Last month we opened a conversation about the merits of program integration. We focused on two topics: the benefits of integrating peers into a traditional workforce and the advantages of integrating physical health services into behavioral health services. In both cases, the evidence supporting integration is indisputable, yet the implementation is very slow in coming.
We ended the conversation by pointing out the urgency of beginning the integration process now. Yes, there will be resistance. But if you resolve your own resistance first, you'll be in a good place to help others move through theirs.
Your own resistance may sound like this: “Integration is obviously a good idea, but we can't get into it right now. We have too many other priorities and too many things are up in the air-funding cuts, regulations, and so on.” We pointed out that these are exactly the reasons why now is the best possible time to move integration forward. When things are up in the air, they are easier to move-it's a law of nature.
Last month we gave you several ideas on how to get started. This month we want to talk directly to you, regardless of who you are or what part you play in the program. Since the readers of this column seem to run the gamut from service users to service providers, we're going to give each of you some unique assignments on how to participate in the changes required for integration. Of course, there will be some overlap, so you can read each of the assignments and borrow ideas from each other. Then again, there are also things that you alone will be best at carrying out. But it takes all of us, a unified front, to create positive change and to make a big difference.
We want to remind you of the importance of our mission before we hand out assignments. The integration we are talking about will bring significant improvements for those who use our services. So this isn't just another one of those reorganizations based on turf wars, ego trips, or economy. The integration of peers and physical health into behavioral health services will result in people getting significantly better services.
Research shows peers to be very effective additions to the workforce given their ability to engage people and build relationships based on strengths. And in terms of physical health, the lifespan disparity for people diagnosed with a mental illness (an average of 25 years shorter) is enough reason to integrate physical and behavioral health services immediately. Agreement abounds on both of these issues, yet not much happens.
It's time to hand out the assignments. First, here are some tasks that apply to all of us:
Please go back and read last month's column. This will give you some general ideas and some tips on how to proceed, regardless of your position in the program.
Try not to ask “What's in it for me?” when it comes to integration. There is a lot in it for all of us, but if that becomes our focus, we will be blinded by self-centeredness and unable to see the bigger picture.
Try not to look around and gauge the commitment of others in order to measure your own. This is about you making a difference by maximizing your own inherent abilities. It's about doing your best.
Now let's get down to the individual assignments. Start at what a traditional organization considers the bottom of the classic organizational pyramid-just below the front-line workers. Here's where we find the service users-the reason the whole organization exists in the first place. (A recovery philosophy suggests turning the pyramid upside down with the service users on top where the decisions are made, as seen in the figure-but we'll save that for next month's column.) Service users, here are your assignments:
Check your attitude. If you see yourself as a powerless victim with no influence over what happens in the programs offered to you, get over that right away. Owning your own personal power is one of the first steps toward recovery. So see yourself as someone who has an important contribution to make to the planning and delivery of the services you hope to receive.
Think about the ways a peer could support your recovery process. Think about how your health could improve if you could get physical health services combined with your behavioral health services. The concept here is that your health providers would actually talk to each other about what they are doing to improve your health. What a concept!
Once you have a clear idea of how these services could benefit you, start talking to people about it. Talk to other service users, your physical health doctors, your treatment team, and your legislators. Speak using language that is simple, passionate, and clear.
Don't get mad if you don't get your way. Be reasonable and persistent, and be willing to compromise. Don't give up; just keep chipping away at it. Service users still outnumber service providers and if you get your act together, you can change the whole system.
Next up on the classic organizational pyramid are the front-line workers. Your front-line workers may feel like some of the least important parts of the system, but this is not true. You are the eyes and ears, the arms and legs, and, most importantly, the voice that communicates what you are experiencing firsthand. If you go about your job just “putting in your time,” your voice cannot convey the important information you are able to gather. Here's what you can do to move transformation forward:
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