Sunday, September 14, 2008

A Busy Week Ahead: Talking Mental Health Reform in the Big Apple

I'm a little nervous this week:  I am traveling to Weill-Cornell Pediatrics in Manhattan tomorrow, where I am presenting Pediatric Grand Rounds on mental health reform in Massachusetts,  we have our first meeting of the academic year for the Worcester Mental Health Network and there is a Rosie D forum on Friday.  This in addition to the usual seeing of patients and teaching and Medical School interviewing and- well, you get the idea.  It has proven to be quite challenging to capture the breadth of what has happened in Massachusetts over the past 4 years in a one hour talk.  I thought that I might lay out some of my reflections here, so see what you all thought-  it is not too late to change it before Tuesday, after all.
I was impressed by a talk I heard at Judge Baker a few months ago, in which Marylou Sudders of MSPCC and David DeMaso of Children's outlined a way to look at changing systems, which I have shamelessly adapted into my talk.  As a model, it fit with my view of the last few years, which is that the problem is quite apparent, the policies that we
 need are reasonable well understood and that current "Rube Goldbergian" system has been held in place only by the lack of political pressure.  In Massachusetts, we sort of had the perfect storm of political happenings in all three branches of government:  the Rosie D case, the change in administration and the Act Relative to Mental Health as depicted in the this other slide (the model is from the US Government's website, but I figured that it was still relevant). I've tried to weave the story to go between policy and the kids that I see in my practice.  It is hard to integrate the timelines- they are related, but it can be very confusing for the outsider.
What this contemplation has made me realize that systems in general live in equilibrium; in order to get them to change, you have to be willing to risk a bit of chaos, and that the art lies in not using more force than is necessary in upsetting the apple-cart.  There are those who think that Rosie D. was overkill, that we could have gotten change without the overwhelming force of a court order.  Most parents are still not convinced that the current political change will result in better services for their children.
Turns out this is a reasonable way to think of conflict in general.  The task before us is, now that we have established these areas of change, can we actually implement the changes that we have planned and come up with a better (likely not perfect, but better) system?
I think that that the talk will go well; my nervousness stems from the realization that I intend to discuss the politics of medicine in front of an audience that is usually more focused on the science.  Anyone who wants to look at the slides, drop me an e-mail and I'll send them out for you to look at.  

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