Tuesday, June 30, 2009

Thank for your help: My Fellowship is over.

The woods were dark and deep (and wet),
And I must have some sleep (you bet).

Last week was my reintroduction to clinical practice- as I mentioned when I started this thing, I am a primary care pediatrician who has been given an extraordinary opportunity by the Center on Medicine as a Profession to spend a significant chunk of my time exploring ways in which a primary care pediatrician can advocate for improvements in the children's mental health system. I have worked with coalitions, written articles and op-ed pieces, given testimony, organized "events", hosted meetings, given talks on children's mental health, all with the intention of building a better system in Massachusetts (and eventually the world). Along the way, I have come to understand a few things:
1) There is a lot about children and mental health that we don't know.
2) Families are the key to managing children with mental health issues.
3) Medications are useful, but not an answer without the rest of the system.
4) This is going to be difficult, and take many years to get right.

In my work, I've gotten to work with advocacy groups like HLA and PAL, clinical groups with the UMass MCPAP team and the WMHN and state-sponsored groups like CBHI and MBP. All have been helpful. I have watch a bill make it through the State Legislature, another go through the Federal one, and watched as dedicated public servant drew up the blueprints for a new system out of whole cloth. I think that, on the whole, I have contributed positively to the process.

Tomorrow, my funding is done; as of July 1, I am back to being a full-time pediatrician, cranking through the patients and trying to do right by them. Of the 25 kids I see most days, 3or 4 will have serious emotional disturbance. Half of those will already be in some sort of treatment; the rest will need help getting there. I'll be trying to work with CSA on this; in the long run, however, that is not going to be good enough. We need the promise of the CBHI to be fulfilled and that requires that each of us think hard about how to help the CBHI achieve its maximal potential. With that thought, I close. Thanks for your help; now the real work begins.

Oh, don't think that you've heard the last of me- I will keep posting. Probably not as frequently, but there is still much to do.

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