Here are the key survey questions, and what I wrote.
1. Briefly describe the top 5 issues (in rank order) that, if addressed, would have a significant impact on the lives of persons with substance abuse challenges in your community?
1 Establish a clear path to safety and good health, and align system resources to support that path
2 Eliminate system-created barriers, delays and disincentives
3 Foster population-level nonclinical social support and volunteer-delivered service networks
4 De-emphasize pathology thinking (e.g. AA), emphasize personal strengths, learning, improved cognition, improved relationships, and safe environments
5 Align justice system practices with the path to safety and good health
2. Briefly describe the top 5 issues (in rank order) that, if addressed, would have a significant impact on the lives of persons with mental health challenges in your community?
1 Establish a clear path to safety and good health, and align system resources to support that path
2 Eliminate system-created barriers, delays, and disincentives
3 Establish population-level nonclinical social support and volunteer-delivered service networks
4 De-emphasize pathology thinking (e.g. personal identity connected to clinical diagnosis), emphasize personal strengths, learning, improved cognition, improved relationships, and safe environments
5 Align justice system practices with the path to safety and good health
3. Do you have specific ideas about how to address the issues you mentioned in questions 1 & 2? Please explain:
For a variety of reasons, our systems pay lip service to the notion that behavioral health is biopsychosocial. We only invest in biological methods. We underfund the psychological, and ignore social support completely. This imbalance creates failure, because we are trying to solve population level problems with the most expensive techniques imaginable. Our system has developed a siege mentality. It is plain from reading community plans that system leaders mostly look inward, fretting over the little resources they have. The system must start facing outward, and figure out ways to serve the whole population effectively. This means that, instead of acting like 88 service fortresses in 88 service deserts, the system needs to act more like a network of service hubs. If the system can’t support funding a particular technique (e.g. medication assisted treatment for addiction), it should remove the service from the behavioral health carve-out, and find ways to collaborate with systems that can support the technique. There should always be a path to the least expensive, most accessible way to deliver what is needed when it is needed. People should feel safe and connected if they must wait for a more intensive service.
The relevant techniques for redesigning effective service systems are community organizing, appreciative inquiry, civic engagement, asset based community development, and the IDEO Human Design toolkit.
I developed NAMI Ohio’s court and jail training, worked on the Hamilton County SAMI team. I have developed crisis de-escalation training, and worked on tough issues in multiple service systems. I have been working and learning from Peter Block and other civic engagement experts about how to generate positive solutions to seemingly intractable problems. I do licensing and accreditation work for service delivery agencies. For the past several years I have focused on what ordinary people can do to support each other, and writing about how to change the experience of having mental illness. I have written a well-regarded book that embodies what I have learned. For the past year, I have also worked with anti-drug advocacy groups in Northern Kentucky about heroin poisoning issues. I have learned that it is possible to articulate a path to safety and good health that is practical, understandable, consensus based, and effective.
4. Who would you need to partner with in your community in order to effectively address the issues you mentioned in questions 1 & 2?
Behavioral health is a population-level issue. The whole community has a stake in it. Effective system reform will come from engaging business leaders, neighborhood groups, church groups, parent groups, service system users and political leaders. Today’s reforms are mostly about responsiveness and clarity, not about delivering a smidgen more of what the current system cannot deliver.
5. Briefly describe what the impact would be to your community if these issues were addressed?
People with substance abuse issues – particularly heroin – would move from having a life that is unsafe, at risk of harming others, and is essentially criminal, to a life of a person who is enrolled in a system, who has first aid available, who is safe from infection, whose life is managed, not criminal, less risky, positive, supported and safe. People with mental illness would retain economic and social capacity, move from social isolation and control by others to a life that is safe, socially supported, with access to care as needed, delivered in an ethical, collaborative fashion, and oriented to achieving the ordinary milestones of human development.
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Photo By Carin fuerst (Own work) [CC-BY-SA-3.0-at (http://creativecommons.org/licenses/by-sa/3.0/at/deed.en)], via Wikimedia Commons
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