Morning Zen Guest blogger ~ Jody Levison-Johnson
This Zen post was written in response to the recent CMHNetwork update on upcoming dialogues addressing key issues in the Helping Families in Mental Health Crisis Act.
It’s time to nail down what we mean. If children’s mental (behavioral?) health advocates truly intend to come together to advance what would be considered “good policy”, then we had better get really clear on what we are talking about. In our lofty aspiration to advance a better system we often use sweeping generalizations about what we are seeking, “expanded community-based services for individuals with severe mental illness,” “community-based services and supports,” and “array of outpatient treatment options” and about who we are advancing this system for “people with severe mental illness,” “those with significant emotional and behavioral challenges,” “children and youth with serious emotional disturbance.”
Some may say that this is simply a matter of semantics. And it is; just not simply. All of these terms mean different things to different people. Advancing a coherent and cogent policy statement will require agreement on these things, which can potentially be as complex as the AOT dialogue.
This discussion is of critical importance. Determining “the who” ultimately drives “the what.” If we intend to launch a credible conversation to align the content of HR 3717 with what we know to be best practice we need to think long and hard about whether we are advancing a policy that is focused on young people (defined how precisely?), their families (which includes adults who often face similar challenges)? Are we simply concerned about mental health or are we willing to concede that addiction challenges and co-occurring disorders are far too common, equally not effectively addressed, and that we can’t afford to leave those out of what will hopefully shape up to be a capable future system?
Once “the who” is addressed, then great thinkers from across the spectrum (young people, families, clinicians, researchers, system partners, advocates) need to come together and agree on “the what,” the best practices worth advancing. When good policy is passed it will fall to federal, state, and local governments to respond with “the how.” Leaving that to chance is a crapshoot we should not be willing to take. This is worthy of thoughtful consideration. If you think things like “community-based services and supports” are clearly and universally defined, travel to different parts of the country and listen to what this means to them. In some states, this term can and has been used to refer to large congregate care settings that defy best practice standards but are situated “in the community” (i.e. not on some campus in rural wherever-you-may-be miles from a population center). Some have even argued that private hospitals and those on campuses with other services are in fact “community-based services” because they may be located in an urban center or are co-located in a “community” of other services. We must ask ourselves and ultimately answer these questions: what is the effective array of services and supports that effectively prevent and treat mental health and addiction issues? What services and supports need to be available for people to live productively before, during and after a mental health or addiction challenge?
It’s time to get down to semantics people…or else we compromise our credibility and our ability to advance best practices to people who truly deserve them.
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Jody Levison-Johnson is the Executive Director of the DC and Maryland operations of Choices, Inc., a children’s care management organization. She has served as a top state behavioral health official and also provided technical assistance and support to communities across the country in advancing best practices in the area of children’s behavioral health. Jody serves on the Children’s Mental Health Network Advisory Council.