Sunday, January 11, 2009

One Small Point: Not Really a Failure of the Law...

I confess to not following the Stuart Little analogy in Robbin's post on the MBHP Alert #55.  However, I do hear her annoyance at the additional procedure's needed to provide mental health services, and hope that she is able to forge a more collaborative relationship with those charged with administering the money.   

I must correct her impression of the role of the law in this matter.  Over the course of the last few years, we have had two "legal" forces at work, creating change in the mental health system.  The Rosie D. case, which is the driving force behind the "mobile crisis interventions and home-based therapy interventions" is aimed solely at those children with Serious Emotional Disturbance.  I suspect that those children will have no trouble being authorized for more visits;  their ICC case-manager will see to that.  The new Children's Mental Health Law actually says little about the Crisis Teams or the Home-Based Therapy, but does aim to create an environment in which increased access to the outpatient therapy could happen.  Both of them would argue that the nature and duration of treatment is the result of a discussion between the family and the therapist.  But, as long as we are paying folks on a fee-for-service basis,  it is likely that the payor will want to exert some oversight over the process, and, as the money grows tighter, that oversight will become more onerous.

Robbin's point final point is still well taken.  As we build a Cadillac (or should I say Mercedes, in the current environment?) for the children with Serious Emotional Disturbance, we need to be careful not to forget to leave some gas in the tank of the Taurus that serves the majority of children with mental health problems in the Commonwealth.  The relationship between a child and  a therapist is the key to the successful management of the children, to PREVENT them from developing a Severe Emotional Disturbance.  That is something that we must strive to preserve.

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