May 25, 2014

Social services, and pots of money

I learned about pots of money in grant proposal writing class.

The instructor showed us four flowerpots, four empty cups, and a watering can. Each cup had a label. Each flowerpot had a label. She poured water from the watering can into each of the cups. Then she matched each cup to each flowerpot, then she poured from each cup into its matching flowerpot.

The instructor said funding social services meant thinking in terms of pots of money. These turned into pots of client service. Enough pots, and the agency could sustain its work.

This lesson was absolutely true. My boss at Catholic Social Services often talked in terms of pots of money. A pot of money meant a pot of agency resources to put staff people in jobs. Each pot let our agency address a certain kind of trouble. One problem, one service, one flowerpot. Our agency was a tray of flowerpots, funded with matching pots of money.

People in service agencies have adapted to pot-of-money thinking. We analyze each person looking for service who walks through our doors, identify each person’s list of problems, match the problems to pots of money, and deliver whatever services might match. And only those services. What we deliver is always hit-or-miss.

The truth is that our pot-of-money system is perfectly designed to deliver hit-or-miss services. It does that every day, even though the process started with all the resources in a single watering can.

Is there a way to ditch the cups and flowerpots, give up on matchy-matchy pot-of-money thinking, and start a real garden instead?

Photo Rod Allday [CC-BY-SA-2.0 (], via Wikimedia Commons

May 1, 2014

The Service Fortress in the Service Desert

I have been reading through a collection of community mental health plans, shocked and disappointed by the number of people that Ohio’s state and county governments have written off.

Our mental health service system has become a fortress in a desert. Sentries guard the doors. Leaders signal for help and unload supply wagons, but hesitate to let people inside.

This makes no sense in modern times. There is no special magic in a walled-up system. People who need mental health services are dispersed throughout our society. They need help where they are.

Ohio has a system of county mental health boards, whose mission is to look out for what the population needs. Read enough community health plans, and you’ll see the siege mentality that has taken hold. Planners count survivors and fret about what's left inside the fortress walls.

In Hamilton County, where I live, the poverty rate has climbed from 10.8 percent to 18.5 percent from 2002 to 2011. This factor alone drives increased rates of depression and dysfunction, but our county public system does not address this. The county planners write.
Due to limited resources, there is limited capacity for outpatient counseling for those clients who do not have a severe and persistent mental illness.
In practice, “limited capacity” means “no service.”

The implications of “no service” are predictable. People suffer. Families suffer. There’s economic damage, career disruption, more poverty, more drug abuse, more crime, more violence, more failure.

What our planners write about the downside of “no service” is this.
The limited capacity for outpatient counseling for clients who do not have a severe and persistent mental illness could result in the use of more costly Medicaid and non-Medicaid services.
Untimely access to pharmacological services for children and families due to the shortages in child psychiatry services may result in more rapid decompensation in children’s functioning which could lead to more utilization of inpatient services, out of home placements, and other costly interventions.
Gaps in access for low income populations, lack of resources for housing, medication and long term residential services, ultimately impacts the AOD [Alcohol Or Drug] client either using jail bed days, hospital days or death. This is a high cost for the community.
Ohio’s mental health system is self-focused, inward looking, not community focused. It chooses not to adapt. It chooses to live under siege, when it might focus on collaboration, and on creating seamless networks of service that permeate communities.

There’s a lot of noise and self-congratulation this Mental Health Month. Pay no attention. The people in the service fortress are whistling in the wind. The service system needs a good wallop of retargeting and reform  Read the service plan before you buy the ticket to the gala.

Ohio’s community mental health service plans can be found at this link.

photo © Dr Michel Royon / Wikimedia Commons