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Community Mental Health: Adds Value and Makes a Difference

Oct 28, 2017 by

Tom Watkins –

I have witnessed the public community mental health system unfold, in one capacity or another, for 40 of the past 53 years since President John F. Kennedy’s signing of the Community Mental Health Act of 1963. 

I have been a therapist, a program coordinator, director of a local CMH agency, deputy director of administration and chief deputy and director of the former Michigan Department of Mental Health under Governor Blanchard. After four years as President and CEO, and leading the transition from the former Wayne County Community Mental Health Agency to the Detroit Wayne Mental Health Authority (DWMHA), it is time to move on. The DWMHA is now an independently governed, $700 million dollar “Authority”. Effective August 31, 2017, I will step down to explore new opportunities. 

I have both witnessed and helped facilitate change that has led to progress for this organization from its beginnings four decades ago. When I took the job with DWMHA I brought forth a set of guiding principles (http://www.dwmha.com/files/2515/0186/6904/Authority_Guiding_Principles.pdf) that I believed could provide a foundation upon which our system of care could be developed going forward.  These guiding principles say that we exist to serve and support individuals with mental illness, developmental disabilities and substance use disorders. Everything we do should be towards that end. We must always ask ourselves: ​​​​​​​‘How do our actions help the people we are committed to serve?’

Author Tom Watkins addresses more than 800 of his public community mental health colleagues at the CMHA (Community Mental Health Association).  “Embrace human values, lead, change or die” he challenges his colleagues.

Change Management that Leads to Progress

The improvements the DWMHA team has made to both operations and service are remarkable, universally acknowledged and I expound upon and lay out challenges that lie ahead in a recent Dome Magazine article (http://domemagazine.com/tomwatkins/tw081117); numerous national recognitions, awards and documentaries the DWMHA has produced can also be found in our Annual Report (http://dwmha.com/files/2814/7940/6323/Annual_Report_2015-2016_Website_Copy.pdf). 

A pathway forward to keep the focus on consumer care and support has been laid out.  The landscape of community mental health is forever changing. As we look to the future the one certainty we can predict is that there will be constant pressure to adapt and change, or become irrelevant.  Change is never easy, but producing change that adds value to the consumer and taxpayer on both a short term and long term basis is far more difficult. 

Decisions that benefit consumers and taxpayers vs. the “system” will take us down a path that will add value and make a difference. If power, control, politics and ideology drive policy decisions in the coming years, I predict future policy makers will have a huge mess to clean up down the road.

So here we go – my predictions, suggestions and ideas to help promote a mental healthcare system that is responsible for the care and support of hundreds of thousands of our fellow vulnerable citizens. Physical healthcare will not stand separately from behavioral healthcare – it needs to be integrated into a single delivery system. We need to treat the whole person; the mind is connected to the body – it is foolish to proceed as if they are disconnected.

Some of the ideas presented here have been articulated by others. Some are bolder than others, and a few purposely push the envelope to force policy innovation, making others rethink long held positions. All are offered as a way to better serve vulnerable people while maximizing value to the taxpayers.

Advocacy/Collaboration “Innovative Initiatives”

  • Pass legislation that mandates the health plans and public mental health systems find administrative efficiencies, without impacting consumer care/service, of at least 5% which would be redirected to consumer service. With a budget of $2.6 billion for behavioral health systems and $9 billion for Medicaid Health Plans, $580 million would be redirected.
  • Stop the stigma of mental illness and demand Congress appropriate money to research the causes of serious mental illness, developing responses to these disorders that wreak havoc on individuals, families and society. Advocate groups need to make this their next “big thing”. 
  •  Digital technologies and Artificial Intelligence will change social interactions and behavioral health services profoundly. More and more consumers of behavioral health services are digital natives, having grown up using technology on a daily basis. Chatbots, intelligent personal assistants, artificial intelligence-supported messaging apps or voice controlled bots – all are forecasted to replace simple messaging apps soon. In healthcare, (behavioral health) these could well take the burden off of medical professionals in regards to easily diagnosing health concerns or quickly solving health management issues.
  • Read about the evolution of bots as health assistants: http://medicalfuturist.com/chatbots-health-assistants/
  • The Governor should call on Michigan’s universities, the tech community and professional behavioral health workers to design apps that take the lead in developing technology based apps to meet the needs of over 300,000 citizens in Michigan using the public behavioral health system of care– helping them not just live, but thrive in society. Foundations should put up significant “prize” money to develop technology approaches that would lead to:
    • Enhanced quality of life for those using public mental health and substance uses services
    • Reduced length of time in state in public and private hospitals
    • Reduced suicides
    • Other measurable improvements in quality of life and saving tax dollars.
  • Survey behavioral health professionals, consumers and their families about their most frustrating problems, then seek assistance from university professors and grad students to do the research that addresses these real life issues. Tie university funding to helping to address real life needs that impact people in our state.
  • Arrange to have regular meetings between leaders of the public and private (profit and non-profit) health plans around ways we can work together to meet the needs of society’s most vulnerable people. Fostering better relationships between the two entities can only benefit consumers.

Tom Watkins (along with Nick Lyon, Director of the Michigan Department of Health and Human Service and Bob Sheehan, CEO of the Community Mental Health Association) receiving the top recognition by his colleagues, “The Hal Madden Award given to individuals from within the public mental health system who have made, over time, an outstanding contribution to the public mental health system.”

Suggestions “Thinking Outside the Box”

  • Study how the public policy to close state hospitals en masse in the 90’s contributed to today’s problems (jails and prisons being the de facto psychiatric hospitals). What are the “lessons learned” that policy makers should take into consideration in their march to turn $2.6 billion dollars over to the private/profit-making Health Plans?
  • We should radically change where and how traditional mental health services are provided. Gone are the days of the traditional fifty minute therapeutic hour in an office. We need to adapt mobile technology to meet the behavioral healthcare needs of our community going forward.
  • Stop paying lip service and truly engage consumers and behavioral healthcare advocates on an equal plane. This means assuring the consumer mantra, “nothing about us without us”, is not simply a slogan but a reality. Look to fund advocacy organizations at an adequate level to enable them to hold the system accountable. Without their eyes, ears and noses in our business the system will slip off track and the consequences will be as devastating to people’s lives as they will be costly to repair.
  • The behavioral health community must find ways to more effectively engage employers to meet the needs of the ever changing workforce while helping to increase worker productivity and reducing employer cost. The silos between employers and health professionals need to be breached. We need to partner with employers around behavioral health awareness, acceptance, prevention, and recovery in and out of the workplace. Employers should be viewed as allies not adversaries.
  • Commission a study that shows the good, the bad and the ugly – what is working well (and what isn’t) in the public mental health field under the auspice of public control. What is working (and not working) in the private/ non-profit and profit health plans. Use this data to make public policy going forward.
  • Create legislation that no state administrative official, legislator or legislative staffer involved in the transfer of public money to the private/profit making Health Plans can accept a job, contract or any form of remuneration from the industry for a period of two years after leaving state service.
  • Move to have non-violent persons in our prison system with serious mental health disease transferred out of corrections and into a proper behavioral health programs when appropriate.
  • Hold local profit and non-profit hospitals accountable to serve persons with serious and acute mental health issues in their communities (it is a known fact that games are being played to avoid serving these citizens). The State needs to get serious about using all the tools at its disposal, including Certificate of Need, Licensing, and tax policy.  Penalties include revoking tax exempt status from nonprofit hospital not serving the public need, invoking significant financial penalties, etc. It is unacceptable that persons with mental illness in need of a hospital settings are being denied service.

Predictions “Mental Healthcare in Michigan”

  • We are going to see a massive consolidation of public and private healthcare and behavioral healthcare organizations. One thing is very certain: escalating costs, fewer resources and pressure for efficiency will result in fewer and bigger private companies, taking over smaller and less powerful public agencies. We will see significant consolidation driven by the notion that integrated consolidated systems are more efficient than large numbers of public and nonprofit organizations. Well-positioned hospitals and national insurance companies buying provider organizations while well run, efficient and entrepreneurial provider groups consume other nonprofits. 
  •  If public providers of behavioral health service wish to survive in a new world order they must find new, non-traditional partners and take on an aggressive entrepreneurial spirit. What is the niche you do better and cheaper than anyone else? If you don’t have one you will be irrelevant going forward.  Staying even is falling behind and you will disappear going forward.
  •  The trend to integrate physical and behavioral health care is real and moving forward, it is not a matter of “if”- but “when and how.” We must truly work to find ways to fully integrate all services that benefit the consumer and taxpayer.

Joe Stone, President of Community Mental Health Association, Tom Watkins and Bill Allen, all exceptional leaders in the community mental health movement.

Going Forward

The vision, values and dedication of the public behavioral health community in Michigan are second to none. Never shy away from advocating for what is right. There are leaders among you. Stand up and be willing to lead going forward. We must always act as though the decisions we make will impact someone we love – because ultimately it will.

When I took the reins of the Detroit Wayne Mental Health Authority I presented a mantra that we would be: Consumer- and community-focused, data-driven and evidence-based in all we do. We need to encourage all in the behavioral health and healthcare business to adopt this mantra. I know the road ahead seems uncertain. It is for this reason I implore you to not simply sit back and adapt to change – but to boldly lead it!

While I am leaving my role at DWMHA, I am not leaving the field. Collectively we need to join with advocates to change what needs to be changed while preserving the value and the values of the public mental health system. There are so many good people, past and present at DWMHA, CMH, PIHP, MACMHB, MDHHS, advocate groups, providers and more that I have worked with over the years. Thank you for your support, friendship and for standing up for what is right. Together we have—and will continue to—make a difference!

Tom Watkins is Michigan’s former state superintendent of education and a business and educational consultant in the US and China. He is an advisor to the Michigan-China Innovation Center, Detroit Chinese Business Association, and Michigan US/China Exchange Center. He can be emailed at: tdwatkins88@gmail.com, or followed on twitter at:@tdwatkins88

Source: Community Mental Health: Adds Value and Makes a Difference

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