Grasping the Opportunity for Accepting Responsibility and Making Dramatic Improvement in Behavioral Health

By Peter C. Brown, Executive Director, IBHI

April 25 and 26, 2013 I attended the New York Association of Psychiatric Rehabilitation Services, Inc. (NYAPRS) Executive Seminar in Albany.  The title of the two day program was Mastering the Opportunities in Healthcare, Olmstead and Budget Reforms in New York State.  The first panel this morning (April 26 day two) was titled Rethinking the Mental Health System in Response to the Newtown Legacy.  The speakers were Paul Applebaum from Columbia, Ron Manderscheid now Exec Dir for County Behavioral Health and Developmental Disabilities Directors, Daniel Fisher of National Empowerment Center and Steve Coe of Community Access in NY.  Moderator was Harvey Rosenthal Exec. Dir. for NYAPRS.

The presentations varied in direction, but each in their own way decried  the action of the media, and the response of the public, in blaming behavioral health clients for all manner of violence. They also expressed dismay with the ability of the gun lobby, personified by the NRA, to make the discussion about dealing more harshly with behavioral health consumers than controlling the means of violence.  The call in general was for the field to begin to come together to prevent such media attacks in the future, and to change public attitudes.

Following the presentations in the brief time available for comments, I made the following case to the assembly which I believe is both useful and a call to action :

“Thanks very much to the Panel for the excellent stories and presentations they have made.  We have heard some important stories this morning, and stories are important because they generally help us recognize alternatives to our current state of affairs.  The stories we’ve heard should make us appreciate the opportunity this crisis of confidence offers. At the same time we need to be careful not to kid ourselves about what is possible in this environment.  I’m reminded of Vaclav Havel, who, for those who may not remember, was a playwright who was the first popularly elected president of the Czech Republic following the dissolution of the USSR.  In his first address to Parliament and the public he said “You have been lied to consistently for the last fifty years. I trust you have not elected me so I could continue to do the same thing.”  He then gave them an honest accounting of the state  Czech affairs. So, I think it is important to appreciate that taking responsibility in times such as these can create great opportunities.

These times of upheaval are often times of attempts to avoids responsibility.  The NRA has done that very well, and the behavioral health field has not completely avoided succumbing to the same temptation.  I suggest it is in taking responsibility that there is real opportunity, and these moments of adversity offer opportunity.

In that vein we must not kid ourselves.  The US public is not sufficiently distressed by the amount of violence in the nation to force any significant change in the potential for it.  Only in places where such violence has struck particularly close to home, such as Connecticut and Colorado, is opinion enough aroused to force change.  However, when Kendra Webdale was pushed to her death in front of a subway car in New York City (in 1999) the net result was: the behavioral health system in New York state received an additional $100 million.  It also received the now often maligned Assisted Outpatient Treatment program ( involuntary outpatient commitment).  The major result of this Act was to place much more responsibility on providers to assure people who were placed under the AOT system were maintained in treatment and support. Certainly the Act has negative aspects but assuring provider connection to consumers is a powerful benefit.

It is this taking of responsibility which is key to creating a better system of care, and a better place for behavioral health providers.  The one thing providers could do tomorrow or next week to ensure a much better reception and success for behavioral health care, is to collect and publish their rates of recovery.  I can hear the protests now, “ How  can we do that? “How do I know everyone will measure the same way?” and the biggest cop out, “ Our consumers are much sicker than anyone else’s.”

None of this is important enough to prevent starting to measure, and if we do, it will change the entire field, and you don’t need to wait for someone to require it or lead the way, you can do this right now. If you do you will ultimately be rewarded financially, and others will have to start to do it as well.

In subsequent conversation it was pointed out the  Affordable Care Act is pushing us in this direction, and ultimately such change will be irresistible.

In a post scrip I’d like to observe, the objectives and the results I foresee are the following major improvements in care and in public perception:

  • If a few major providers publish their results, both consumers and other interested parties will begin to ask other providers why they aren’t publishing their similar results.
  • When results are compared those interested in getting better results will begin to ask why provider A is reporting better  results than provider B.  This will open the opportunity to understand how to get better results ( by asking provider B) or why the reported results aren’t comparable.
  • Over time this comparing of results will improve the performance of the whole field.
  • As the potential for recovery becomes better recognized and understood, the general public will change its perception the diseases of behavioral disorders, and come to accept behavioral health problems as comparable to other manageable or curable diseases.   The issue of stigma will decline to the level of many other diseases from which we all suffer.
  • There is no change which does not carry some potential negative result, and this change may lead to some temporary issues about the relative value of care by varying providers.  Despite this issue, in a reasonably short time the true value of behavioral health care will become better appreciated and providers will no longer have to fight to retain funding and reimbursement. The value of treatment will become understood, and policy makers will appreciate the importance of the behavioral health care provided, just as cancer care or cardio-pulmonary care is appreciated today.

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