Nursing Influence in Public Policy: A Case Study

Wednesday, 1 August 2012

Dale Mueller, EdD, MS, RN, NEA-BC, NHA
School of Nursing, California State University Dominguez Hills, Carson, CA

Learning Objective 1: Identify at least two examples of how nurses can participate in public policy formation to promote access to care.

Learning Objective 2: Describe one successful policy intervention and one setback as illustrated through this case study of The Mental Health Services Act implementation.


Purpose is to utilize the successes and setbacks of the implementation of The Mental Health Services Act (MHSA, 2004) in California to illustrate the power of collaboration to influence public policy. The Act was initiated by ballot initiative by voters after failing in Congress and provided for funding of mental health services in perpetuity through a 1% tax on income of Millionaires in California. The Act mandated reform to the public mental health system, initiating a model of recovery and resilience. Culturally and linguistically appropriate services were mandated,  as well as training of licensed and lay staff to facilitate recovery for mental health clients. Nurses, social workers, psychiatrists and other professionals collaborated in many ways to ensure preservation of the monies and wishes of the voters despite political pressures to dilute programs and designation of funds.


Case study analysis of the historical events that have occurred in the political arena designed to either support or dilute the MHSA since its inception in 2004 will illustrate critical junctures where nursing advocacy and collaboration has had an impact on the success of the implementation.


Results are displayed through an historical review of critical periods in this case study as well as growth of programs and services to underserved populations. External threats as well as leadership responses will be illustrated in this poster presentation.


Nurses can be powerful advocates for systems change and sustainable programs. Recently, the MHSA has received diminished funding due to economic downturns, but the upcoming 5-year plans emphasize peer support as a way to sustain program effectiveness during challenging times. Nurses have played a significant leadership role in shaping the programs and sustaining factors as illustrated by the events since 2004 and plans for the future.