I go to most of the millions of meetings I attend so that I can advocate on behalf of consumers or educate providers and systems on behalf of consumers. Sounds fun, but it takes a lot of ... well, cojones ... to face down or gently persuade or whatever the situation calls for. And, of course, like anyone would, I get tired of it. So, meetings like that aren't often among my favorite things to do. I usually pay both a physical and an emotional price.
But every once in a while I get to go to a meeting that really does change my perceptions about our world. And recently, I got lucky—I was invited to participate in a very small, exclusive, high-powered "think tank" on the future of mental health care. I was surrounded by people from Harvard, Yale and Princeton. We had former state health directors, hospital system directors, insurance execs, pharma people, clinic directors, therapists ... and me. But hey ... at least there was a consumer there.
Before I go too much further, I do want to mention that you would be proud of how I represented consumer needs and interests in the meeting. At the end of the two days, many of these top-tier leaders said that the most important thing they gained there was an understanding, finally, of the disconnect between what consumers want/need and what the system is actually providing them. And I was able to "represent" that to them.
I wish I could share with you everything I learned, but I had to sign a confidentiality agreement. The information delivered and developed officially belongs to the consulting company that came in and the think tank's funder. What I can share with you, though, are some overriding themes for you to consider about the future of health care and what those might mean for mental health services. I doubt that you'll be surprised by any of these.
- Health care funding systems that are already-broken and not sustainable in the future: We face rising insurance costs—co-pays, deductibles, prescription prices—and increasing limits on what is covered. Could we be moving toward a system of catastrophic coverage only? By that, I mean we'd have insurance but it would only help us if something truly major happens to us. What does this mean for insurance parity? What does this mean for wellness programs or chronic care models?
- An increasing focus on evidence-based practices (EBP), treatment algorithms and data mining to identify what's working and which doctors have the best results at the lowest prices: As many before me have indicated, EBPs can be seen as simply a way to deny insurance coverage for anything not included in the "evidence." And that evidence is often, by its very nature, out of date and applicable only to systems and treatments that existed, say, 10 years ago. What does this mean for advancing research or having access to new treatments?
- An increasing impact on the provider workforce: If insurance gets more complicated, data collection more time-consuming and there are more pressures on doctors to fit treatments into artificial algorithms or EBPs, many doctors might opt out of insurance of any kind ... or of practicing at all. On the other hand, nurses might be used for 90% of our face-to-face time with the more expensive doctor being used just during the last 10% of our already-short visit. So, what does this say about the availability of psychiatrists?
During the meeting, I was asked to write a "headline" for a fictional newspaper story about what DBSA is offering in the face of these potential changes. My headline was "Sisters (and Brothers) are Doin' It for Themselves" (apologies to "The Eurythmics"). Not that I think we should throw away the doctors, the medication or the talk therapy. You don't want me to stop my meds, trust me. But what I do think we need, both now and in the future, is the type of wellness tools and resources that DBSA and other groups have been developing.
For example, a WebMD story that just came across my desk quotes Teresa Seeman, PhD, a professor of medicine and epidemiology at UCLA as saying, "Our research shows that having good long-term relationships provides as many physical benefits as being active or a nonsmoker." WebMD suggests that we all "Make the effort to connect with the friends you already have." Well, the nature of our illnesses sometimes means that friendship isn't easy or readily available. But a good support group, like the ones DBSA offers, can offer the same benefits as a long-term relationship.
The same WebMD article, entitled "The Happiness Factor," encourages people to write a gratitude journal. DBSA and other groups have online journals ... tips and tools for doing just that. We've also created online tools that are very specific to our diagnosis like mood charting and wellness planning (some amazing tools are available, for example, in our Facing Us Clubhouse).
So, in the face of a possible grim health care future, I've become even more convinced that personal wellness strategies are going to be critical in the years to come in the face of decreasing access to treatment and increasing costs. In other words, we need each other and we need to be "working our wellness" no matter what the changes are that swirl around us.
Published On: March 13, 2008
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