Effective Communication: A Shared Illusion

Shaw_George-001I wrote last week in my post, Mental Illness Is A Community Disease that I was planning to participate in today’s public listening session held in connection with the development of new criteria that will impact Certified Community Behavioral Health Clinics (CCBHC). Mandated under Section 223 of the Protecting Access to Medicare Act of 2014, the intent is to strengthen community mental health systems by establishing higher standards of care and better coordination and communication across individuals, organizations and agencies that provide assistance and care to individuals in their communities.

Among the five topic areas discussed today (see previous post), not surprisingly I found Care Coordination to be the most interesting because of the parallels I recognized between mental/behavioral health and post-acute/long-term care. These include:

both groups of individuals typically require help from both community-based services and supports, as well as healthcare providers, and the lack of sharing of timely information across those entities in both instances is a challenging obstacle to managing care;

both groups rely heavily on Medicaid to fund needed services and care – and so both are likely to increasingly have to navigate the world of managed care – which doesn’t bode well in light of the point above;

both groups have evidentially achieved significant benefit from taking a holistic approach to care;

there is a need with both groups to understand and address the impact that varying levels of cognitive awareness can have on patient activation; and

the ability to achieve sustainable wellness in both groups is often primarily dependent upon the ability to maintain meaningful, long-term connectivity with care providers (in particular where medication management is concerned).

Most importantly however, germane to – yet beyond just – the importance of care coordination, a key take away from today’s sharing of thoughts, insights and the occasional organizational promotion and positioning was the shared impact that ineffective communication has in mental/behavioral health as it does in post-acute/long-term care. And really, across all of healthcare as has been discussed here before.

Effective communication is an art form, but it’s an art that can be taught and learned among willing participants. All too often, however, that willingness comes from a desire to be heard rather than to be understood – and to understand. George Bernard Shaw (pictured above) once wrote that, “the single biggest problem in communication is the illusion that it has taken place.”

Despite, or perhaps in good measure because of, all the technological advancements that have achieved miraculous achievements in healthcare we still fall well short of our potential to reduce human suffering because of a basic inability to communicate effectively.

I would like to see more sharing of experiences and best practices in care integration between mental and behavioral health and post-acute/long-term care: each probably could learn a lot from the other. But that would involve effective communication . . .

Cheers,
  Sparky

Mental Illness Awareness Week

The Policy Pub wishes to share with our patrons Mental Illness Awareness Week sponsored by the Substance Abuse & Mental Health Services Administration. Mental and behavioral health concerns are growing in awareness across the country. MIAW’s aim is to “help educate all Americans on the needs of individuals with mental illness—including serious mental illness—and their families.”

According to SAMHSA, of the approximately 10 million adults with a serious mental illness, less than one-half of those individuals will receive the services and care they need. Social stigmas continue to be a significant barrier in this regard. As part of its week long effort to continue bringing awareness and education combating stigmatization SAMHSA recommends:

  • supporting individuals with mental illness by helping them understand they are not alone;
  • becoming educated on ways to prevent mental illness, particularly by proactively screening and addressing potential issues during childhood;
  • building greater awareness that effective treatments of mental and behavioral health disorders are available; and
  • celebrating that very often those treatments make a tremendous difference in the quality of life of the individual: People do recover.
  • The SAMHSA website is a fantastic resource on a wide variety of knowledge and information on mental and behavioral health issues and concerns – from advocacy to education to emergency assistance. I encourage you to take a moment to become familiar with what is available there and share with others who might benefit from knowing where to turn – whether because they are seeking to help a loved one, someone they’ve never met, or themselves.

    Cheers,
      ~ Sparky

Don’t Make Mental Health Policy About the Stigma

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Cost of not caring: Stigma set in stone by Liz Szabo, USA TODAY.

This second article of a USA Today series, Mentally Ill Suffer in Sick System, this morning began exploring, "the human and financial costs that the country pays for not caring more about the nearly 10 million Americans with serious mental illness." But the article didn’t address any of the aggregate human costs nor any of the financial costs the country pays due to serious mental illness. Maybe future articles will, and that’s what I would like to encourage with this post.

Now, admittedly, USA Today isn’t in the top 10% of resources I normally rely upon for keen insights and emerging trends and drivers in healthcare, but nonetheless I think they deserve enormous credit for using their national reach to bring greater awareness to a critically important issue.

From a public policy perspective, however, this first contribution is wide of the mark in advancing the type of dialogue that could actually lead to meaningful public policy initiatives impacting mental and behavioral health services. So though I very much doubt their editors will ever see this post, I would like to provide some input that might be useful in developing content for future articles in the series.

Today’s article focused on two themes: the latent impact that stereotypes associated with mental illness still have, often creating self-absorbed obstacles to seeking and receiving much-needed diagnosis, treatment, support services and ongoing care; and the dramatic lack of sufficient resources committed to helping those who are brave enough to seek assistance and support.

Of course, stigmatism is still very real, yet very difficult to understand: it isn’t just a case of stereotyping and ignorance. Mental illness is difficult for many of us to comprehend because the mechanism responsible for its existence is the same mechanism we use to understand it. Most of us can use our brains to understand heart disease, diabetes and lung cancer. But somehow using our brains to explore and reason through a disease process that in others (or, to be sure, often ourselves) impacts our thinking can be uncomfortably counterintuitive.

The inherent stigmatization isn’t just in the fact that someone with mental illness is, "different." It’s the added frustration of having difficulty understanding why they are different. An individual receiving chemotherapy for cancer may look different than their appearance prior to disease. Someone who has had an amputation resulting from diabetes has a noticeable difference in appearance. But mental illness very often doesn’t carry with it the externalities of these changes in appearance (the manifestation of behavioral health consequences resulting from mental illness may lead to dramatic changes in appearance, but those are usually self-chosen much the same way one would choose a different hair color or style).

So while it may be said that ignorance is a lack of understanding acted upon, I agree we should continue to concentrate efforts on building understanding and awareness through continued education, rather than trying to coach away ignorance through reprimand and humiliation that too often characterize so many public awareness campaigns.

Such efforts have had beneficial impact: as a society we are generally much more accepting today than 20 years ago that mental illness is not a self-chosen condition bearing the shame of poor choices and moral subservience. And they have concurrently raised awareness about the urgent need to develop more effective public policy to address accelerating mental and behavioral health needs.

And so, as related in the USA Today article, the most emotionally convenient and expedient approach to lobbying for additional funding in support of MH/BHS is to continue making the case that mental illness should be viewed just as any other disease of a human organ – since the brain is, after all, a human organ. This reflects the inherent strategy that fighting the stigmatization of mental illness will hold sway over those able to increase funding of MH/BHS policy initiatives. But I don’t think it will because every dollar allocated to healthcare is becoming increasingly precious.

From a policy perspective, I believe it is both folly and a wasted effort to spend valuable resources on lobbying for more funding without being able to provide realistic and achievable budgetary offsets. To do this, advocates of MH/BHS programs need to focus their time and energy on generating evidentiary support for where and how funding of existing programs that address the consequences of mental illness can be more effectively invested in programs that diagnose and treat mental illness – i.e., before that illness results in consequences which place resource strain on other areas of social health and welfare (e.g., utilization of hospital emergency departments and the criminal justice system, the economic impact on families and the cascading effect that has on the rest of society). This is, I assume, what USA Today claims the series intends to do via relaying the “human and financial costs” of mental illness. We will see.

In healthcare, we are now living in an era where the expectation that research and evidence support clinical decision-making has steadfastly made its way into organizational administrative and financial decision-making. Quite obviously, we cannot hope that will ever be the same in Congress, but through the Affordable Care Act and various programmatic changes impacting state Medicaid budgets legislators are by default forcing healthcare providers to much more carefully analyze alternative investments – and to use return on investment as a tool for that analysis. Mental health advocates need to recognize this reality if they want their efforts to ultimately result in constructive public policy consistent with their overarching goals and objectives.

I really hope this understanding is reflected in future articles in the USA Today series. I understand anecdotal human-interest stories that tug at the heartstrings help sell newspapers, but they contribute very little to the knowledgebase of understanding needed to assess where and how limited resources can best be reallocated to address this tremendously difficult challenge that we all face as a society.

Cheers,
  Sparky

Picture Credit ~ Jim C. Jeong for USA Today

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