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In a Challenging Year, Creativity Prevails

In a Challenging Year, Creativity Prevails

April 2022

Come July, when people in acute mental or emotional distress need help, they will have an alternative to what too many of us tend to do, almost by default. Because we’ve got a problem and we don’t really know what else to do, we call 911. This sets off a chain reaction that all too often results in a law enforcement response. The police show up, and a crisis that might have been resolved in a nonconfrontational way — with far better outcomes for everyone involved — ends up with criminal charges filed, involving the courts, and the initial problem goes unaddressed.

Fortunately, as of July 2022, there will be an alternative to calling 911. That’s when 988, a national three-digit number for all mental health crises, will go live, leveraging the existing National Suicide Prevention Lifeline network of call centers to help people in any kind of mental health, substance use or suicidal crisis.

But when people call the number, what resources will be available in their community to help – and provide a mental health response to mental health crises?

And of course, there’s the challenge when people show up at their nearest hospital’s emergency room, straining that facility’s resources and, once again, leaving underlying mental health problems unaddressed.

Expanding crisis services in communities across the country was the main goal of the National Alliance on Mental Illness (NAMI), winner of the Council’s 2022 Advocacy Innovation Award in the Communications category. To address all these problems, NAMI laid the groundwork for more services to be available behind the 988 number, recruiting an impressive array of partners to build awareness of the need for alternatives and support for the hotline focused on reimagining our crisis system.

The two other Innovation Award winners are the Cruise Lines International Association (CLIA), recognized in the Lobbying category, and Vot-ER, winning in the Grassroots category. “These three winning organizations are inspiring,” Council Director of Digital and Policy Communications Nick DeSarno says. “During a time of challenge for so many, they found creative ways to strengthen industry and heal communities. They offer great examples to their colleagues and peers.”

Communications Innovation: National Alliance on Mental Illness

The most important part of preparing for the launch of 988, says Hannah Wesolowski, NAMI’s chief advocacy officer, was “making people aware that there was a need for a change in our response to crises. And to do that, we needed to reach beyond the mental health community itself, because of the scope of the problem. We wanted to reach out to a broad cross-section of stakeholders, which would include law enforcement, for example, and people of color who tend to be the most impacted by law enforcement being involved.”

To that end, NAMI assembled more than 40 partners, including the League of United Latin American Citizens (LULAC), the American Academy of Pediatrics, the American College of Emergency Physicians and the Major County Sheriffs of America, all of which, Wesolowski says, “understand the trauma and tragedy of our current response to crises.” Special efforts were made to include organizations that had not previously been active on the issue.

Making ‘Enough Noise’

As NAMI realized, no single organization would be able to “make enough noise alone to garner the investments and major restructuring needed to seize this unique opportunity around the launch of 988. For decades, mental health has only gotten table scraps, leading to people with mental health conditions, on average waiting 11 years from the onset of symptoms until they receive treatment, cycling in and out of jails and homelessness and experiencing more adverse outcomes.”

As part of this larger effort, NAMI hosted REIMAGINE: A Week of Action to Reimagine Our National Response to People in Crisis, which took place last November and included three days of virtual events “targeted at both the general public and advocacy leaders working on-the-ground to advance policy change. Through this event, NAMI engaged policymakers at the federal and state level, state mental health agency staff, thought leaders, advocacy leaders and allied organizations.”

As Wesolowski says, “For the 988 to succeed once it is launched, the important work is building support for its need, and we feel we are doing that — and we are doing so with a very limited window of opportunity.” During REIMAGINE week, NAMI alone sent more than 60,000 messages to Congress, and more came from partners. A poll conducted for NAMI by Ipsos, which found that only 4% of the public was even aware of 988, was covered by AP, The Hill and Kaiser Health News and garnered more than 15 media interviews.

Wesolowski notes how important it was to get the attention of legislators and the public, “This work is ongoing, but the immediacy of the July launch required a bold initiative to raise public awareness that a number is not enough –- we need real investments in mental health crisis services to help people, their families and our communities.”

Lobbying Innovation: Cruise Lines International Association (CLIA)

On March 13, 2020, to protect the health of its member companies’ customers and employees as well as the public, the Cruise Lines International Association announced a voluntary shutdown of operations in response to the COVID-19 pandemic. Until further notice, CLIA said, cruise ships would not be sailing. The next day, however, the Centers for Disease Control and Prevention (CDC) had an announcement of its own. “What they said, more or less, was that while they applaud the industry’s decision to voluntarily shut down operations, given the unprecedented nature of the virus, they made the decision to issue a ‘No Sail Order’ nonetheless,” says Laziza Lambert, CLIA’s director of strategic communications and public affairs.

Ships Under Lockdown

The agency’s No Sail Order for cruise ships amounted to a stop-work order for the $55 billion-a-year U.S. cruise industry. “This unprecedented action,” CLIA says, “stood in stark contrast to most, if not all, other industries in the United States, which had been permitted to continue operating throughout the pandemic.”

And for over a year, Lambert says, “as hard as we tried, engagement between the CDC and the cruise industry was minimal, and so we struggled to make headway in our efforts to develop a pathway toward a resumption of operations in the United States. We had little dialogue and little to no guidelines from the CDC. When we’d reach out to the agency, we were provided a generic email address to field our questions. While the path toward resumption and regular dialogue was not an easy one, we are grateful to now be engaging in regular communication with the CDC as we continue to resume operations in the U.S.”

One reason for the bottleneck, Lambert says, is that cruise lines are “the only travel and tourism industry that the CDC regulates, as they simultaneously work to issue guidance for the entire country.” Another reason is that the CDC “really has no constituents as such to answer to. And we needed to change that.”

With time passing, and circumstances for cruise lines improving almost daily, CLIA realized that, if the industry was to survive at all, members of Congress needed to get involved. Lawmakers needed to tell the CDC that the industry was eager to engage in productive dialogue as it moved toward a resumption of operations.

‘Ready, Set, Sail’

With this goal in mind, CLIA recruited a diverse cadre of advocates, including 50,000 travel agents who are not members of the association as well as industry partners and suppliers. The effort, branded as “Ready, Set, Sail,” was launched in March 2021, and within two days, the campaign had generated almost 10,000 grassroots messages to Congress. Within weeks, more than 156,000 messages had been sent by more than 47,000 supporters, reaching all 435 members of the House and all 100 senators.

CLIA sums up the results: “The impact of this innovative and strategic initiative was felt almost immediately, with numerous prominent voices on the Hill speaking up publicly on behalf of the industry and encouraging the CDC to work to find a solution. Within one week of launch, the CDC updated its guidance to the cruise industry for the first time in more than six months.”

Within six weeks, the CDC and representatives from the cruise industry began a dialogue, with the first U.S. ship sailing last June. Since then, more than 100 cruise ships have sailed, and the campaign has been “hailed as a tremendous success story, including within the CDC, which continues to hold regular dialogue with [the] industry.”

Grassroots Innovation: Vot-ER

In 2019, Alister Martin, an emergency room physician at Massachusetts General Hospital in Boston, noticed that many patients were appearing at the ER whose needs were not only medical but social. One of them, for example, needed housing, so Dr. Martin, who is also an Assistant Professor at Harvard Medical School, arranged with the hospital’s social worker to help the patient find a place to live.

In the process of helping the patient prove Massachusetts residency, the social worker coached Dr. Martin to help the patient register to vote. Surprised, Dr. Martin began to learn more and found that the National Voter Registration Act of 1993 encouraged nonprofits to conduct voter registration. He began to consider how voter registration could be part of how he could help his many patients who presented to the ER, and he ultimately founded Vot-ER with a team of healthcare providers and behavioral scientists in the summer of 2019.

Then came the summer of 2020, and suddenly health care professionals, hospitals, and health associations across the country began asking en masse how they could go upstream to address deeper determinants of health. “This all came about at a time of other important discussions — the onset of COVID, when issues of medical distrust were recognized and talked about, plus the killing of George Floyd, which initiated other urgent conversations,” says Aliya Bhatia, Vot-ER’s executive director.

Growing Recognition

“There was a growing recognition that a patient’s health is influenced by social and political determinants of health,” Bhatia says. “Patients routinely arrive at the ER and community health organizations for non-emergency care because they have nowhere else to go, and this was a time when healthcare workers were facing exhaustion. The people who arrive at the ER with nonemergency problems are disproportionally made up of the young, low-income communities, and people of color, which are the same groups that are often disengaged with the democratic process. And ER doctors were asking what they could to make a difference beyond the hospital walls.”

One important thing they could do, Dr. Martin and others realized, was ask patients if they were registered to vote and provide resources that enabled them to register. More than 50 million voting-age citizens are not registered to vote, and Vot-ER is doing something about it.

Vot-ER provided badges and lanyards to health care professionals, which included a QR code to help patients access voting resources and launched Civic Health Month, a month of action every August to celebrate and uplift the link between voting and health. The numbers don’t tell the whole story but are impressive nonetheless. For the 2020 election cycle, Vot-ER recruited 25,000 healthcare professionals who helped 46,000 of their patients register to vote or request mail-in ballots. About 50% of these voters identified as white, 20% as Black and 30% as other persons of color, which compares to 66% in the general electorate who are white.

Vot-ER voters also had a median annual income of about $36,000 — similar to the median income of the U.S. as a whole. Meanwhile, the country’s voting population has historically skewed wealthier than the U.S. as a whole.

Might having conversations with patients about voting impose an additional burden on overworked healthcare professionals? “Not at all,” Bhatia says. “In fact, a 2020 survey of our members, many of whom are pediatricians, found that the discussions were a great source of wellbeing for the health care professionals and a source of gratitude from their patients. The pediatricians said that as their patients approached 18, when they were already having conversations about changes in their bodies and their lives, talking about voting and participating in the democratic process came naturally.”

Are there policy outcomes that the organization hopes will result from their patients’ voting in greater numbers? “This is a nonpartisan effort, and there aren’t specific policies we are trying to implement,” Bhatia says. “Regardless of party or policy beliefs, the research shows that you get better health outcomes when people — especially those most marginalized in our society — are engaged in the democratic process.”

The Council’s Public Affairs Associate Erica Harris, who oversaw the work of the judging committee says, “The innovation Awards judges were impressed by not just the creativity of the winners but the force behind the campaigns. The winning organizations tackled some of toughest challenges of our times and never lost determination.”

About the Innovation Awards

The Innovation Awards are presented annually at The Advocacy Conference. Winners are invited to present their campaigns during the awards ceremony.

Could your organization be a future winner? Learn more.

The winning organizations tackled some of toughest challenges of our times and never lost determination

Erica HarrisPublic Affairs Council

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