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Marketing a CommunityMental Health CenterDonald E. Maypole PhD aa Director, Department of Social Work,University of Minnesota, Duluth, MN, 55812Published online: 18 Oct 2008.

To cite this article: Donald E. Maypole PhD (1991) Marketing a CommunityMental Health Center, Health Marketing Quarterly, 9:1-2, 139-153, DOI:10.1300/J026v09n01_11

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Marketing a Community Mental Health Center

Donald E. Maypole, PhD

ABSTRACT. The author describes the application of marketing principles to the development of a public community mental health center.

This paper describes the successful applicationof marketingprinci- ples to the devcloprnent of a community mental health center, based on certain theoretical underpinnings. The author's thesis is that mar- keting isa major, ongoing management responsibility, rather than just a "luxury" added to the administrator's shoulders in a time of crisis and, therefore, it should be routinely included in managerial plan- ning.

It could be asked if social and health agencies can be "pack- aged," "marketed" and "sold" in the same fashion as John Deere tractors? Probably not! Can the techniques of "marketing" be ap- plied to mental health agencics? Absolutely! In the present era, pub- lic and private social and health agencies have to exist within a condition of "resource scarcity." This scarcity mandates that agen- cies apply marketing techniques, (1) to mect their basic survival goals and, (2) to develop and maintain services to their clients. Of course, other management techniques, such as cost containment, must be applied also.

As indicatcd by Holmes and Rieckcn (1980), the written literature on nonprofit agency marketing tended to come from non-human ser- vices sources until the late 1970s. Some examples were materials devcloped by Kotler (1975, 1979), Rados (1981), Shapiro (1973), Church (1980) and Rubright and MacDonald (1981). Since the late

Donald E. Maypole is Director, Department of Social Work, University of Minnesota, Duluth, Duluth, MN 55812.

Health Marketing Quarterly, Vol. 9(1/2) 1991 O 1991 by The Haworlh Press, Inc. All rights reserved. 139

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1970s, a number of noteworthy books and articles have been pub- lished in social work media by Brawley (1983), DeLoach (1976), DiGiulio (1984), Phillips and Folts (1978), Rosenberg and Weissman (1981), Genkins (1985), and Lauffer (1984a). Lauffer made a note- worthy contribution with his second book in 1984(b), which was de- voted specifically to marketing. However, some of the social work writers have tended to show some conceptual confusion, in that they have considered fund-raising or public relations to be synonymous with marketing. This paper takes the stance that they are not the same.

An understanding of the critical differences between business and social marketing is important. Clearly, business firms seek to make a monetary profit from their contacts with a customer, and, this dyadic relations hi^ "drives" the marketing activities. Evaluation is rather straightforward-was a profit made for the year? Money is used to evaluate the success of the "exchange" relationship with the customer.

Social program marketing, however, is much more complex. Lovelock and Weinberg (1984) listed the unique characteristics of public and non-profit marketing:

Emphasis on services . . . (rather than goods). Dominance of nonfinancial objectives . . . Need to devote marketing resources to attract donations or tax- derived revenues. Need to develop and orchestrate marketing programs that are responsible to the needs of multiple constituencies-not just the immediate consumers.

o Conflicts that can arise between fulfilling the long-term insti- tutional mission and catering to short-term consumer prefer- ences. Greater public scrutiny of organizational activities and the in- creased likelihood of nonmarket prcssurcs being brought to bear on the strategy. Tensions created by board members, volunteer workers, man- agers and professionals . . . , all pulling in different directions (P. 38).

Dcaling successfully with these issues will require more focus on marketing in management courses. One must be attuned, moreover,

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to the cautions advocated by Reichert (1982), who pointed out that a total embrace of the market system could lead social workers away from the more vulnerable groups in society. As an alternative, it should be possible to accomodate to the market model, while maintaining a social reform goal, he suggested.

EXEMPLAR CENTER

The Mississippi River Human Services Center was a federally- modelled and funded community mental health center.

Outpatient clinics were located in each of the three catchment area counties. Each clinic location provided outpatient evalua- tion and counseling for those with emotional problems, devel- opmental disabilities, alcoholism or other drug abuse. These locations also served as outpatient emergency referral points, as well as consultation and educational resources.

A general hospital provided emergency and acute inpatient psychiatric services and inpatient alcoholism treatment, as a part of the Center program. A county nursing home was an affiliate of the Center, with its day treatment and long-term inpatient programs.

All three of the affiliated facilities were bound together by a "continuity of care" contract. In addition, there was unified medical direction and administrative coordination. The long- range process goal of the Center was to develop comprehen- sive sewices for all three of the mentally handicapped disabil- ity groups.

BASIC DEFINITIONS

"Public relations," "selling," "advertising," and "marketing" are not synonymous. Public relations, advertising and selling are sub-categories of marketing. Public relations activities are designed to create a positive "image" or "position" of the agency in the eyes of clients (Ries and Trout, 1981), the community power struc- ture and other publics. Recall the, "You are in good hands with Allstate" insurance ads. Advertising points out the benefits of the productlservice to the consumer. The selling of a product or service

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results in the exchange of some sort of resources, such as money or legitimacy. Agencies with little legitimacy, i.e., general public and/ or community power structure acceptance, are in very different situ- ations. This was the situation facing the MRHSC when its market- ing endeavors were begun.

Kotler and Clarke (1987, p. xi) define marketing as "the effec- tive management by an organization of its exchange relations with its various markets and publics." All of the agency's "publics" (sometimes used synonymously with "markets") must be identi- fied. Combining Lauffer's (1984a) "publics" list with Von Berta- lanffy's (1968) thcoretical transport equation produces the diagram in Figure 1.

The "imput" public is composed of all sources of resources needed to provide the product or service to the clients. The "throughout" public is the board, staff, volunteers and clients (if involved in providing services). The "output" public is composed of the people served by the agency and other recipients, such as other community agencies and local governments, if consultation or help is provided to them, and the general public, if community edu- cation is provided. This adaptation of Von Bertalanffy's transport equation helps to conceptualize the agency's essential publics. As indicated in the examplar, a variety of marketing approaches can be

Input D VI --+[-I Money S t a f f Cl tents

F a c i l i t i e s 8 Board Equ lpment

Volunteers Expert ise

C1 i en ts Pol l t i c a l In f luence

Legitimacy

Other Agencies

General Pub1 i c

Figure 1. General Systems Theory: Transport Equation Application t o Market Segmentation.

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Donald E. Maypole 143

used with each of these publics. However, some techniques are more appropriate for a certain public than others.

PROMOTIONAL STEPS

There are clearly definable steps in developing an overall market- ing program. The first is to determine the need or problem at issue and the second is to determine the target "publics" (or markets) which have the problem, need or.desire, to which the message will be directed. The third is to establish the objectives of the marketing endeavor. The objectives will relate to the acquisition of some type of resources by the provider agency in exchange for other re- sources, such as information. The fourth step is to choose the spe- cific methods which will be the most effective with the defined target publics.

The filth step is to assign the tasks and set the timetable with the staff and board (and, perhaps, volunteers). The sixth step would be to implement the plan, and the seventh step would be to evaluate the effectiveness of the endeavor.

First Promotional Step: Problem/Need

Each agency or program rests in a "niche" in a complex service delivery system, which, itself, reflects a web of relationships. Mar- keting (i.e., securing resources) requires that the agency's own "boundary" be crossed. This "boundary" crossing or "exchange management" function requires that problems or needs be analyzed from both internal and external perspectives. However, since most resources are obtained from the agency's environment, most focus must be placed on the agency-environment relationship.

For the Center, the first step involved a study of the needs and problems at issue. In relation to studying the "problem" in the marketing program, there are a number of questions which need to be asked about one's agency, as well as about the target publics. What is the agency's mission statement? What are the problems in the environment with which the agency is trying to deal? How does the general public feel about what the agency is trying to do, or about a particular service? Are there other agencies which might have similar functions i.e., what is your "position" in the minds of

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the target publics' potential or actual reservoirs of enthusiasm or support?

Are there reservoirs of indifference or hostility? What are the relations with organized groups in the community,such as the med- ical society, clergy, mental health associations, association for re- tarded children, Alcoholics Anonymous? What are the agency's re- lations with the newspapers, radio and television stations? Lastly, what major marketing techniques, especially publicity, have been undertaken over the last several years, and have these been effec- tive, or not?

Performing this type of market "research" can be accomplished by formal or informal means. Formal means involve the usual needs assessment techniques used by helping professionals: key infor- mants, open forums, analysis of agency records (such as in studying referral sources) and written surveys. Informal techniques could in- volve less systematic personal discussions or unobtrusive obsewa- tions.

As agencies "segment" the general population to determine who will be appropriate clients for the agency, i t is necessary to "seg- ment" the problems based on priorities and feasibility. Usually, the problems or publics most central to the agency's mission are given the highest priority. Always, of course, organizational survival is paramount. All subsequent planning of approaches must be tied to the specific problem/publics under study. A lack of focus or a "shotgun" approach may waste resources. Furthermore, there must be a clear relationship between the long-range goals and the objec- tives to be met to resolve the problems.

With a history dating back to just 1969, the exemplar Center needed the usual gamut of human resources (staff, board and cli- ents), financial resources and, perhaps more importantly, "legiti- macy" in the eyes of the community power structure and general public.

The next step was to determine (i.e., to "segment") the overall market of people into the target publics to whom it wished to get the message across. (See Figure 2.)

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Doitaid E. Maypole:

Figure 2 . Yiss lss ipp l River Human Services Center's n P u b l i ~ s . n

The Prst target public was the staff and the board of directors of the Center, itself. The staff and the board of directors must be all on the same team, working in the same direction. If the staff works in one direction, the board in another and the executive director is somewhere in-between, not a lot is going to be accomplished. They must all clearly see what the agency's functions are, what its re- sponsibilities are, what its plans are, and that all parties play an important role. As representatives of the agency, staff and board members are on their own when they are out in the community. If we expect the board of directors to support the agency, they must fully understand it.

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The second target public was the center's clients. They merited such status for a couple of reasons. First, if clients can be provided with as much information about our agencies as possible, their anxi- ety in seeking appropriate services should be reduced. Second, we all know the power of the word-of-mouth is well known. Clients quite often come from high-risk target groups and if they are con- vinced that the agency is a place to get help, they will tell their friends, relatives and neighbors.

The third targetpublic was that of the three County Boards. The MRWSC was organized under the auspices of the three County Boards; therefore, although the major funding was provided by the state mental hygiene agency, the County Boards were funding re- sources also. The County Boards had to be kept abreast of progress, problems, and plans. In addition, County Boards had to understand the agency as a resource for the community (in terms of handling community problems and thereby lessening pressure on the County Boards from their various constituencies).

The fourrh tatget public was called the collateral community agencies and citizens' associational groups. This group included the social services departments, the county nurses, the general hospi- tals, (which were sources of referrals) and such citizens' groups as the citizens' alcoholism committee, the association for mental health, and the association for retarded citizens. The associations were exemplary in their provision of "political" support for the Center (which was clearly an exchange for the services provided to their constituent groups).

The fifth target public was the public-at-large. A responsibility was felt to keep the general public informed, through various models of the mass media. Ultimately, the general public provides the "legitimacy" needed by all social and health agencies (as parts of the social welfare institution).

The sirth target public was composed of the staff in the related state and federal agencies. The state and fedcral agencies functioned as funders and regulators. Their granting money to the Center conferred a certain amount of "legitimacy" in the eyes of the local community power structure.

The seventh tnPget public was composed of the state and federal

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legislators. They sometimes served as information and legislative lobby resources for the Center.

Third Promotional Step: Objectives

Studying the answers to these sorts of problem questions and defining target groups helped in determining objectives to secure resources of some nature, such as funding or "legitimacy." These objectives should be seen in a continuum, in that the short-range objectives lead to the long-range goals. The short-range objectives must be articulated with their specific long-range goal, as well as with the activities to meet objectives for other goals, since an agen- cy's resources are always limited. This central coordination role is the responsibility of the agency director.

Fourth Promotional Step: Methods

The marketing fourth step was to choose the methods for ap- proaching the specific target groups, which would be the most ef- fective. Communication theory has contributed much to under- standing the dynamics of human interactions in individual and small group communications. For example, when proposing the develop- ment of a totally new community care system for alcoholics to the Centcr's three County Boards, the director (social worker) was ac- companied by the most respected and oldest physician in the area. The physician's status and prestige helped to carry the day!

As an introduction to this section, it can be said that there are three primary ways of communicating. The first is done on an indi- vidual basis, e.g., personal conferences, letters, and phone calls. The financial cost is high, in terms of people reached, but it's low in relation to effective results. The second category of communica- tions is that of small group communications. This category relates to group meetings, printed newsletters and bulletins for specific tar- get groups, and talks before conventions.

The third category of communications is that of the mass commu- nications. This includes the newspapers, radio and television, and general newsletters. The advantage for this category is the largest possible audicnce for the effort involved; however, as with printed materials used in small group communications, its drawback is that

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there is no opportunity for two-way communication. The opportu- nity for "affective" influence within the one-to-one or one-to-a- group relationship is lost. Without "feedback," it is difficult to determine the effectiveness of the message and approach chosen. Therefore, mass communication should be seen as supplemental to individual and smallgroup communications. Where time and funds are limited, best results are frequently achieved by concentrating on the communication mode in which costs are low, in relation to the projected effectiveness of results.

Let's go to some ways of communicating within this latter cate- gory-mass communications, since many agencies need the most help in this area. The first media is that of the newspapers. Using specific formats aids in newspaper editors' use of the material. There are formats for releases, feature stories and editorials in nu- merous books and pamphlets, which can be found in libraries. Spc- cial efforts must be made to make the acquaintance of local editors, feature writers and reporters.

The second form of mass media is radio and television. These are probably, especially television, more effective than newspapers in reaching large numbers of people. In terms of possible financial cost, they also can be quite expensive, unless the station staff is willing to devote public service time to the agency's endeavors. However, if they see that you are attempting to advertise your agency for free, it can be assured that they will not accept the mate- rials.

With both radio and television, i t was found that i t was better to telephone the news in to the stations. Some of the stations have voice-recording equipment attached right to their telephones, so they'll just ask one to go ahead and dictate the news. This would probably be the best bet to get something into the news portion of a broadcast. Asking for public service time for other kinds of endeav- ors should be done on an individual basis with the public service director. Radio time was found to be much more available.

The third category of the mass media, as used by Center staff, related to written materials, such as brochures, annual reports and newsletters. Because of the 2500 square mile catchment area and scarce staff resources, the MRHSC placed a great deal of emphasis on these. For example, an introductory brochure was developed for

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the overall Center program, which was given to all patients and visitors who walked into any of the MRHSC's seven locations. It was providcd to all of the County Board members, the community "power structure" and the collateral agencies (referral sources) throughout the three counties.

In each of the first three quarters of each calendar year, the Cen- ter published a newsletter. The newsletter was designed to provide information of interest to each of the target publics. During the year's fourth quarter, the Center's annual report was substituted for the newsletter and it was sent out to the community power structure and other specific target publics. Considerable time and effort was devoted to making the annual report an interesting document, with lots of "white space," pictures, diagrams and, sometimes, case histories (disguised). Case histories frequently make complex mate- rials more relevant to readers.

Thefourth mass media communication method used was that of slide shows. The MRHSC staff dcveloped a two-minute presenta- tion which was provided to the TV stations in Eau Claire and LaCrossc. Generally, the TV stations preferred a slide series of 30 seconds, or 60 seconds. However, at times, they were amenable to taking the two-minute presentation. Mental health association vol- unteers showed the slides at each of the three county fairs in the area. Extra copies of the slides were used by the staff members when they spoke to community groups. The "speaker's bureau" prescntations made by the staff, however, would fall under the small group communication category.

~hefijth-mass media communication method related to the use of displays, posters and exhibits. As an example, the MRHSC had a large three-paneled display borad in the waiting room of the main Center office in Indepcndence. Information about the Center's achievemcnts was posted on the board, which was primarily di- rected toward the patients who had to sit right next to the display - they had no choice-and to visitors. In addition, for talks with the County Boards, the county health planning committees, or the re- gional health planning organization, audio-visual aids, such as the poster board, and other sorts of displays, werc frequently used. Anti-drug abuse posters were put up on all the schools, public buildings and medical buildings in the catchment arca.

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The sixth technique used was that of conferences and special events. The MWHSC staff believed that one of their primary respon- sibilities was to provide leadership to the communities to work out health and social problems. For example, they provided day-long, inservice training programs for area teachers. They held a series of conferences with the law enforcement personnel in each of the three counties on dealing with emotionally troubled people and alco- holics, and dealing with some of their own frustrations. In one county, for example, this conference technique was co-sponsored by the county peace officers association. These meetings were at- tended by many of the wives of law enforcement officers.

For feature events, MRHSC staff held open houses when new programs were developed. Newspaper coverage was secured for all of these endeavors. Another featured event was their joint "Staff and the Board of Directors Banquet." It was believed that having the staff and their spouses and the Board of Directors and their spouses get together, at least once a year, was a worthwhile en- deavor to encourage interaction. Members of the State Legislature were invited. Center staff didn't, however, just relate to their State Legislators on a one-time-a-year basis. The legislators were kept informed of the overall Center, its problems and progress (as a tar- get public).

Fifth Prosnotional Step: Plan

The fifth step in developing the marketing plan was to mate target public problems, needs or desires, objectives and methods and to assign implementation tasks to specific staff, administrators, board members and volunteers. This also entails the setting of a time schedule. The plan must be a written document and must be distrib- uted widely throughout the agency. Pt is mandatory that all parties involved in implementing the marketing plan also be involved in its conceptualization, including the board of directors. Without a writ- ten plan, the Center staff experienced implementation problems.

It was the responsibility of the executive director to implement the plan, as the sixth step, and to periodically check on his own, the voluntccrs, the staff and the board's progress in thc cndeavor.

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Seventh Promotional Step: Evaluation

After the project was initiated there were formative (checks dur- ing the course of the project) and summative (end of project) evalu- ations of the implementation effort. Evaluation, the seventh promo- tional step, can be done on a formalized, systematic basis, such as by interviews, or by mailed surveys, or it can be done on a less formal basis, such as feedback from people in day-to-day contacts. These may include securing information from collateral agencics, county board members, consumer-advocate groups and staff mem- bers, themselves. Because of scarce resources, the Center depended on informal feedback. However, it must be recognized that the va- lidity and reliability of such information is opcn to question. The MRHSC, however, was fairly successful in acquiring funding and "legitimacy" during the time period described.

Time series analysis lends itself very well to monitoring quantita- tive data. For example, if the marketing goal is to increase referrals or funding sources, baseline data would be compared to the nurn- bers after beginning the program. Other quantitative data could be volunteer hours, number of grants, newspaper column inches, or percent of target groups aware of the agcncy. See McKillip et al. (1985) for an innovative application of time series analysis to a media campaign.

CONCLUSION

A last caution is in order. Marketing should not be thought of as just a "campaign" to get the moncy for a new building or to main- tain present programming. Marketing is a year-round, manadatory, administrative responsibility (requiring a written plan), which in- volves all aspects of the organization-staff, administrators, board of directors and volunteers. The specific resources to be secured from each target group should be clearly spelled out.

All staff, administrators and board members must have skills in marketing, selling and public relations techniques. These skills should be applied in the individual, small group and mass media communication modes. If training is needed, faculty in universities1 colleges frequently have the ncccssary expertise and should be con-

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tacted. The National Public Relations Council is an excellent re- source for written materials.

Textbooks in human services administration should now contain extensive discussions on marketing principles. It is the author's hy- pothesis that the skillful use of marketing techniques will enable an agency or program to develop a powerlservice delivery base, which will help it to weather out the present resource-scarce storm. Fur- thermore, all of the previous discussion is pertinent to programs within larger bureaucracies, such as social service departments in general hospitals, as they seek resources within their own organiza- tions.

The acquisition of marketing skills by students in the helping professions will enhance their contributions to their agencies, cli- ents and communities. Furthermore, these types of skills, such as public speaking and use of the mass media, will enhance their com- munity leadership "images," thereby helping their own careers and, ultimately, our clients.

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Brawley, E. A. Mass media and human services: Getting the message across. Beverly Hills, California: Sage Publications, Inc., 1983.

Church, D. It's time lo tell: A media handbook for human services personnel. Washington, D.C.: U.S. Department of Health and Human Services Office of Human Development Services and the Office of Family Assistance, 80-10009, 1980.

DeLoach, W. F. Public relations: A state of mind. Social Casework, 1976, 57, 432-437.

DiGiulio, I . F. Marketing social services. Social Casework, 1984, 65, 227-234. Genkins, M. Strategic planning for social work marketing. Administration in So-

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Kotler, P. and Clarke, R. N. M a r k e h g for Heal~h Care Organizations. Engle- wood Cliffs, New Jersey: Prentice-Hall, Inc., 1987.

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Rados, D. L. Marketing fornon-profit organizations. Boston, Massachusetts: Au- burn House, 1981.

Reichert, K. Human services and the market system. Health and Social Work, 1982, 7, 173-182.

Ries, R. and Trout, J. Positioning: The battle for your mind. New York: Mc- Graw-Hill, 1981.

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Rubright, R. and MacDonald, D. Marketing health and human services. Rock- ville Maryland: Aspen Systems Corporation, 1981.

Shapiro, 8. Marketing for non-profit organizations. Harvard Buriness Review, 1973, 51, 123-132.

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