Dr. Jeff Sheldon discusses various topics from a London School of Economics public policy analysis course: agenda-setting recommendations

Introduction

Between 31 January and 16 April 2024 I took a ten week, 80+ hour graded course from the London School of Economics and Political science (LSE) in public policy analysis. In this series, presented in the order of the ten LSE course modules, I offer up selections of my writings from across the course that include topics in economics, institutions, policy, statistics, policy evaluation, and politics, etc. Most are an answer to a prompt or question (provided if applicable), and vary between 250 and 800 words in length, short but hopefully insightful. This discussion is the follow-up to the piece posted on 23 July of this year. As always, you might not agree or agree only in part with my answers or assessments so feel free to engage me in dialogue, it will be most welcome. Likewise, if you’d like context, please don’t hesitate to ask. Enjoy!

Agenda-setting recommendations

In this module we learnt about the influence of politics on the evaluation process and strategies for every stage of the policy cycle. Here, from the perspective of a policy entrepreneur, I chose a policy issue of interest and one I was knowledgeable about here in California, and based on my own research I was asked to answer three questions:

1. What do you think would be the most effective way to bring this issue to the political agenda, and why?
2. What factors do you think would be the most important to consider in order to ensure that implementation is successful??
3. What type of evaluation would be the most effective for your policy proposal? What are some of the constraints that can appear in such evaluation?

As you can imagine, there are multiple factors and considerations for each of the three questions listed above, but I was not expected to cover all aspects, rather to choose the most effective and important aspects for each question.

Context

To frame the policy issue, Governor Gavin Newsom has made mental health a policy priority since he took office in 2019. During the recent primary elections in March 2024 a ballot initiative was approved by a slim majority of voters providing billions in tax dollars to fund more housing, more treatment beds, and a concerted focus on un-housed people with serious mental illnesses. This initiative is not, however, without criticism. Specifically, ballot measure opponents are concerned it could siphon money from community mental health organizations possibly causing closures and cuts in other mental health programs (Weiner, 2024).?

Question 1: What do you think would be the most effective way to bring this issue to the political agenda, and why?

Answer 2: Now that policy is law it presents unique challenges in terms of how funds get spent in individual counties and the most effective way to bring decisions about how funds will be spent to the political agenda. All California counties must invest 30% of state funding in housing programs, including rental subsidies and navigation services, with half (15%) targeting chronically un-housed individuals or those living in encampments; a quarter of the money can be used to build or purchase housing units. There are two factors at play in setting the political agenda around spending, and subsequently, implementation. First, county governments (i.e., elites) are tasked with fiduciary responsibility in overseeing how funds are spent during implementation so have a voice in spending and implementation decisions. Second, housing, increasing treatment beds, and a concerted focus on un-housed people with serious mental illnesses are issues that impact advocate groups and those who will benefit directly from policy implementation (i.e., exogenous factors/externally driven) so they should have a voice in how funds will be spent and what implementation entails.? Thus it seems clear that the most effective way to agenda setting is Kingdon’s 2013 multiple stream competitive model. In this case the spending agenda includes both governmental and non-governmental players so it is imperative that bringing all players to the table as policy entrepreneurs to discuss likely spending prioritization and implementation problems, solutions, and the politics involved in using tax-payer generated funding and determining who gets to sit at the table makes the most sense.

Question 2: What factors do you think would be the most important to consider in order to ensure that implementation is successful?

Answer 2: At hand for county officials and stakeholders with a vested interest in mental health is deciding how to prioritize spending state funds in an equitable way and then implementing those funding decisions to change mental health practice outcomes. Implementation comes in two forms. First, deciding funding priorities (each county has a unique mental health and housing landscape), second, spending funds on housing, treatment beds, and un-housed persons with severe mental illness. In this case, government and non-government actors will be responsible for implementing both forms so to avoid failures there first has to be clear agreement on the objectives of the spending prioritization process, and once those priorities are set how to apply those funds in the most efficient and effective ways possible to improve mental health outcomes. Second, both implementation processes could fall apart without clear communication and coordination because messaging will occur between multiple parties so each party has to receive and interpret messaging so there is no ambiguity. Third, there needs to be a way to mitigate the complexity of having so many stakeholders through a clear understanding of and consensus on the sequencing of tasks from forming a spending prioritization task force to holding meetings to determining what needs to be done to implement each funding priority. Last, because the purpose of the policy is wholesale change in the way mental health is approached there has to be compliance by all involved parties to make that change happen. Given that the mental health status quo has endured even under pressure from previous reform efforts it is likely to resist change presents a significant compliance challenge to the group as a whole.

Question 3: What type of evaluation would be the most effective for your policy proposal? What are some of the constraints that can appear in such evaluation?

Answer 3: The first implementation is in decision-making regarding setting priorities for spending state funds on three mental health initiatives - housing, increasing treatment beds, and a concerted focus on un-housed people with serious mental illnesses. The type of evaluation that makes the most sense is a process evaluation to sort out whether a representative sample of all players (i.e., county government officials, advocates for mental health, those suffering mental health, and even detractors of the initiative) are at the table, who was involved in setting the agenda, tracking the number of meetings held, tracking the content of discussions and who was involved, charting the progress of discussions including dissenting opinions and the ways in which those opinions were acknowledged and incorporated, and finally the spending priorities in terms of what gets implemented in sequence. To determine the extent to which (in the sequence they were implemented) the amount of housing, treatment beds, and persons with severe mental illness were housed and the lives of those living with mental illness were improved both cost-benefit and impact evaluations will be conducted (Centers for Disease Control and Prevention [CDC], 2012). The cost-benefit evaluation will be used to justify to the State of California the costs of building more housing, increasing treatment beds, and housing persons with severe mental illness compared to the number of persons served. The impact evaluation will be used to determine the extent to which the lives of persons living with mental illness were improved in terms of functionality, stability, basic needs being met, and integration into society.???????????????

References??

Centers for Disease Control and Prevention. 2012. Step 3: Focus the evaluation design. Available: https://www.cdc.gov/eval/guide/step3/index.htm [2019, September 2].

Kingdon, J. 2013. Agendas, alternatives, and public policies.2nd?ed. United States: Pearson Higher Education.

Weiner, J. 2024. With Prop. 1 passage, Gavin Newsom again changes how Californians with mentalillness. https://calmatters.org/health/mental-health/2024/03/proposition-1-gavin-newsom-2/

Thanks for reading. Please feel to ask questions or offer comments below. Next up: accountability and representation.