I have an ax to grind with the mental health system in our country. I've long suspected that our mental health treatment systems are probably inefficient, but my views came into sharper focus over the past few years as I attended graduate school for social work, completed my internships, and, following graduation, gained employment as an outpatient substance abuse counselor -- a position which I have since relinquished.
To clarify: an inefficient system, to my way of thinking, is one that consistently fails to produce the outcomes it is purportedly designed to produce.
One thing that many people, and many organizations, have been really good at throughout American history is making money.
(dollar dollar sign, y'all, from Google Image serach)
Think about it: each of the products we all know and consume -- from McDonald's to automobiles to clothing to gasoline to TVs to music to computers to cell phones -- started with someone having an idea and creating processes by which to mass produce, market, distribute, and sell the manifestation of that idea for a profit.
Put another way, many people throughout history have made a lot of money because they turned their idea into a commodity, i.e., a sought-after, even needed, object. Consumers spend enormous sums on the products I listed above (and many others, of course); and, as many of us know, banks and lending institutions have expanded the availability of credit to consumers over the past 50, 60, 70 years, thus making it easier for us to spend even more on these products. Money flows out of consumers' pockets and trickles up, if you will, the organizational chain, with the result that lots of people -- not just executives making millions -- earn a good living.
I'm not here to criticize that model. It brings its problems, of course, but it's also brought a lot of good in terms of facilitating a better way of life for many people. No, the thing I want to underscore about that model, rather, is that it is a highly efficient system. Capitalism is explicitly about making money, and many systems created within the capitalist paradigm -- successful businesses -- have done a very good job of doing just that: making money. Like it or not, that's efficiency. Like it or not, it can teach us something here.
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When I got to grad school, and I learned more about the realities of mental health provision in our country, I found myself asking, "Why haven't we figured out a way to make our mental health systems efficient?"
An indicator of the systems' inefficiency, to me, is the abysmal pay, generally speaking, of mental health professionals. Having a systemically underpaid professional workforce creates numerous problems. For one, many mental health professionals find themselves needing a second job to make ends meet. Sadly, lots of folks do that these days, so it isn't unique, per se; but the issue is that an exhausted mental health worker is less likely to be an effective mental health worker -- which means, of course, the client suffers. Another issue here is that systemically low pay contributes to high rates of employee (therapist) turnover. After all, if you have a master's degree (or a doctorate, even), and you're working your ass off, but you aren't earning enough money to cover your expenses, you're probably going to seek other opportunities, right? And who suffers when there is high turnover among therapists? Again: clients.
Agencies also suffer when there's high employee turnover, actually. The process of recruiting, hiring, and training new employees is very expensive. It stands to reason, then, that if an already cash-strapped organization is hemorrhaging resources on employee turnover, there will be even fewer resources to allocate to other aspects of organizational upkeep; this, in turn, adversely affects the clients. Once again.
That, folks, is a horribly inefficient system. I'm going to go a step further and call it what I think it is: broken. It's ironic that a system which is supposedly intended to help people find a more satisfying equilibrium is itself so out of balance.
(from Google Images)
In many of my more entrepreneurial, ambitious moments, I've thought, "What we need to do, basically, is commoditize mental health services. We need to educate the public and our elected officials about the realities of mental health issues; i.e., that they aren't just about being "crazy" or not. We need to sell the public, and our elected officials, on the reality that having excellent mental health services is both vital and highly desirable (just like cell phones are highly desirable). Yes, we need to market and sell these ideas, because right now, mental health is erroneously seen as a liability -- something the government takes care of. We need to help folks realize it's a need, and see the benefit of having that need fulfilled; and once we do that, political and systemic changes will follow."
Admittedly, that's a rather innocent line of thinking, but I stand by the essence of it, because I think it's true. What occurred to me, though, is that this magical system is already in place in the mental health world. Who, or where, is it? It's the pharmaceutical industry, folks. The pharmaceutical industry has done an amazing job of turning mental health into a commodity, they really have. Feeling depressed? Take this pill. Having some psychotic tendencies? Take this other pill. Anxious? There's a pill for that, too. They have successfully raised awareness, via ad campaigns, about their products; and they have created the perception of need -- i.e., a market -- among the general public.
Listen, psychiatric medication is, or can be, an extremely important variable in the mental health equation. I support their provision when they are deemed clinically appropriate -- period. What I mean to illuminate, rather, is that the pharmaceutical industry, from a policy, process, and fiscal standpoint, is getting the lion's share of mental health resources in our country. I do not blame them for this, because they have only done what they were designed to do, after all: create a product, and sell it for a profit. Since they have done it well, they have been given the resources they need, politically speaking, to keep it up.
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It is my position that non-pharma mental health systems can take a cue from their pharmaceutical colleagues. I'm not suggesting that they seek to outright emulate the pharmaceutical industry, but I do think there are lessons to be learned there. I don't have the answers as to how those lessons should be learned or implemented, but I think it needs to happen.
I understand that many folks have negative feelings about the pharmaceutical industry for a variety of reasons; I also understand that many folks are very "down" on capitalism. My view is this: whether you're down on it or not, the bottom line, for now, is that it's the system in which we operate, and in the meantime, people who need help are not having their needs adequately met. To me, if taking cues from an already-existing, highly profitable industry model could help us fix our mental health system as a whole, then why wouldn't we do it?
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