I am one of the new interns working for the Children’s Mental Health Network, and the topic I chose to research and learn more about is the Interdepartmental Serious Mental Illness Coordinating Committee (ISMICC). More specifically, I want to understand how policy influences the work of this committee. Before this internship, I was not familiar with how policy is developed and implemented at the federal level, and I feel I have only scratched the surface as I delve into my research.

The 21st Century Cures Act was signed into law in December 2016. Through this Act (Public Law 114-255), the ISMICC was established to make recommendations for actions that federal departments can take to coordinate better the administration of mental health services for adults with a serious mental illness or children with a serious emotional disturbance. The ISMICC’s purpose is to support a mental health system to address the needs of those living with mental illness and to aid them in achieving a healthy lifestyle.¹ Understanding the relationship between a policy that is impacted by decisions made through this committee and how that affects public health in relation to mental health care in our country is of great interest to me.

The process for how policies come to fruition appears to me to be clouded with layers of uncertainty and bargaining. Everyone wants to get “something out of it,” get their way if you will. I am aware that it cannot be one-sided, and there should always be some give and take, but the health of our communities should not suffer at the hands of backyard fights disguised as “just politics.” I hope that my journey ahead during my internship will allow me to gain a better understanding of how mental health policy will affect my practice, and help to give me a voice to change it for the better. I’m new to this side of mental health practice, and I am learning a lot as I go, which is encouraging for my personal goals.

As my career turned from the bedside and clinical care to more of an advocate role, I noticed that various influences affected my role and ability to care for those in need of mental health services. Once blinded by the seemingly unlimited resources in acute and critical care, once these people are discharged home, there is a struggle to manage their follow up care. My interest in advocacy stems from a particular population I worked with as an open-heart nurse. I saw a fragile and forgotten group of young adults and adolescents who were struggling in profound substance abuse who needed life-saving support for them to survive. These young people are someone’s child, someone’s family; there may even be people out in the world who depend on them. When they decided to turn to a substance, did they have the supports they needed to cope or was this all originating from substance experimentation gone wrong? We know there are so many reasons for substance use, and too often, it goes hand in hand with untreated or ill-treated mental health issues.

Knowing there are several risk factors a child faces that they cannot change in regards to their potential substance use, we as advocates are challenged to find ways to build up these kids’ protective factors. As advocates, we are tasked to use our resources for those in need and help these families whenever we can. There is a long history of the saying “prevention is the best medicine.” Let’s build on that, develop and evolve our preventive supports in our communities, and foster a positive and nurturing environment for our at-risk kids. We want practices and interventions that are going to hit home with our kids, and let’s not forget the already limited resources allocated to mental health as opposed to other “physical conditions.”

We, as a community, should be pushing for policymakers to make the most of our funding and use our resources wisely. Policy and the tedious work of establishing law are a proverbial rabbit hole that almost feels purposely impossible to navigate. No wonder policy is such a blind spot for most of us, but real strings are being pulled. Sometimes those “behind the scenes” actions can be helpful, but too often, what is done in the dark can be detrimental to a cause.

I look forward to investigating how the ISMICC is implementing the charge given to them through the 21st Century Cures act.

References

1. SAMHSA website, Interdepartmental Serious Mental Illness Coordinating Committee, https://www.samhsa.gov/ismicc