Journal of Primary Prevention, 3(1), Fall, 1982
Fiscal Myopia or Constituency Building WILLIAM G. HOLLISTER Will primary prevention die aborning? In these halcyon days of budget cuts and recisions, the community mental health professions may soon be reaping the harvest of one of their most glaring omissions, namely failure to do constituency building. Our blindness can be understood. During these last affluent 30 years, with an opulent NIMH ready to be our sugar daddy and with enthusiasms running high, we have been seduced into believing that mental health is "good in and of itself," and obviously deserves to be financially supported. We have come to believe that all we needed to do was to "tell our story," document the need, evoke concern for the unfortunate and lo, the treasury gates would be open to us. We have slipped into assuming that fervent appeals by the professionals (often perceived as grinding their own axe} would be adequate to win over our legislators and bring us sustained funding for our costly adventures in behalf of human well-being. Now, and I hope not too late, we are finding that professional benevolence, good intentions, and special appeals are not enough to help us obtain a larger slice of dwindling tax dollars. We are rediscovering what political scientists and community organization personnel have been trying to tell us--that no social movement survives if it doesn't have a considerable body of active vocal support in the general electorate. Many of us have known this, but we have been lured into the more satisfying tasks of clinical work and program development. We have been relatively reluctant to follow the mundane routines for building up a constituency, for creating a following that could become our principal resource for political and fiscal support. Perhaps some of us have been "turned off" by such political activity as being beneath our professional dignity. The realm of politics, which I define as the study of how communities make decisions, has acquired such a pejorative connotation that we have avoided looking at a social dynamic on which our very future rests.
0278-095X(82}1500-0003502.75
3
© 1982 Human Sciences Press
4
Journal of Primary Prevention
Now that our funds for clinical and prevention activities are being seriously threatened, we can easily get discouraged and disappointed that too few people seem to be coming forward to say loudly enough, "mental health and mental illness prevention programs are important." We are like generals going into battle with no troops behind us, competing with other better organized constituencies for a share of the tax funds. The literature of sociology, political science, group processes, health education and other fields is replete with descriptions of the technologies of constituency building. Its efficacy has been documented over and over. No politician who wishes to survive dares neglect it. The process goes far beyond diagnosing the health power structure and making s u b r o s a contacts with political bellwethers. Its key objectives and actions are captured in such words as "participation and involvement," "achieving citizen ownership via real representation," and "feedback for ratification" as well as "open accountability" and "citizen acceptability checking." It is a challenging process that calls for skill and social sensitivity. It is an intricate process that can enmesh the unwary or trap one into the unethical snares of "operating a lobby " or settling for the pseudo-support of a "rubber stamping board." Yet, for all its pitfalls, it is an honorable operation that can be conducted with professional integrity; it is a field of endeavor that promises potential survival and much personal satisfactions. But why are we so reluctant to invest in mobilizing community support? Some of us may be afraid of losing professional control, of being taken over by lay leaders. Is this due to a belief that we cannot build honest face-to-face egalitarian working relationships (our supposed forte} with citizens as colleagues? Is it hard for us to step down from the professional pedestal? Is it difficult for us to blend our expertise with the layman's expertise? There are and can be experts who are quite sensitive about people's personal needs, concerns, about ways of reaching people, and about citizens' reactions to professional programs. It is strange that in consultee consultation we espoused the cause of mutual problem solving, yet some of us find it difficult to be accountable to a board or seek advice and counsel from a neighborhood council on whether a program is acceptable and would be used by their neighbors. Have we forgotten that demonstrating our humility and capacity to receive counsel from others makes it easier for those others to receive and accept counsel from us? We need to have the courage to pick up the mirror, to examine our reluctance and see why it is that we have little or no constituency who will rise to fight for our cause. More than that, I hope the present fiscal
William G. Hollister
5
crises will sober us to the fact that some percentage of our time must legitimately be spent in community constituency building and developing citizen advocacy. It has priority for our survival. W h a t about a constitutency for primary prevention? Let me venture a prediction. Every time we sit down to "listen" to a neighborhood advisory council of four or five citizens, and once we get beyond the first few minutes of talking about ill people, someone almost always asks about prevention. Repeatedly we find that citizen groups not only want care for the troubled, b u t they also want something done to prevent the marriage failures, the alcoholic deteriorations, the child behavior problems and the role breakdown they see around them everyday. I am convinced that there is a latent hunger in the citizen population than can be tapped, that can be mobilized to contact decision makers and to call for and sustain more research and program development for primary prevention. The constituency for prevention is there, b u t it is latent. It must be uncovered, cultivated, and nurtured into full potency by professional interest. With a little outreach on our part it could become a constituency that would support us by means of citizen demand and citizen willingness to p a y for primary prevention efforts. Prevention's latent constituency is there for us to uncover, if we are only willing to invest in its flowering and maturation.
Fiscal Myopia or Constituency Building WILLIAM G. HOLLISTER Will primary prevention die aborning? In these halcyon days of budget cuts and recisions, the community mental health professions may soon be reaping the harvest of one of their most glaring omissions, namely failure to do constituency building. Our blindness can be understood. During these last affluent 30 years, with an opulent NIMH ready to be our sugar daddy and with enthusiasms running high, we have been seduced into believing that mental health is "good in and of itself," and obviously deserves to be financially supported. We have come to believe that all we needed to do was to "tell our story," document the need, evoke concern for the unfortunate and lo, the treasury gates would be open to us. We have slipped into assuming that fervent appeals by the professionals (often perceived as grinding their own axe} would be adequate to win over our legislators and bring us sustained funding for our costly adventures in behalf of human well-being. Now, and I hope not too late, we are finding that professional benevolence, good intentions, and special appeals are not enough to help us obtain a larger slice of dwindling tax dollars. We are rediscovering what political scientists and community organization personnel have been trying to tell us--that no social movement survives if it doesn't have a considerable body of active vocal support in the general electorate. Many of us have known this, but we have been lured into the more satisfying tasks of clinical work and program development. We have been relatively reluctant to follow the mundane routines for building up a constituency, for creating a following that could become our principal resource for political and fiscal support. Perhaps some of us have been "turned off" by such political activity as being beneath our professional dignity. The realm of politics, which I define as the study of how communities make decisions, has acquired such a pejorative connotation that we have avoided looking at a social dynamic on which our very future rests.
0278-095X(82}1500-0003502.75
3
© 1982 Human Sciences Press
4
Journal of Primary Prevention
Now that our funds for clinical and prevention activities are being seriously threatened, we can easily get discouraged and disappointed that too few people seem to be coming forward to say loudly enough, "mental health and mental illness prevention programs are important." We are like generals going into battle with no troops behind us, competing with other better organized constituencies for a share of the tax funds. The literature of sociology, political science, group processes, health education and other fields is replete with descriptions of the technologies of constituency building. Its efficacy has been documented over and over. No politician who wishes to survive dares neglect it. The process goes far beyond diagnosing the health power structure and making s u b r o s a contacts with political bellwethers. Its key objectives and actions are captured in such words as "participation and involvement," "achieving citizen ownership via real representation," and "feedback for ratification" as well as "open accountability" and "citizen acceptability checking." It is a challenging process that calls for skill and social sensitivity. It is an intricate process that can enmesh the unwary or trap one into the unethical snares of "operating a lobby " or settling for the pseudo-support of a "rubber stamping board." Yet, for all its pitfalls, it is an honorable operation that can be conducted with professional integrity; it is a field of endeavor that promises potential survival and much personal satisfactions. But why are we so reluctant to invest in mobilizing community support? Some of us may be afraid of losing professional control, of being taken over by lay leaders. Is this due to a belief that we cannot build honest face-to-face egalitarian working relationships (our supposed forte} with citizens as colleagues? Is it hard for us to step down from the professional pedestal? Is it difficult for us to blend our expertise with the layman's expertise? There are and can be experts who are quite sensitive about people's personal needs, concerns, about ways of reaching people, and about citizens' reactions to professional programs. It is strange that in consultee consultation we espoused the cause of mutual problem solving, yet some of us find it difficult to be accountable to a board or seek advice and counsel from a neighborhood council on whether a program is acceptable and would be used by their neighbors. Have we forgotten that demonstrating our humility and capacity to receive counsel from others makes it easier for those others to receive and accept counsel from us? We need to have the courage to pick up the mirror, to examine our reluctance and see why it is that we have little or no constituency who will rise to fight for our cause. More than that, I hope the present fiscal
William G. Hollister
5
crises will sober us to the fact that some percentage of our time must legitimately be spent in community constituency building and developing citizen advocacy. It has priority for our survival. W h a t about a constitutency for primary prevention? Let me venture a prediction. Every time we sit down to "listen" to a neighborhood advisory council of four or five citizens, and once we get beyond the first few minutes of talking about ill people, someone almost always asks about prevention. Repeatedly we find that citizen groups not only want care for the troubled, b u t they also want something done to prevent the marriage failures, the alcoholic deteriorations, the child behavior problems and the role breakdown they see around them everyday. I am convinced that there is a latent hunger in the citizen population than can be tapped, that can be mobilized to contact decision makers and to call for and sustain more research and program development for primary prevention. The constituency for prevention is there, b u t it is latent. It must be uncovered, cultivated, and nurtured into full potency by professional interest. With a little outreach on our part it could become a constituency that would support us by means of citizen demand and citizen willingness to p a y for primary prevention efforts. Prevention's latent constituency is there for us to uncover, if we are only willing to invest in its flowering and maturation.
