Monday, October 08, 2007

Reforming Behavioral Health Care.

I was having a discussion with a NAMI (National Alliance on Mental Illness) Executive Director the other day and naturally we discussed the challenges of mental illness and ways to reform the entire field of behavioral health. I was asked to succinctly list the ideas contained in my book for reforming behavioral health care. I had pointed out that this was the last section of my book to be worked on, even though I had some direct experience in behavioral health care, and that in some ways it was the hardest to work on. Although my ideas for reforming healthcare are sweeping, behavioral health needs a lot of solutions tailored directly for it.

Behavioral health, much of its most debilitating diagnoses have been conclusively tied in large part to brain chemistry, tend to be chronic, long-term in nature and needing of various medication and psychotherapy. Assessing the state of mental wellness and treatments and the way they are handled by insurers and government, leads to a short list of necessary reforms. It's funny, whenever I'm asked to list some of my ideas for health care reform, and I do, people often find many of them interesting and possibly revolutionary, but they also always point out that if I'm able to give them a succinct and detailed list so quickly, how can I possibly really fill up a whole book with these ideas. Of course, there is more to the explanations than that. And I point out that there are political obstacles and tax ramifications that all need to be explored. But those who know me don't necessarily believe these explanations as much as they believe that I like to talk and always have lots, LOTS to say.

To reform behavioral health care we need complete parity. Mental illness must be treated like any other illness. There have been major inroads lately but we are not there yet. Also, because of its chronic and debilitating nature in many instances, we need to expand residential services, because supervised and supported places to live are much cheaper than longer-term hospitalizations, as well as much better for the long-term mental health of the service recipients and their families. We need more supported employment programs to help people get to work in whatever capacity they are able. Work builds self-esteem, gives people true meaning rather than something to keep them busy and provides financial assistance. We need reform of assistance programs at the state and federal level so that as the consumers of mental health services make money in supported employment, or in the traditional job market, they don't have to worry about losing their benefits, and other support structures that might otherwise tempt them to avoid employment in the first place. We need a comprehensive and national level, with regional variations, anti-stigma campaign. Mental illness is not something to be ashamed of or to be feared by others. Stigma is caused by ignorance and fear. In order to ensure that people are comfortable seeking out help and treatments, that people seek out the most effective treatments and assistance, and are comfortable adhering to treatment, we need to remove the stigma that has built up and remains over time. Stigma affects all aspects of behavioral health care. In order to ensure appropriate and adequate housing, employment and adherence to treatment we need a true effort to combat stigma. All of these things, along with the reforms to healthcare in general, can help us improve health care delivery and results, control costs and yet still maintain the most innovative, forward thinking and dynamic health care system in the world.

Because I believe that comprehensive anti-stigma campaigning is one of the core and key factors in reforming behavioral healthcare and helping it to move ahead as one complete reformed healthcare system someday, I am part of a mental health anti-stigma project. Anyone interested in this topic should visit the blog: The link is also in our links section to the right. It is another piece in the movement to reform all healthcare.