Here is the simplest idea that I can come up with for mental health reform. DO MORE OF WHAT MAKES THINGS BETTER AND LESS OF WHAT MAKES THINGS WORSE. Unfortunately the guiding rule of mental health is often DO MORE OF WHAT MAKES MORE MONEY AND LESS OF WHAT MAKES LESS. Ultimately mental health is whatever insurance companies pay for. Rightly or wrongly it is whatever insurance companies pay for.
And too often insurance companies pay more for what doesnt work very well. And too often they pay little or nothing for things that do work well.
Samhsa recently stated that 20% of people psychiatrically hospitalized are rehospitalized within one month. Another study says the 40% are rehospitalized within a year. New York has a concept they call potentially preventable hospitalizations “……. namely people who had a hospital stay that either did not leave them well enough to avoid readmission or they lacked good community-based followup so that they became, again, acutely ill and received another (potentially unnecessary and expensive) inpatient stay within 30 days.” They found out that in one year they spent $814 million on such admissions. And that was for medicaid patients only. It does not include the cost of jails, and other social services.
In Tennessee we are in the strange position of not being able to afford to put people in the hospital. It costs too much. (And like I said above it really doesnt help in any lasting way.) But because it costs too much we find ourselves refusing or finding ourselves unable to pay for the resources to keep them in the community. It is a classic case of cutting off your nose to spite your face. But in times of financial crisis we are doing more than cutting off our nose. We are slitting our throats.
Mental health systems are ultimately conservative. They do what it is normal to do. They do what they are used to doing. They do what seems by habit to be the obvious thing to do. Change is about finding a new normal and that is an incredibly hard process. Things that pay well develop a complete and encompassing world view that makes it hard to see that they don’t work nearly as well as conventionally thought or that there may be another way of doing things.
We have a model based on management (keeping things from getting worse) and not one based on transformation (making life better). Obviously these or not either or alternatives. Some things must be managed before transformation is possible. But if your means of management make transformation harder or impossible are you solving or creating a problem?
The medical model is what gives us the management focus. Cure what you can cure and what you cant cure at least manage to the degree that people can live with it. I have talked with literally hundreds of people who have been in psychiatric hospitals and it is a rare person who talks about it as a transformative experience or as an experience that sets the stage for transformation. Doctors talk about it as “stabilization” but given the statistics quoted earlier it is really questionable how well it does that. At best, it provides a safe place for a couple of days, but the experience of many is that it is anything but safe.
Part of the problem is that transformative experience is not about cure or management, but about care. It is not just about what we do with the “illness” but what we do with the person. Experiences that tell people they are deficient, damaged, and that life is an overwhelming challenge they can never meet or that tell you that something helps that really doesnt do more harm than any short term benefits they offer. Too many people experience the mental health system as being as big a challenge as the mental health issues they deal with.
The recovery model recognizes the importance of management but also recognizes the possibility of transformation. But it posits a way of looking at things that is very much a “new normal” and in many places interventions and programs based on the recovery model find that they are not reimbursable or at best looked upon as being adjunctive to “real treatment.” They find the hardest thing is not just to get people to see things differently, but also to look differently.
The mental health system is too often like the man looking for his wallet. He is looking under a bench in a park underneath a park light. A man comes up and says, “Did you lose your wallet around here?” The man shakes his head and says no. He points over to a dark part of the park and says, “I lost it over there…. The light is just clearer over here.”
In our commitment to things that dont work we sometimes have a hard time in seeing what does.
Here is the simplest idea that I can come up with for mental health reform. DO MORE OF WHAT MAKES THINGS BETTER AND LESS OF WHAT MAKES THINGS WORSE. Unfortunately the guiding rule of mental health is often DO MORE OF WHAT MAKES MORE MONEY AND LESS OF WHAT MAKES LESS. Ultimately mental health is whatever insurance companies pay for. Rightly or wrongly it is whatever insurance companies pay for.
And too often insurance companies pay more for what doesnt work very well. And too often they pay little or nothing for things that do work well.
Samhsa recently stated that 20% of people psychiatrically hospitalized are rehospitalized within one month. Another study says the 40% are rehospitalized within a year. New York has a concept they call potentially preventable hospitalizations “……. namely people who had a hospital stay that either did not leave them well enough to avoid readmission or they lacked good community-based followup so that they became, again, acutely ill and received another (potentially unnecessary and expensive) inpatient stay within 30 days.” They found out that in one year they spent $814 million on such admissions. And that was for medicaid patients only. It does not include the cost of jails, and other social services.
In Tennessee we are in the strange position of not being able to afford to put people in the hospital. It costs too much. (And like I said above it really doesnt help in any lasting way.) But because it costs too much we find ourselves refusing or finding ourselves unable to pay for the resources to keep them in the community. It is a classic case of cutting off your nose to spite your face. But in times of financial crisis we are doing more than cutting off our nose. We are slitting our throats.
Mental health systems are ultimately conservative. They do what it is normal to do. They do what they are used to doing. They do what seems by habit to be the obvious thing to do. Change is about finding a new normal and that is an incredibly hard process. Things that pay well develop a complete and encompassing world view that makes it hard to see that they don’t work nearly as well as conventionally thought or that there may be another way of doing things.
We have a model based on management (keeping things from getting worse) and not one based on transformation (making life better). Obviously these or not either or alternatives. Some things must be managed before transformation is possible. But if your means of management make transformation harder or impossible are you solving or creating a problem?
The medical model is what gives us the management focus. Cure what you can cure and what you cant cure at least manage to the degree that people can live with it. I have talked with literally hundreds of people who have been in psychiatric hospitals and it is a rare person who talks about it as a transformative experience or as an experience that sets the stage for transformation. Doctors talk about it as “stabilization” but given the statistics quoted earlier it is really questionable how well it does that. At best, it provides a safe place for a couple of days, but the experience of many is that it is anything but safe.
Part of the problem is that transformative experience is not about cure or management, but about care. It is not just about what we do with the “illness” but what we do with the person. Experiences that tell people they are deficient, damaged, and that life is an overwhelming challenge they can never meet or that tell you that something helps that really doesnt do more harm than any short term benefits they offer. Too many people experience the mental health system as being as big a challenge as the mental health issues they deal with.
The recovery model recognizes the importance of management but also recognizes the possibility of transformation. But it posits a way of looking at things that is very much a “new normal” and in many places interventions and programs based on the recovery model find that they are not reimbursable or at best looked upon as being adjunctive to “real treatment.” They find the hardest thing is not just to get people to see things differently, but also to look differently.
The mental health system is too often like the man looking for his wallet. He is looking under a bench in a park underneath a park light. A man comes up and says, “Did you lose your wallet around here?” The man shakes his head and says no. He points over to a dark part of the park and says, “I lost it over there…. The light is just clearer over here.”
In our commitment to things that dont work we sometimes have a hard time in seeing what does.