Mental Healthcare for LEP Individuals

POLICY MODELS

Policy Models: Reducing Mental Health Disparities among LEP Individuals

A policy is a course of action or plan used by an agent of change to realize a certain outcome or goal (Porsche, 2023). The policy is the process that the agent uses to realize the policy solution, which is the answer to the identified policy problems. In the US governmental structure, fundamental policymakers include judiciary officials, legislators, and members of the executive (Porsche, 2023). Nurses can engage in the policymaking process through advocacy, which involves collaborating with policymaking agents or policymakers to influence the process of policy-development or gather support for certain policy options (Porsche, 2023). Different models provide different frameworks for achieving this. This text analyses why the narrative policy framework would be the most appropriate for the proposed advocacy, which seeks to address mental health disparities among individuals with Limited English Proficiency (LEP).

The Narrative Policy Framework

The narrative policy framework (NPF) is based on the assumption that the complexities of public policy can be more effectively explained using narratives or stories because these resonate better with stakeholders (Crow & Jones, 2018). Porsche (2017) defines a narrative as a story detailing a series of events based on a plot that presents a specific moral to the story. The NPF attempts to use a story to guide the development of policy solutions (Porsche, 2017). As is the case when telling a story, the NPF uses media, communication strategies, and information to develop policy narratives that influence public opinion about a policy and shape the policymaker’s preferences (Porsche, 2017). At a minimum, the narratives have four main features: setting, plot, characters, moral of the story (Porsche, 2017). The setting is the context of the policy narrative, the plot is a description of how different aspects of the policy relate, the characters are the policy actors, and the moral is the potential solution (Porsche, 2017). The narratives influence policy development at three levels: micro (individual) level, meso (subsystem) level, and macro (organizational/institutional) level (Porsche, 2023; Porsche, 2017).

Relevance of the Framework to the Advocacy Area

The policy problem to be addressed is poor mental health outcomes resulting from health disparities among LEP individuals. The first step in advocating for the mental health rights of LEP individuals is to get the target population to understand their rights to healthcare, specifically, mental healthcare. The NPF facilitates this in two ways. First, the framework simplifies the complex policy making process into culturally-congruent narratives that the target population can identify with and own easily (Crow & Jones, 2018).

Secondly, the framework offers a means to influence policy at the individual, meso, and macro levels (Porsche, 2017). Most of the other frameworks place their focus on the macro level, which involves influencing policy at the political or legislative level. However, for the proposed advocacy, creating mental health and rights awareness at the individual level is crucial for successful policy implementation at the macro level. For instance, the agent may push for the adoption of legislation that compels all healthcare organizations to put in place and publicize their reporting systems in multiple languages to cater for LEP individuals who feel aggrieved. However, LEP individuals will need to understand their rights for such a policy to be effective.

To get the proposed advocacy into the political agenda, which is the macro level, therefore, the agent will adopt strategies at both the micro and meso levels first as the NPF suggests. At the micro level, the agent will focus on influencing individuals’ beliefs and attitudes towards mental health. They will conduct interviews and focus group discussions with the target population to understand their mental health beliefs, the origin of these beliefs, and their preferences on how desirable policies could be designed to improve access and eliminate disparities (Jones et al., 2014). The information on individuals’ beliefs will then be used to develop policy narratives that are congruent with their culture and preferences (Jones et al., 2014). As Jones et al. (2014) suggest, the most memorable narratives are those that challenge the status quo and persuade the audience to change their beliefs.

The developed policy narratives will then be used at the meso level, which involves using groups or coalitions to influence belief systems at the subsystem level (Baumgartner et al., 2018). At the meso level, the agent will push for the policy narratives through partnerships with the media, local celebrities, local entrepreneurs, professional organizations, community leaders, and religious leaders that together will constitute an advocacy coalition. The advocacy coalition will be used to educate the public on mental health and at the same time use its influence to push for the proposed policy narratives at the macro level.