Improving Health through Community Advocacy

In July 2022, the City of Des Moines announced an expanded Crisis Advocacy Response Effort (CARE) program. Trained mental health professionals assist 911 dispatch staff in screening mental health calls and deciding the level of response needed. If the situation doesn’t require a response from officers, a team of pediatric mental health professionals, new to the CARE program, is sent to respond.

Getting to this point of improving Des Moines’ children’s mental health crisis response system has involved many stakeholders, including more than a hundred community leaders advocating through AMOS (A Mid-Iowa Organizing Strategy). AMOS’ involvement began with conversations in congregations, living rooms, neighborhoods, and community centers five years earlier.

“I really think AMOS is the democracy in action that we crave,” said Crystal Loving, who has helped lead these efforts through AMOS. “The decisions being made are things we’re advocating for.”

Mid-Iowa Health Foundation has invested in AMOS’ work over several years, most recently with a grant to further its community-based advocacy efforts focused on mental health. The work aligns with the Foundation’s priorities of elevating the expertise of those directly affected by issues with the decisions that impact their well-being and to advance system changes that improve community health and well-being.

Mental health is one of several issues related to the social determinants of health that AMOS has organized community members around. Its mission is to support an intentional process of listening, building relationships, and developing leaders who can carry out actions that address concerns raised in the community. In this capacity, AMOS works as a connector, helping community members see where there is energy to create change and supporting efforts to put the pieces together to make that change happen.

“Many years ago, a phrase stuck with me: ‘Powerlessness is bad for your health,’” said Denise Swartz, Senior Program Officer of Mid-Iowa Health Foundation. “AMOS’ model for civic academies goes right to people’s living rooms, listens to their ideas of how they would like to see our community, and helps coach them on the pathways to make that vision a reality. It’s been this incredible combination of research and collaboration among stakeholders, along with grassroots organizing to advocate, that has led to a stronger system of support for families facing mental health crises today.”

According to Courtney Dufford, Lead Organizer of AMOS, not only do the changes AMOS advocates for promote improved conditions for health, but also the act of organizing and advocating for changes fosters agency that improves the well-being of community members involved.

“The process of organizing intentionally brings us back together in meaningful relations,” Dufford said. “We are not about chit chat about the weather, but really it’s about what is going on and what do we want to do about it.”

Action on Mental Health

AMOS’ advocacy on mental health began when conversations within faith communities and neighborhoods elevated the issue as a major concern for several people. In one instance, as members at Our Lady’s Immaculate Heart Catholic Church in Ankeny expressed how they were struggling to help family members who had mental health challenges, the deacon shared how he’d lost his son to suicide after long delays in trying to get him services.

“People went and sat in the pews next to each other, but they didn’t talk about this,” said Dufford. “Having these conversations really created space for them to talk about it as a church community.”

When delegates from 40 AMOS member organizations gathered to discuss what they were hearing in their communities, the group recognized there was energy to do something around children’s mental health.

Thus began AMOS’ process of researching the topic of mental health services for children. Early on, a meeting with Anne Starr, CEO of Orchard Place, uncovered that the organization had convened 35 agencies to explore research and current resources and to create an outline for a children’s mental health crisis response system. The study, funded by local partners including Mid-Iowa Health Foundation, specifically highlighted the lack of children’s mental health crisis services in Polk County and recommended specific strategies for building a stronger system, including a hotline for parents to call, mobile crisis teams focused on children, not sending police to assist with a mental health crisis, and having observation and stabilization centers specifically for children.

“AMOS focuses on issues that are important to the community and helps organizations push ideas forward,” said Connie McKeen, who co-led the AMOS research team. “The Orchard Place survey identified the needs. Now we had the focus of our research.”

McKeen, a member of Walnut Hills United Methodist Church, felt that her personal mission to serve others and help bring about social justice made volunteering for AMOS a logical choice. A retired HR consultant with a global company, McKeen also connected with the issue of mental health. Her children’s father died by suicide. She saw how that event affected her children into adulthood. Additionally, her son-in-law, a mental health therapist lifted the need for additional mental health services for children.

But stepping up to co-lead the research team happened unexpectedly. When the AMOS leader chairing the mental health team said she needed to step back, she asked for another member to step forward. After a period of silence, McKeen turned to the person next to her, whom she didn’t know, and said, “If you co-lead with me, I’ll do it with you.” Linda Krypel agreed and the two worked together over several years, sometimes spending 20 hours a week, preparing for, facilitating, attending, and following up from meetings as they sought out opportunities for moving the children’s mental health crisis response system forward.

AMOS leaders met with nonprofits, health care administrators, elected officials, clinicians, providers, and others to better understand what was happening with services provided to children with mental health needs and where the gaps were.  Following the AMOS process, every meeting included 3-5 AMOS members who each had assigned roles. At the end of the meeting, the group would ask the person they were meeting with who else AMOS should talk with and if they make an introduction. Immediately following the meeting, the group met to discuss what they’d heard and determine next steps – always moving to the next action.

The study, along with the information gained from community meetings AMOS conducted, inspired the Children’s Mental Health Crisis Task Force focused on creating children’s mental health crisis services for central Iowans. Made up of leaders representing the city, county, hospitals, and nonprofit organizations, the task force used the study’s findings to begin defining what new services would look like and a timeline for implementation.

One clear need was securing adequate, sustainable funding for services. In late 2018, the City of Des Moines asked AMOS to help with a campaign encouraging residents to vote yes to allowing the city to raise its sales tax, with the promise that some of those dollars would go to children’s mental health crisis services. AMOS leaders helped rally community members to vote, and the proposal passed in March 2019, after its second time on the ballot.

AMOS also organized efforts to join mental health advocates in encouraging state leaders to fully fund the state’s children’s mental health system that it had established a year prior. AMOS members sent more than 4,000 postcards urging lawmakers to prioritize funding for children’s mental health. Days before the Capitol shut down due to the COVID-19 pandemic, AMOS held a Day on the Hill for members to meet with lawmakers.

At the start of the COVID-19 pandemic, the research team took a pause from the work. Then in January 2021, members began again, using Zoom to continue their meetings in the community and performing extensive research on best practices for children’s mental health services. In late spring, McKeen and Krypel needed to step back from their chair role. As happens with AMOS, they asked for another leader to step in and Crystal Loving raised her hand.

Loving’s involvement with AMOS began through her church – 1st Unitarian – which focuses on the interconnectedness and worth of all people. Loving had just attended the Day on the Hill event and was eager to connect to the work at a time when people were isolating to stop the spread of COVID-19. Unable to travel for vacations, she used her time off from work to volunteer. Then the issue became personal when her child struggled with mental health and she experienced how difficult it was to access services even with insurance, connections, and a good income.

With Loving’s leadership, AMOS members urged the City of Des Moines to move forward on implementing children’s mental health crisis services now that it was collecting additional sales tax, especially encouraging the city to implement best practices.

One critical change the study identified, and AMOS supported, was to have trained mental health professionals, rather than police, respond to mental health crisis calls only if there was not a safety issue. Research shows that Black youth are more likely to be arrested and sent to detention for a mental health crisis than White youth. The Black community especially expressed how distrust of police meant families wouldn’t call for help when they needed it.  

“It would have been easy to add services to the existing system,” said Loving, “but AMOS really pushed the implementation of best practices and the key things that the community identified they needed.”

In 2021, AMOS mobilized 100 people to attend a Broadlawns’ Board of Trustees meeting where McKeen and Loving joined teachers, advocates, and other community leaders in expressing support for the hospital to add mental health staff trained in working with children and youth to the mobile crisis response team. The Trustees voted yes to providing the services.

Just this summer, the expanded crisis services have come online.

“The support and commitment by AMOS for the Local Option Sales & Service Tax was instrumental to its overwhelming passage in Des Moines back in 2019,” said Scott Sanders, city manager of Des Moines. “We are now seeing the rewards of those efforts in the expansion this month (July) of the Crisis Advocacy Response Effort or CARE program. This new collaboration with Des Moines Police Department and Broadlawns Medical Center allows us to better serve the emergency mental health needs in our community – particularly Des Moines youth.”

Advocates reflect on how getting to this milestone stems, in part, from 85 community listening sessions that engaged 5-30 people at each session. All told the story of how a lack of mental health services was hurting families. While it took many more meetings with city officials, hospital administrators, nonprofit providers, elected officials, educators, and others to share these concerns, the members kept pushing to build on what leaders in the mental health space were pushing for.

“We just kept creating political momentum to say, ‘We can’t wait. We have to do this now,’” said Loving.

Elevating more than mental health

Dufford became lead organizer of AMOS during the pandemic, when the mental health work was already underway, after serving in organizing roles in Seattle and Las Vegas through the Industrial Areas Foundation network of which AMOS is a part. She was drawn to Iowa because of its urban, suburban, and rural communities and Iowans’ engagement in politics.  

As a staff of one, her job is not to do the work, she says, but to train and mentor citizen leaders to do the work on their own. She supports AMOS member institutions through the process of holding listening sessions in the community and then building momentum for action around issues of common interest. This process also elevates diverse perspectives about what the needs are and how to address them.

AMOS representatives across its member institutions come together four times a year for a delegate assembly and make decisions about what issues to work on together. Dufford then helps set up meetings, as well as works with leaders to organize civic academies that prepare community members to train others on issues, while also hearing what they would like to see changed.

“For me, the work is about ordinary citizen leaders recognizing the agency that they always have had and that they can do something about these issues,” she said.

AMOS is not about following one charismatic leader, she added, but rather, how people see themselves as leaders and work together to create change. Loving agrees that her work with AMOS helped her see herself as an advocate leader, even though she holds leadership positions through her job, and that she has seen the value of intentionally building relationships to have open and honest conversations on issues.

“Not one of us can do work alone,” said Loving. “There has to be buy in within AMOS members willing to enter into this work and be a part of it.”

This approach to system change is not for everyone, members note, because it is about making small changes over time, starting with simply being in conversation with others.  

“This kind of change is about iterative, incremental types of change,” Dufford said, pointing out how AMOS has advocated for expanded mental health services for five years now. “It’s this whole messy process that has engaged hundreds of community leaders in Polk County in these conversations. It also proves that people are ready to do the work.”

Work on mental health continues

In fall 2021, the AMOS delegate assembly secured commitments from Sanders and Des Moines Police Chief Dana Wingert to continue implementing mental health services. Out of that meeting launched civic academies that have trained about 250 community members on the crisis mental health system now in place so that it is utilized, as well as gathered feedback on what other changes are needed.

One issue that has emerged is the need for an expanded mental health workforce. AMOS members are hearing that organizations want to offer more mental health services and make these services more accessible to diverse populations but cannot find enough mental health professionals, especially those who speak languages other than English.

An AMOS summit in December 2021 featured mental health providers, educators, and other stakeholders who talked about workforce challenges and how to address them. AMOS leaders then put together a proposal to Polk County this summer, asking for $1.8 million in American Rescue Plan Act (ARPA) dollars to go toward strategies that would help recruit, train, and retain mental health workers in the region, supporting nonprofits and hospitals efforts. In July 2022, Polk County Supervisors voted to approve and fully fund AMOS’ mental health workforce proposal.

Civic academies this spring also elevated the issue of mental health in schools. AMOS leaders are exploring opportunities for how the community could better partner with school districts to support students’ mental health needs. Loving is interested in how to ensure other cities in central Iowa are implementing best practices in their crisis response and advocates still are pressing state lawmakers on the need to dedicate adequate and sustainable funding for the children’s mental health system in Iowa.

AMOS’ role in this work continues to be about mobilizing community to push for changes that make systems work better.  For many, the volunteer work has brought meaning when they see what’s possible.

“All along the way, it’s been about being able to find additional advocates to support this effort,” said McKeen. “It was not about what AMOS wanted, but what needs AMOS uncovered in the community. It’s about a group of people who are willing to push the idea forward and push it forward again.”

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