Week 5: Historical and contemporary role of institutions and actors

Health policymaking is a complex process. Regardless of the form the policy takes (i.e., laws, rules or regulations, operational decisions, or judicial decisions), and the level (federal, state, or municipal), all policies are made through similar processes. Health policy encompasses various determinants of health that often overlap and must be taken into consideration by everyone involved (Longest, 2014).

In the United States, policies are made in the executive, legislative, and judicial branches of the government. Elected legislators (i.e., members of the U.S. Congress, state legislatures, or city councils), members of the executive branch (i.e. the President, governors, mayors, and other senior public sector executives), and the courts are the major actors in the policymaking process. While legislative and executive policymaking takes place in the wide-open arena, the courts focus on issues involved in specific cases, interpreting the U.S. Constitution, or ambiguous laws, or establishing judicial procedures which later become a policy (Longest, 2014).

Policymaking process is a fluid, continuous cycle in which decisions are made and then later revisited as necessary. The three components of the policymaking process, policy formulation, policy implementation, and policy modification, are interactive and interdependent. Policy formulation involves agenda setting and legislation development. Once the new laws and health policies are passed, they must be implemented effectively to affect the determinants of health (Longest, 2014).

Meeting with Senator Rick Gray during American Foundation for Suicide Prevention (AFSP) State Capitol Day was a truly delightful experience. He explained that reading hundreds of pages of Senate bills is part of his daily job, and as such, he expressed his appreciation for the opportunity to be informed about the bills that could directly or indirectly impact suicide rates in Arizona.

The two bills advocated for by AFSP were HB 2072 and HB 2321. HB 2072 would provide loan forgiveness for licensed mental health professionals, including psychiatrists, psychologists, advanced practice nurses, professional counselors, clinical social workers, marriage and family therapists, and chemical dependency counselors, who make a commitment to provide at least five years of consecutive service in the State Department of Corrections or at a correctional facility operated by or under a contract with the State Department of Corrections or the Department of Juvenile Corrections. Having all or a portion of student loans paid off would encourage new graduates to pursue careers in mental health and to provide services to underserved communities and populations, which in turn would increase the number of providers available overall for people in need of mental health services across the state of Arizona. HB 2072 is a Partisan Bill (Republican 3-0), first introduced in House on January 13, 2020, and voted on and passed by the House Appropriations Committee on February 12, 2020.

HB 2321 would create a legal process for Severe Threat Orders of Protection which would prohibit a person at risk for suicide from having a firearm in his or her possession for a period of up to one year. Severe Threat Orders of Protection can fill a gap that currently exists for families who want to protect a loved one who owns a firearm but who isn’t able or willing to take voluntary steps to ensure safety during a suicidal crisis. HB 2321 is a Partisan Bill (Democrat 12-0) that has not yet been read in the House of Representatives.

Having a teen suicide survivor in our group steered the conversation with Senator Gray in the direction of suicide prevention among adolescents. Senator Gray expressed his full support of The UBU Project, an arts education outreach organization specializing in K-12 suicide prevention, substance abuse prevention and anti-bullying residencies. He emphasized the importance of the work done by the UBU Project and suggested that schools across Arizona would benefit from it. He also suggested that more funds should be allocated towards counseling services at schools as a suicide prevention measure. He thanked the suicide survivor in our group for being active and transparent in sharing her story with others. Hearing this story of survival gives others hope and courage to share their thoughts and feelings with mental health professionals. It encourages them to get the help they need for their suicidal ideations. As senator Gray stated, we need community connections. Having students involved in such an important cause is extremely powerful and life-changing for many.

Participating in the AFSP Suicide Prevention rally and meeting with Senator Gray was a very empowering experience. Nurses can make a real difference. They can influence policy development, implementation, and legislation in a variety of ways. Whether it is through meeting with policymakers, actively engaging in professional organizations, serving on a board of directors, voting, volunteering for a political campaign, running for office, or finding their voice and providing testimony, nurses must stand up for what is important (Patton et al., 2019).

Longest, B. (2014). Health policymaking in the United States (5^th ed.). AUPHA, Arlington, VA.

Patton, R., Zalon, M., & Lutwick, R. (2019). Nurses making policy: From bedside to boardroom (2^nd ed.). Springer Publishing Company, New York, NY.