Saturday, June 28, 2008

One Last Post on Partnership: Then On to Budapest

I came back from the hills to a bunch of work, much of which involved rehearsing for our upcoming performance in Budapest with the Robert Page Festival Singers.  What does Hayden have to do with Children's Mental Health?  Not much, other than to underline my desire to be part of too many things.  Still, I did have at least one thing I wanted to share with you all before departing for foreign realms (and I may have more to say once I am over there-  we will see what the Internet access is like in Budapest).  
Earlier in the month, I was lucky to attend a meeting in Worcester on "Creating Integrated Levels of Care", in which we were invited to join with the Partnership to create working models of programs to do what the courts and the families want us to do:  create a system of care that makes it easier for them to address the fluctuating course of mental illness throughout the life cycle.  It was sponsored by the Massachusetts Behavioral Health Partnership, which is a true gem in our struggle to build systems of care.    The bottom line was that there is progress, folks, but the road is hard.

The meeting was packed:  there were folks from community-based agencies working at a variety of different levels, including adult and child providers.  We first heard from “Motivating Youth Recovery” program, a new program that is located in Worcester and provides inpatient detox services to “dual-diagnosed” adolescents. The program started a couple of years ago, and is doing well, bringing in kids from across the state.  A few interesting points:  they are seeing more girls with heroin problems and more boys with marijuana problems,  and we all marveled that crystal meth has not yet hit our communities in a big way.  The main point is that the service is rare, and that we need to find a model that allows more programs like this around the state.

The meat of the meeting focused on improving access to care across cultures: are there barriers to care that are different from families from different cultures and backgrounds.  They looked at the data provided by the various deliverers of care, obtained hrough the Treatment  Outcomes Package (TOP ) form, an admittedly difficult instrument that was not always completely completed (can I say that?) by the patients.  The data is subjective;  the diagnoses are subjective and is often driven by the credentials of the therapist (if I can treat attachment disorder, then there must be a lot of it out there).  Still, it seemed that Latinos, African-Americans and Anglos differed in the types of problems for which they presented (Latinos tended to be suicidal more frequently than the other groups seeking care and seemed to wind up in in-patient settings more often).  To be clear, we also didn't know if there was a difference in the rate of actual suicide in these populations.  Still, this has a clear inpact on treatment cost and efficacy, and implies that, among Latinos, there are some factors that impair their access to care.

We talked about some of the possible reasons for this:  the notion that for some, a vision we might perceive as evidence of psychosis may be seem only as a visitation from an angel or a devil, the idea that seeking mental health services might give you mental health problems, that in some cultures, family and spiritual leaders may be considered a more important resource than a physician or psychologist.  Language and culture of the therapist also play a part; but several agencies reported that, even with bicultural and bilingual staff, the barriers remained.  We clearly need to need more about information about the nature of this seeming disparity.

I was, of course, disappointed with the lack of data on children and adolescents  The discussion, however, led to some ideas for improvement.
  • Partnering with religious organizations: Forums on mental health.
  • Creating a workgroup to create a vision for a system of care. 
  • Building recovery principles into programs.
  • Using more peer counselors to breach cultural barriers.
  • Partnering with local academics to create an interest group.
I of course, volunteered to be on the committee.  It is great to see that some folks are able to use data to drive their work forward.

That's all for now.  Off to Budapest.

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