Monday, April 27, 2009

In Our New Systems, Relationships are the Key.

Claudia Meininger Gold has an op-ed in the Globe today, highlighting the reasons why caring for mental health problems  requires relationship.  Patients and parents hold tightly to their stories, and the insight of the story is really needed to guide their care.  Otherwise, we are just ameliorating the symptoms.  I remember many similar cases:  I am working with a family of a school aged child right now who clearly meets criteria for ADHD in the context of a divorce;  I am being somewhat slow to medicate, and hoping that, with some work on the trauma of divorce, we can manage this without medication.
The system lesson from all of this, however, is that systems of care need to allow and encourage the development of relationships, between patient and primary care doctor, between parent and doctor, between patient and doctor and therapist-  these relationships need to be encouraged to thrive.  This doesn't happen when the systems teat "providers" as interchangeable components on an assembly line.
I may have more to say later-  I will be going over the State House to observe the reaction to the budget.
It's later.

A packed room (I crouched in the back with the folks from Health Care for All), lots of people, one message:  the people in the room were gathered to raise revenue and invest in the future of the Commonwealth.  We heard speeches from a variety of political leaders:  the mayor of Somerville spoke of the need for partnership that preserves services at the local level.  He thinks that people are smart enough to want to keep critical services in place, but he knows that we cannot put this all onto the property owners, and that other forms of revenue are needed.  A nurse from the Worcester Public Health Department spoke of the impact of local aid cuts on the City of Worcester;  the city of Worcester will essentially cut out the Public Health Department on May 1st, after which there are only a few people left to do the work.  A member of the Coalition for Social Justice spoke of the cuts in Substance Abuse services, which would have affected her personally had they happened 3 years ago.  She is three years sober, but still subsidized by the Department of Substance Abuse.  While typing, it got really crowded.  Labor was there as well, framing this as an issue for working families.  Working families are not responsible for this crisis;  the bankers are and that we need to hold them accountable for this.  We closed with Youth, the voice of the future, telling us to go out there and make sure that there is something for them to grow up for.

So, what’s the down side?  Really, it comes down to who you are going to raise the revenue from.   Proposals currently out there seem to focus on raising the regressive taxes like the sales tax, and not the income tax, which would  allow us to target the cost to many of the folks that caused it.  Still, without these additional revenues, mental health reform is not going to happen.  As the group went off to visit the members, it was with a single message:  “Raise Revenues, Reduce Cuts”.  It will be interesting to see if it sells.

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