Seven Governing Realities of Mental Health Policy: Inherent Societal Beliefs have More Sway Than the Agenda of the Dominating Political Party of the Day‪.‬

A subtle shift has occurred during the 17 years that this column has appeared. In the 1990s, leading Washington-based representatives of the behavioral health community confidently lectured members of the press on their strategy to advance their objectives on Capitol Hill. Those strategies changed over time, as objectives changed from ensuring a role for behavioral health in President Clinton's comprehensive healthcare financing plan to convincing a newly elected Republican congressional majority of the cost-effectiveness of mental health spending. At that time the people who lobbied for mental health care and substance abuse treatment felt that they understood the game and how to win it. This is no longer true. Policy advocates for behavioral healthcare at the midpoint of George W. Bush's presidency generally appear grumpy and cynical. Behavioral healthcare scores occasional victories on Capitol Hill and in the courts, but these occur (literally) on a case-by-case basis. As a result, supporters of greater access to affordable, quality behavioral healthcare privately look toward a major electoral revolution in Washington as the best hope for substantive progress.