Feb 26, 2014

Solving campus mental health

Mental health is all the rage on campus today.  I came across this article about mental health activism at the University of Virginia   and the cover article from Newsweek about college mental health from mid February.

These articles, and many others, show the disconnect between the population that college systems were designed to serve, and the populations they actually serve today.

When colleges were ivory tower, elitist institutions, in isolated spaces, they operated under a set of cultural assumptions. People would arrive prepared to attend college. There would be a scarcity of college slots. Admission would be competitive. Only the finest minds could have access.

For many years, students did arrive expecting a mental pressure cooker experience.  People who could not succeed were systematically removed from the population. There were four exit options: Succeed, flunk out, flake out, drop out.

Today’s college environment differs from the college environment of the past. Instead of serving a select population in an isolated, controlled setting, today’s colleges and universities serve a population that mirrors the population as a whole. There is more economic diversity. There is more diversity with respect to academic preparedness, more diversity of social preparedness, more diversity of health concerns, more diversity of economic preparedness. And more diversity with respect to mental health.

Colleges are learning that the whole population brings all of its trends with it.
  • Today’s college population includes more women, and therefore colleges are encountering increased rates of depression.
  • Today’s college population includes more people who have experienced poverty, and so on campus there are many more people with histories of exposure to so-called “adverse childhood events” – the assortment of tough situations that cause cognitive difficulties and trouble with building social connections.
  • Today’s college population includes many recent combat veterans, and therefore more risk of post-traumatic stress disorder.
  • Today’s college population still retains its basic age range, young adulthood, the sweet spot for the onset of schizophrenia.
Colleges are also learning that their menu of trouble solutions is inadequate for today’s populations. The clinical system is designed to be expensive, so systems designed to “identify and refer” troubled students are doomed to bottlenecks and resource deficiencies. Tried-and-true academic “kick out, shun and isolate” failure-delivery systems that worked safely for elite populations create tragedies when colleges apply these “consequences” to members of less-resilient populations.

What colleges need for mental health is what our whole society needs for mental health: a complete system, one that permeates the population, redesigned to support the whole population.

This means a system that stacks up remedies, starting in families and in informal groups, and then proceeding to organized social, nonclinical experiences, and from there to clinical systems.

We must simplify the conversation. Information overload adds to fear, and mental illness is scary enough. People need enough information to understand what is happening and put together a plan.

Everyone must be encouraged and authorized to do what they can. It's hard to have hope if you're helpless. Every person with symptoms, and every potential ally, needs a way to pitch in. This builds confidence, promotes safety, and makes hope real.

It pays to focus on strengths, not symptoms. Sickness and stigma steal our attention, blinding us to strengths that people retain and to strategies people can use to build capacity.

We must allow recovery to mean something. These days, most people with mental illness regain the capacity to participate in the larger community, and lead a meaningful life. Recovery is social and developmental as well as medical. We deny ourselves a sense of making progress if we over focus on symptom relief. We deny people progress when we do not help them regain their place in society.

We must practice nonstigma. Nonstigma is true inclusion, a belief of the heart that everyone belongs together in the world.  Everyone can work on becoming welcoming, tolerant, accommodating. Nonstigma is more than technique. Nonstigma is a virtue.

And so, for colleges, the suicide rate will drop once nearly everyone knows something about suicide prevention. More people will complete college once colleges reform their service delivery and failure systems.

If we want to live in a positive, safe world, we have to embrace the need to create it, and include everyone as we bring the vision forward. 

Feb 5, 2014

Icy Weather at Ohio's Health Exchange

The Affordable Care Act ground game is playing out just as healthcare opponents have planned.

Yesterday evening I visited a healthcare.gov sign-up and outreach event. The weather was terrible, so there was not much of a crowd. The event was designed for people who did not use the Internet. The people who attended yesterday were a mix of somewhat older adults and recent immigrants.

Ohio’s anti-Obamacare legislation and administrative practices clearly affected what was happening. The state adopted legislative and regulatory tactics that have virtually wiped out the capacity of health advocates to do marketing, sales, and customer service work to assist with enrollments.

For one thing, only licensed insurance agents can assist with navigating the healthcare.gov website. Volunteers and outreach workers cannot help customers, beyond setting up email accounts (a precondition to beginning the process). Several nonprofits that had signed up to do customer service work (navigator work) bowed out because of the risk of prosecutions and civil penalties for saying too much about the process or the plans.

Ohio’s Department of Insurance has to approve sales materials, and has 90 days to say yes or no to whatever groups want to print. Consequently, the written materials available at yesterday’s event said very little. If anything needed clarification, program workers could not just type and print what they needed.

There are over 60 health plans in our area. Because nothing was available on paper, there wasn’t even a “binder full of health plans” that people could page through to see benefit choices, drugs in the formularies, and price ranges. This makes it impossible to browse through benefit packages and do head-to-head comparisons –or have a serious chat about choices -- in advance of logging on to the system.

I was told that Ohio’s bad attitude towards the Affordable Care Act is expected to result in very low enrollment rates. This is a shame, especially for vulnerable populations. 

People with mental health concerns have complicated coverage needs. They need information from peers and from other families who have faced similar issues in order to make good healthcare enrollment choices. This is exactly what Ohio's restrictions forbid.

(Image from www.heraldsun.com.au)