A Look at the Process of Formulation of a Mental Health Policy

Introduction and Objectives of Policy

This policy seeks to improve the process of mental health diagnoses in primary care. The main objective of the policy in development is to ensure that patients receive appropriate diagnoses and care in relation to mental health disorders. The goal is to have patients analyzed more qualitatively rather than quantitatively in order to have more holistic healing instead of treating single symptoms as they come. Mental health is more often than not poorly understood and overlooked in primary care.

The Formulation Stage

Defining The Formulation Stage. According to Hayes (2001) Policy formulation is “The development of effective and acceptable courses of action for addressing what has been placed on the policy agenda.” The main components of this definition are that the policy must be effective and acceptable this means that the policy must be implementable and that it has to be likely to be accepted by legislators. During this process, the policy is revised to ensure that the basis is strong as the formulation of the policy can completely fail if every detail is not thoroughly thought out. The evaluations during the formulation stage can help improve the policy before it is presented to decision-making legislators.

The Process of Formulation and Stakeholder Involvement. In order for a policy to be completely sound, a policymaker that does not have a conflict of interest with the policy must create it. However, the policymaker cannot be completely biased towards the approval of the policy. Policymakers must make sure that all information about their proposal is made available to legislators that have to make decisions.

There are many different ways of approaching policy formulation. However, Gostin’s steps to formulation are a well-rounded way of forming healthcare policies. According to Gostin, the steps to creating a sound health policy proposal are as follows: Examine the public health interest, examine the overall effectiveness of the policy, make sure the policy is well-targeted, identify its human rights relations, and to examine whether or not the policy is the least restrictive alternative. Gostin makes a positive point about how the formulation process should be implemented and his steps ensure that the policy is well-rounded and set up for success because it examines the policy from all perspectives before it is sent to legislation. Through this process the policy for mental health diagnoses can be presented in a comprehensive way. According to Wittchen, Muhlig, and Beesdo (2003) 50% of the United States population experience a mental disorder symptom once in their life and 25% have suffered through mental disorders. This is relevant to public health interest. In relation to human rights, all humans in healthcare have the right to fair treatment and this is a topic in healthcare in which patients have been mistreated greatly in the past. Finally, the policy can be seen as the least restrictive since the diagnosis will be more holistic rather than merely following the steps of the DSM, which in itself has moral discrepancies.

In relation policy stakeholders, the policymaker must ensure that all information is present for stakeholders to analyze. To begin with, the policymaker must engage stakeholders and present their proposed policy to them. The stakeholders must view the policy through the lens of utility, feasibility, propriety, and accuracy (Centers for Disease Control, 2014). This means that stakeholders must decide whether or not the policy is useful, possible to achieve, morally sound and is an accurate solution to the problem the policy addresses. Policymakers must be held accountable for all of these aspects in case they are not met. Stakeholders have to collect all relevant information to the policy in question and they must analyze whether or not the policy can reach its goals. According to Dodson (2014) the key factors that must be addressed are the accessibility of the policy especially to those without insurance, its affordability, the long- term outcomes of the policy and its likelihood of being passed.

The Legislative Stage.

Defining the Legislative Stage. The legislative stage is the most complex and often frustrating stage for policymakers. The legislative stage has several steps, which are: 1. The Referral to Committee, 2. Committee Action, 3. Scheduling Floor Action, 4. Debate, 5. Voting, 6. Referral to Other Chamber, 7. Conference Committee Action, 8. Final Floor Action, 9. Executive Action, 10. Congressional Override (American Association of Critical-Care Nurses, 2016). Essentially, the policy bill must pass through both the House of Representatives and the Senate in order to be approved through multiple debates and voting. The legislative process is immensely complicated and it requires thorough attention to detail. However, stakeholders also largely influence how healthcare legislation is processed and stakeholders in recent history have helped progress healthcare policy exponentially. For example, the large medical stakeholder The American Hospital Association has recently taken $155 billion dollars in pay cuts in order to aid the government in reforming healthcare policy such as Medicare and they have endorsed closing the drug coverage gap (Beutler 2009). The AHA recently endorsed a House of Representatives healthcare bill in the past year. Stakeholders such as the AHA or the American Medical Association can influence legislators’ decisions on healthcare reform policies because they can offer both financial aid and informational aid to those who make decisions. Although this can be a negative in some cases, there is a world of possibility for how much a stakeholder can help progress the passing of a healthcare policy bill.

The Implementation Stage. The Implementation Stage is not a mere execution of the proposed policy. Implementation is a process in which the policy is introduced to the system and is slowly put into practice. According to Dr. Brian Slack (1998), a proper process for implementation includes well-informed staff and resources, adequate time to execute, theory and policy being compatible, communication, and compliance. The implementation stage is not the end of the practice of the proposed policy. However, it is one of the most important steps of making a policy official because although a policy can be approved, its approval does not ensure success in practice.

Accountable Parties In Implementation. There are multiple levels of accountability in healthcare policy. Accountability can be left to the patient, the healthcare providers and the government. There are three models of accountability in healthcare, which are the Economic Model, the Professional Model, and the Political Model (Ezekiel J. Emmanuel and Linda Emmanuel, 1996). In the Economic Model, patients are accountable because they are viewed as the consumers of healthcare. In this model it is up to the consumer to decide where healthcare will be of the most quality and this model of accountability will mostly be applicable in the end of the implementation stage since it would be difficult for a consumer to make a decision based on a practice that is not fully formed. In the Professional Model, physicians are accountable towards both their patients and their colleagues. This has been the most traditional way of implementing accountability (Ezekiel J. Emmanuel and Linda Emmanuel, 1996). This form of accountability implements (or attempts to) measures that ensure that there are no conflicts of interest financially between the patient and the physician. The last model is the political model and in this case, both patients and healthcare providers are citizens who are more than just economic providers. The accountability is held to the government and this is near the core of the policy’s development. Implementation by the government is one of the most important aspects of ensuring that policies are implemented correctly. This model should be the most active since the decisions that the legislators make affect all citizens who need healthcare. The government should be held accountable because it has the most power to implement legislation in public health facilities.

Conclusions

In order for healthcare policies to be made in the best interest of the patient, it must be looked at qualitatively rather than quantitatively. During formulation policymakers must make sure that what they intend to put into practice is both helpful for the public health sphere and feasible. If stakeholders are well informed about the policy that is presented to them, they can help influence legislators’ decisions immensely because they can provide both their public endorsement and financial aid. The government, however, should be ultimately accountable for what healthcare implementations occur because they have the final decision on policies that are presented to them.

References

• Beutler, B. (2009). Influential Players: How Six Big Stakeholders Shaped Health Care. Talking Points Memo. Retrieved from TPM.com
• Center For Disease Control (2016). Retrieved March, from http://www.cdc.gov/
• Dodson, J. (2014). The Policy Process: Evaluation, Analysis and Revision. Retrieved from http://www.academia.edu/10093266/The_Policy_Process_Evaluation_Analysis_and_Revision
• Emmanuel, E., & Emmanuel, L. (1996). What Is Accountability in Healthcare? Medicine and Public Issues.
• Gostin, L. (1995). Society’s choices: Social and ethical decision making in biomedicine. Washington, D.C.: National Academy Press.
• Hayes, W. (n.d.). Defining Policy Formulation. Retrieved March 15, 2016, from http://profwork.org/pp/formulate/define.html
• A. (2016). Introduction to the Legislative and Regulatory Process. Retrieved from http://www.aacn.org/wd/practice/content/publicpolicy/intro.pcms?menu=practice
• Slack, B. (1998). The Policy Process. Retrieved from https://people.hofstra.edu/geotrans/eng/methods/ch9c2en.html

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