(This is part two of the post that began with “A System That Isn’t One.”)
Those Community Mental Health Centers (CMHCs) represented a big step in the formation of a true behavioral healthcare system. They provided:
A central point of access for patients and families.
Something we’re still struggling with— the need for the one-stop shop. Of course nowadays, the CMHC would be supplemented by a host of online and phone resources that weren’t even on anybody’s horizon in the late 1950’s. All you’d need is a Smartphone to visit an informational website, find a link to all your local services, check out their offerings, get feedback from others who used them… a whole world of helpful information, unavailable until a few years ago. Couldn’t help but become a more informed consumer. And simply linking these centers together would represent the makings of a truly nationwide screening and referral system.
And yes, that would dramatically reduce the burden on the taxpayer from expensive hospital and emergency care— everybody’s long-dreamed-of goal.
Access to true experts.
Let’s face it: Mental health, like the rest of healthcare, is getting more and more specialized, and cases are getting more complicated. Nonetheless, providers are expected to address a range of patient needs, not just the one or two disorders they’re most comfortable with. How to gain that expertise? Through a team approach, like the one described here in other areas of medicine.
Using the nearest CMHC as a base, practitioners could present cases to true experts. That would go a long way to improving the overall quality of care in areas or communities that can’t otherwise access the sort of clinical wisdom required in many difficult cases — and most importantly, it’s there when they need it.
Coordination of care.
A real problem in modern healthcare— getting providers to coordinate their activities with other providers involved in the case. As is, we often wind up with two or three professionals working independently on different “parts” of the same patient. So who has the big picture? All too often, nobody.
An example: The nation’s current epidemic of prescription drug abuse and overdose started in the nation’s doctor’s offices. How do we ensure that some physician X isn’t prescribing opioids to somebody that therapist Y is treating for opioid addiction? Certainly can’t rely on the patient to ‘fess up. Somebody, somewhere, has to make sure all involved are working from the same (accurate) information.
Then there’s the issue of patients lost to treatment simply because they can’t successfully navigate their way through a network of providers and programs. A CMHC could provide a navigator of the sort used in cancer care, to lower the dropout rate and increase retention throughout the system.
There’s that word again: system. But to make the CMHC system a reality, we’d need— hold your breath, this can be scary— a national plan that requires stable funding.
These are chronic illnesses that not surprisingly, do not disappear with time. Means we can’t justify leaving this up to the vagaries of the political process. It’s naive to think that even the best-intentioned legislators won’t at some point seek to make critical cuts, when money’s tight and some other problem is grabbing headlines. How many times does this have to happen to us before we begin to anticipate it?
Better to hunker down and build the other half of the network of CMHCs that we somehow never got around to building in the first place. Find the money, and keep finding it, the way we manage to do with so many other essential services.
After all, how often do we get to build something that we already know will work?
Scott – Thank you bringing this to your readers. Ironically in 2010, I was the first test patient for our local health care system coordination of care. I was assigned an advocate that helped guide me to appropriate care. And she also would advocate for me in emergency situations. Myself, my then 3 year old daughter and my advocate, Becky were the poster kids of the system failing me. I still have the article. I was made aware of the abusive relationship I couldn’t get out of. We later that year quietly and safely relocated to a larger city, with more resources. Now, when I move to a new city. I arrange for my own medical “team”. I sign releases so they can coordinate with each other. A couple times at first, I was treated even worse when I announced my requirement. I have introduced my doctors to Trauma Focused Health Care. It really helped me. I am no longer Trauma Focused, due to simplifying my all around care, I was able to work through situations that in the past would have triggered my PTSD. Recovery has been wonderful!