Wednesday, September 5, 2012

Unintended Consequences

The article by Paul Gionfriddo entitled "How I Helped Create a Flawed Mental Health System That's Failed Millions -- and My Son" tears at one's heart and points out the need to address the needs of those with mental illness in a holistic way.  It is clear that earlier recognition of these issues by schools, the courts and society in general is desperately needed.  It is equally clear that a tendency to blame bad parenting and to call everything "attention deficit disorder" also contributes to this societal and personal (for Mr. Gionfriddo and others in the same situation) disaster that is all too common.  I only wish that I believed that the solutions he outlines would be effective.  In the same way the system he helped dismantle through legislative action and the system that he attempted to build in its place contributed to some of the problems he  has lived through, the solutions that he has outlined may have other unintended consequences as well.

Something must be done and I wish I knew the right answers and was as certain that this author is about the need for certain specific actions.  Here are some of my thoughts about his suggestions as to what he would do if he were a legislator today, taken with the understanding that I have not had to live through his experiences with his son.

  • "I'd mandate - and provide funding to ensure - that every teacher receive training in recognizing symptoms of mental illness in students and how to handle students with a mental illness effectively."    I strongly agree that schools must have people who have more knowledge of mental illness.  The challenge is that training every teacher and then having those teachers only use those skills infrequently almost guarantees that those taught skills will become rusty and below that which is needed.  While our answers are often to train, we have to understand that training only works if the skills that we train on are reinforced and used in an ongoing way.  
  • "I'd implement the Affordable Care Act's Medicaid expansion for single adult without delay in 2014 and put much more money into community mental health services."  As a physician who has watched the Medicaid payments get squeezed to a point where few physicians and therapists will see patients, I do have a hard time understanding how sub-optimal therapy that is expanded to more people will create better care when the resources of talented people with time to spend on each patient is still far too limited.  I too believe strongly in the promise of better community mental health services and only wish that they could be put into place with their effectiveness being measured directly by the families of those mental health patients affected.  
  • "I'd integrate how services are delivered by funding collaborative community mental health  programs and have them run by mental health professionals."  Here again I worry more about how this will be done to ensure that the services are those that actually help the people involved.  Translating a good intent into effective regulations and policies is often where those pesky unintended consequences occur.  
  • "Finally, I'd insist that the spirit and mandates of the federal Mental Health Parity Act of 2008 be enforced uniformly across the states."  I agree with the emotion that the intent of that law passed in 2008 should be followed everywhere but with culture and resources varying so much from state to state and from locale to locale it is hard for me to agree that all the mandates should be followed in the same way.  Rather I would like to see an understanding that people with mental illness must be treated with dignity and care so matter where they are treated and that they and their families be the people to decide if that treatment fits their need.  
Let us all share Mr. Gionfriddo's outrage and pain and do all we can to improve the total life care of those who suffer as his son suffers and to work to create a different improved path for those children who are starting to show signs of significant mental illness.