May 20, 2018
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Maine needs new vision for mental health care

By David S. Proffitt, Special to the BDN

Now is the time, in the midst of this fiscal crisis, to build a better mental health system. The question is do we have the vision and the will to do what is needed.

Maine needs a new vision for mental health. Although we have a need to reduce spending, we also are desperate for new hope. People with mental illness, along with their families, need to have a belief that they will receive necessary treatment. The message should not be one of “lower your expectations.” The message must be “we can do better.”

Vision for reform can create a mental health system that is home- and community-based, innovative, outcome-oriented, and patient-focused. Recovery for people with serious mental illness, providing the ability to lead a successful life in the home and community, ought to be a requisite part of the vision.

Seeking help should be associated with obtaining a real home, a fulfilling job and deep relationships. Not on losing rights, being subjected to force, or being told to want less from life.

For too many Mainers with mental illness, the mental health services they require remain fragmented, disconnected, inadequate and, for many, ineffective. This frustrates the opportunity for recovery. Rejection of help occurs by those in the most need.

Although there are great recovery-oriented services, there are also services that do little to further the growth, resiliency and satisfaction of the person served. For many, becoming “better” is not predicted by involvement in the “system.”

How can we improve and cut costs? One way is to demand that public funded services be able to demonstrate improvement for the persons served.

Some things we currently rely on just don’t produce recovery outcomes. To implement such a system, vision change requires one thing — an absolute belief that all people can grow and improve their lives.

Easier said than expressed by policy or the current care delivery system.

If a person has fidelity to the principle of recovery, that all persons can grow and improve, then high-level, high-cost, long-term programs that are marked by the perpetual levels of acute care needed by individuals would be rapidly phased out. Services that are sought out by people in need, leading to higher levels of autonomy and assisting persons in obtaining personally valued societal roles, would then be grown.

As elementary as it sounds, the benefit of services should be tracked. To continue to receive tax funding, services must be able to demonstrate that they lead to (1) increased autonomy, (2) stable independent housing, (3) adding valued occupational involvement, (4) improved health, (5) normalized community affiliations, and (6) improved relationships. Services that do not support achieving these outcomes should not receive public funding.

People in recovery cost less over time than those who are perpetually acutely ill. Recovery of people with serious behavioral health is an important fiscal and social outcome.

We need to open the mental health system to genuine competitive practices to increase choice, lower costs, and raise quality of care. By embracing an outcome-oriented system of care that measures how effective we are in the lives of people who come for services, a new vision can be advanced.

Quality of care improves when we can see what’s working well and what isn’t. A new vision of the mental health system in Maine can be that of a truly patient-focused system, where those who are being treated are invited to collaborate with caregivers and policymakers.

The president’s New Freedom Commission on Mental Health (2003) recommended “a fundamental transformation of the nation’s approach to mental health care.” The time is now to create a new and improved vision of the mental health system in Maine; a system that reduces waste and improves outcomes. Outcomes are important. Recovery outcomes are critical.

The system today is marked by people with mental illness who long to recover, but spend a lifetime seeking effective care. The belief in recovery, although frequently spoken about, is not reliably reflected in policy. Frequently the system of reimbursement structures, politicians, providers, and bureaucrats all fight against anything that challenges the status quo. Now is the time to achieve our aspirations.

David S. Proffitt is the president and CEO of The Acadia Hospital in Bangor.

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