Beyond the ACA, Part Two: Change the Culture of Care

Ron Manderscheid, Ph.D.
Executive Director, National Association of County Behavioral Health and Developmental Disabilities Directors

Ron ManderscheidPreviously on Care for Your Mind, I asked: “If you or a family member needed care today for a mental health or substance use condition, would you be able to get it?” We’ve explored obstacles that stand in the way of accessing mental health care, and we explored how the Affordable Care Act improves access and quality for people with conditions like depression and other mood disorders.

In yesterday’s post, we explored three ways to change the structure of community-based mental health care. Today, we look at how we can change the processes and attitudes through which community-based mental health care is delivered.

Changing the Culture of Care

Improving access to behavioral health care isn’t only about making changes in how care is structured. It’s also a matter of the content and quality of the care.

Professionals should be able to identify people who need care early. Consumers should be engaged in their care. And consumers need to know that the care they seek is going to be effective. That’s why we need change—and advocacy—regarding processes of care.

Three Ways to Change the Processes of Community-Based Care

1.Moving upstream toward prevention. The personal and economic impact of a mental health condition can be minimized by preventing it when possible, or by detecting it early, which can reduce severity and the potential of co-occurring problems. Promoting access to preventive care can help identify and respond to behaviors and symptoms that signal the likelihood of future mental health conditions. It shouldn’t have to take as many as eight years after the onset of evident symptoms for young people to get into treatment. In what ways, if any, is preventive care delivered in your community?

2.Promoting evidence-based practices. To provide effective care, health care professionals increasingly recognize the need to provide services and supports that are known to work well. Services that research and testing have found to work effectively across a range of situations and populations are called “evidence-based practices,” or EBPs. In an era of limited state and local resources, adoption of EBPs—including those involving peers in the care-giving model—is a process change well worth making from both economic and human perspectives. Would you support a change to the use of EBPs? What questions would you raise about such a process change?

3.Emphasizing person-centered care. Changing health care from a disease-centered process to a person-centered one that engages consumers directly will go a long way to improving access. Behavioral care that focuses on the whole person promotes dialogue about issues of access and evidence-based practices. It also fosters exploration of all potential and actual health concerns and advances a shared view by provider and consumer of how health can be achieved and sustained. Do you receive person-centered care, disease-centered care, or some mix of the two? Are there things you would want your medical providers to do differently in approaching you as a health care consumer?

Making Change: It Takes All of Us

Today and yesterday’s posts don’t provide a comprehensive list of opportunities to enhance access. Some of the opportunities identified have yet to become standard practice across the country. Yet, I mention them because each is a key element in making access happen for people with mental health problems. And I mention them because, as with all change, these changes will require our advocacy at the state, county, and local levels.

What can we do?

  • Get educated. What is happening in your state, county and community? What changes are being proposed, if any? What’s working and what isn’t when it comes to care access?
  • Get active. Each of us can and should get involved as an individual advocate, and as a member of a behavioral health-focused organization, as often as we can and as well as we can, to help make change happen in the structure and process of care.

Together, let’s take sustained action. In that way, in the near future, when we again ask, “If you or a family member needed care today for a mental health or substance use condition, would you be able to get it,” the answer will be a resounding “Absolutely, yes!”

How can you advocate for change in your community? Which, if any, of these processes are already in place where you live?

3 comments
Celeste T
Celeste T

How can you advocate for change in your community? Which, if any, of these processes are already in place where you live?

A totaly volunteer, grassroots peer driven independent organization has been formed in our community.  Our goals... better understand our providers needs, open the doors to communiations with them and peer support, education and empowerment.  So far support is being had from our providers. We have only been around two years this month and have much to learn, a need to build up the participation from our peer community but it is slowly growning.  We focus on our strenghts, understand there will be times we can have a need to back away putting our personal needs for wellness first but like the story of the geese as one leaves the flock to mend one other member of the formation joins him till he is well and able to join in the migration forward.  Leaders of the flock will change but the unity of peer support will never die.

So for us local advocacy is we we are at.  For me personally I don't want to be a part of state level legislative advocacy work it is not something I find I have a passion for and remembering there is "no wrong door" is a part of my path to recovery. Each of us needs to focus on our strengths and move forward from there

CFYM_Host
CFYM_Host moderator

Your community-based education and communication process sounds great. It's very important to communicate with the provider community in order to learn about their challenges, offer personal feedback, and spread the word to others. We need to help each other in order to secure attention to issues and generate change.

Not everyone feels comfortable in lobbying. Rallying the community is in itself an essential step. Way to go.

Celeste T
Celeste T

@CFYM_Host  As we become more aware of the struggles our providers are up against.  Paperwork knee hi. time constraints etc. the more the need for them to hear Thank you from us using their services.  The system sucks at times but the people don't.