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Promoting Inclusion, Equity and Deliberation in a National Dialogue on Mental Health

The 15-page article, Promoting Inclusion, Equity and Deliberation in a National Dialogue on Mental Health, was written by Tom Campbell, Raquel Goodrich, Carolyn Lukensmeyer, and Daniel Schugurensky, and published in the Journal of Public Deliberation: Vol. 12: Iss. 2. In the article, the authors share their experiences with the project, “Creating Community Solutions” (CCS), in which six organizations partnered to better understand how the public is engaged around mental health. By implementing three engagement strategies, CCS sought to shift the social norms around mental health and work to improve the inclusivity of how individuals and communities are engaged.

Read an excerpt of the article below and find the PDF available for download on the Journal of Public Deliberation site here.

From the article…

The ability to make progress on the nation’s mental health crisis has been limited not only by inadequate resources but also by the difficulty of addressing underlying discrimination, stigma, and cultural barriers. Indeed, some populations are especially vulnerable and underserved by mental health services. To begin, young people have high rates of mental health problems and low rates of seeking help; three-quarters of mental health problems begin before the age of 24. Second, common mental health disorders are twice as common among individuals with low incomes, and there is a strong correlation between mental illness, poverty, and crime. Third, communities of color tend to experience a greater burden of mental and substance-use disorders, most often due to limited access to care, inappropriate care, and higher social, environmental, and economic risk factors. Fourth, LGBTQ youth are sometimes rejected by their families and peers, and experiencing bullying and bias can lead to anxiety, depression, drug use, and suicide. The stigma associated with mental illness often leads to reluctance to find help. It has been reported that up to 60 percent of individuals with mental illness do not seek treatment and services (Substance Abuse and Mental Health Services Administration, 2015).

The scarcity of safe environments in many communities to acknowledge mental health challenges and to address them systemically has limited the ability to create new solutions. Prior efforts to engage marginalized populations in mental health deliberations have not always shown positive results. For instance, in a study on the engagement of mental health service users/survivors in deliberative democracy, Barnes (2002) examined how notions of “legitimate participants” were constructed within official discourse and argued that the emphasis on rational debates could have excluded the emotional content of the experience of living with mental health problems from deliberation about mental health policy. A related study, conducted by Hughes (2016), on a deliberative system that connected federal policymakers with the disability community found that the discourse of the government agency failed to engage with social difference as a resource for inclusion and collaboration, reinforced stigma around disability, and excluded underrepresented groups. In this context, the project “Creating Community Solutions” (CCS) aimed to change social norms around mental health, reduce discrimination, and bring forward more inclusive opportunities for community engagement. Gastil (2014) contended that scholars in the field of public deliberation must produce not only rigorous research but also field reports that help reformers and public officials refine their methods of public engagement. By discussing CCS and its three engagement strategies, we hope to provide useful information and insights to public officials and practitioners interested in large-scale, solution-oriented public engagement projects.

Blending Deliberative Methods and Designing for Inclusion
Led by the National Institute for Civil Discourse, six deliberative democracy organizations partnered to launch Creating Community Solutions (CCS). A unique aspect of this project was the willingness and ability of the six organizations to collaboratively design the initiative using the strengths of each one to reach communities and to take the program to a national scale. The design included three main strategies. The first was Lead Cities, with mayor-initiated, in-depth deliberative conversations using town hall meetings and neighborhood outreach in six cities. The second, Community Conversations, varied in length and were held in every state in the country. The third, Text Talk Act, used text messaging as a method to get young people talking about mental health. Common to all strategies was a consistent set of topics and questions, a website with supporting resources, outreach into neighborhoods and affected populations to include individuals not traditionally part of the mental health system, and a prioritization process for developing recommendations to respond to mental health challenges.

The three strategies relied on small group discussions facilitated by discussion guides and other materials. These materials included factual information on mental health problems, challenges to key cultural populations, the importance of early identification and treatment, and key questions related to the mental health field. While the larger town hall meetings brought a more representative sample of the local population and generated longer conversations, the addition of community conversations and texting platforms enabled CCS to create more inclusive participation of various segments of the population and to achieve a national reach. Indeed, CCS wanted to build a nationwide conversation but also sought to approach it in a way that would allow voices not normally heard in the discussion of mental health to be considered and acted upon. This effort was guided by three main goals. The first was to reach deeply into selected lead cities with an outreach process that included a representative sample of the population and an oversample of youth and affected communities. The second was to reach broadly across the country by supporting community initiatives to ensure that conversations were held in every state. The third was to reach young people directly by utilizing their preferred communication practices through a readily accessible texting platform.

These strategies were relevant because conversations on mental health often attract the “usual suspects.” In many situations, stakeholder groups are among the first to sign up and take a prominent role, especially if they know that a national audience and local leaders are listening. While the design team understood that providers and experienced stakeholders would want to attend, CCS limited the number of mental health providers and registered participants to ensure a representative sampling of the demographics of the whole community. Through extensive outreach and the use of a questionnaire in the registration process, organizers were able to monitor the representative nature of the participants and achieve a truly community-wide conversation to hear how ordinary citizens wanted to see the system changed. As Michels (2011) noted, inclusion is often best achieved by engaging citizens through social networks, providing open access to forums, and striving to attract participants who are representative of the community as a whole.

Download the full article from the Journal of Public Deliberation here.

About the Journal of Public Deliberation
Journal of Public DeliberationSpearheaded by the Deliberative Democracy Consortium in collaboration with the International Association of Public Participation, the principal objective of Journal of Public Deliberation (JPD) is to synthesize the research, opinion, projects, experiments and experiences of academics and practitioners in the emerging multi-disciplinary field and political movement called by some “deliberative democracy.” By doing this, we hope to help improve future research endeavors in this field and aid in the transformation of modern representative democracy into a more citizen friendly form.

Follow the Deliberative Democracy Consortium on Twitter: @delibdem

Follow the International Association of Public Participation [US] on Twitter: @IAP2USA

Resource Link: www.publicdeliberation.net/jpd/vol12/iss2/art8/

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