to define a healthy, responsive, and ethical health care system.

The time to do this was in the 1980's; the time to do it is now.