Linked Problems: Community Mental Health Framing and Benefit Distribution

• In Event: The Local Politics of Community Health Care

Abstract

In the last decade, federal contributions to community mental health care have expanded substantially. The federal government enhanced contributions to the community mental health services block grant program. Furthermore, in 2014, Congress created a new CMH provider type and earmarked additional Medicaid and grant funding to support expansions of this program. These increases were furthered in COVID-19 relief legislation but began prior to the pandemic.

This project examines how framing of these policies influences the local distribution of newfound CMH benefits. Using a content analysis of the universe of press releases issued by senators referencing community mental health between 2010-2022, I demonstrate that the number of press releases published and issue frames used has evolved over the past decade. The analysis reveals that Democrats published a total of 202 press releases compared to 144 by Republicans and 2 by independents, resulting in a total of 350 statements during the study period. Senators released more press releases annually between 2013-2015 and 2020-2022 than in the preceding periods. Changes in issue frames occurred between 2013-2019 with frames remaining consistent during the 2020-2022 period. Between 2013-2019, violence frames and linkages between mental illness and violence decreased, while behavioral health and substance use frames and linkages increased. Despite these changes, crisis mental health frames, including the inadequacy of crisis mental health services and a need to transform the role of law enforcement in mental health care, have remained the most prevalent mental health sub-topics throughout the study period. Patterns in the number of press releases issued and issue frames are consistent across senator party affiliation.

Following the content analysis, I test the hypothesis that elected and administrative policymakers alike distribute policy rewards in ways responsive to the linked and sub-frames over the traditional targets of CMH policy. Specifically, using a novel, original dataset of all CMH clinics, I examine if changes in the prevalence of substance use and crisis mental health frames correspond to shifts in the delivery of these services by CMH providers, controlling for related changes in the federal and state policy environment. The goal of this analysis is to assess if framing during policymaking produces downstream effects for the local allocation of mental health services.

Author

• Amanda Isabel Mauri, University of Michigan