Mobilizing the political will to develop a children's mental health system in Iowa

While most Iowans know someone who has struggled with mental illness – a family member, friend or neighbor – many Iowans do not realize how fragmented and underfunded our mental health interventions and services are for adults and children in our state. Since 2012, Iowa has been working to redesign and improve the adult mental health system, but creating a system that works for children has largely been an afterthought. Don’t get me wrong, there has been considerable time and energy given to TALKING about creating a children’s mental system. There have been years of Children’s Mental Health and Well-being Workgroup meetings resulting in annual legislative reports with well-designed recommendations based upon innovative pilot projects/learning labs which demonstrated success in both urban and rural communities. Nonprofit organizations, like NAMI, have mobilized their members who devoted significant time developing a comprehensive strategic plan for addressing the mental health needs of children in Iowa. Community coalitions, such as Central Iowa ACEs 360 and the Trauma Informed Care Stakeholders group, throughout the state have spent countless hours advocating and educating policymakers on the key components to developing a children’s mental health system. School districts throughout the state have stepped up and used their limited resources to address the mental health and well-being needs of their students, knowing academic success can only be achieved when it includes a focus on social emotional development, and more intensive supports for children who have exhibited signs or been diagnosed with a mental health issue. Yet, Iowa has lacked the political will to move beyond talk to action…until now.

What is “Political Will” and how do we achieve it?

Political scientists, political operatives and policy wonks refer to “political will” in numerous contexts, but often lack a consistent definition. A journal article, "Defining Political Will," published in Politics & Policy (Aug 25, 2010) by Lori Ann Post of Yale, Amber Raile and Eric Raile of North Dakota State University, attempts to pull together various components in the academic literature on political will into one clear definition, broad enough to cover different circumstances and institutions but with enough substance to allow for analysis and action in individual issues or examples. The article suggests there are four components which comprise political will:

1. A set of decision-makers who have or have been given authority
2. A high level of commitment to resolve the issue
3. A common understanding of the problem
4. A consensus and good-faith belief the policy solution(s) will be effective.

So what does that all mean in the current context of the mental health and well-being of Iowa’s children?

Decision-Makers with Authority

In July, Governor Reynolds announced the inaugural members of the State Children’s System Board. The twenty-member board is comprised of appointees from across the state with various professional backgrounds in health, mental health, education, early childhood, child welfare, juvenile justice, law enforcement and a parent representative of a child with a Serious Emotional Disturbance. The Governor’s decision to create the Children’s Board by Executive Order explicitly gives authority to a distinct set of decision-makers. The Board is charged with developing a strategic plan by November 15, 2018 to design and identify steps to implement a comprehensive children’s mental health system in Iowa. The designation through Executive Order should give the Board authority to direct the various state departments to take steps to create the children’s system. I say “should” because the Board will need to decide if they are willing to use their authority in this manner. Sometimes, “Iowa Nice” can get in the way of giving clear marching orders and holding the state accountable for following through on the Board’s directives. But the Board formation through Executive Order is an excellent first step. This is in contrast to the past methodology where the Children’s Mental Health and Well-being Workgroup gave annual recommendations that the state departments and the legislature could choose whether or not to follow. Even if the Board has the authority to direct the state’s development of a children’s system, there will still be a critical need to collaborate with the Governor’s office, the Iowa Legislature and other key stakeholders to creatively and adequately fund the implementation.

A High Level of Commitment

One can assume the Board appointees have a high level of commitment to develop a children’s system, or they likely would not have applied for consideration. This Board is going to involve a lot of work and critical thinking both inside and outside of the Board meetings to meet the November deadline for the development of a strategic plan. Additionally, the ongoing oversight of the implementation of strategic plan will be equally important and work intensive. The Board members various connections to and experience in the child welfare, juvenile justice, education, human rights, early childhood, law enforcement, health and mental health fields make them experts in their areas of service who will bring valuable information and access to resources to the table. A common and binding thread is the passion which people in these professions typically possess. No one gets rich by being a social worker or a teacher. The commitment these individuals make to their profession is about their capacity to care and make a difference in the lives of the children they serve.

The Challenge Lies Ahead: Creating a Common Understanding, Developing Consensus and Possessing a Good Faith Belief in the Solutions

Perhaps the two most difficult elements of generating political will in the children’s mental health arena are 1) creating a common understanding of the problem and 2) developing a consensus among stakeholders and their constituencies on which policy solutions will be most effective. One would assume a common understanding wouldn’t be so hard to achieve among Board members who devote their careers to caring for children, but for decades our fragmented children’s mental health response has operated in silos, both geographic and disciplinary silos. We have unintentionally built systemic barriers that keep us from working together, across disciplines and across communities, to leverage and braid funding streams to create a unified system for children. To be successful, the Board members will have to take a step back from their areas of expertise, listen to what one another has to share, and be creative in finding cross-discipline solutions. A good-faith belief in collaborative solutions means trusting one another’s ideas and being willing to let go of control over one’s own area and resources to achieve a larger common goal. This is far easier said than done.

To develop a children’s system, we can’t continue to serve children and families with a patchwork of programs and services offered sporadically across the state and rely on programs beyond Iowa’s borders to routinely serve our children. To be effective, children need services to be close to their families and community in order to develop ongoing connections and supports they can rely on throughout their childhood and adulthood if needed. Considerable work has been done by the Children’s Mental Health and Well-being Workgroup to identify essential core services necessary to meet the unique needs of children (News flash…similar, but not the same core services that adults need!) The Children’s Board can expedite their work by listening to the lessons the Workgroup learned over the past six years. A common, simplified message and agreed upon solutions to complex issues is what policymakers need to hear from the Children’s Board. If we cannot communicate that common understanding and agreed upon solutions, we potentially miss our chance to leverage the political will needed to get the job done and finally accomplish monumental achievements for the health and well-being of all Iowa children. Our children are too important to let this opportunity slip by. Now is the time.