We had the good fortune to spend a day with Dr. Ken Thompson, whose career in public service psychiatry spans over 30 years. Until recently, Ken was the Medical Director of the Center for Mental Health Services (CMHS) in the Substance Abuse and Mental Health Services Administration (SAMHSA) in the U.S. Department of Health and Human Services. In that capacity, he provided expert psychiatric consultation to public policy formation and implementation. He is a strong supporter of the principles and practices of recovery.
Given Ken's amazing background in community psychiatry and the big picture overview he had at SAMHSA, we asked him to tell us about what we should be doing to get prepared for the changes and challenges inherent in federal healthcare reform. His message was much more dimensional than it was a “to do” list. While the Healthcare Reform Bill did not address behavioral health concerns directly, he pointed out, those concerns are included as an element of overall healthcare-namely through the expansion of coverage, improved financial accessibility and the beginning efforts to redesign services.
In this context Ken spoke about the importance of partnerships with other elements of the healthcare system and the role these partnerships will play in healthcare reform. We're going to share the highlights of that conversation, first by discussing the nature of partnerships and then wrapping up with a list of things to do to get ready for “reform.”
Defining a “partnership”
Once Ken started talking about the concept of partnerships, we asked ourselves, “What is a partnership?” Webster's Dictionary defines a partnership as “a relationship resembling a legal agreement and usually involving close cooperation between parties having specified and joint rights and responsibilities.” Clearly Ken was describing a relationship that went far beyond a legal agreement.
What about the partnerships we see on TV? On lawyer shows, attorneys are always trying to “make partner,” so there you see partnerships that may need to be worked at and earned. Cop shows provide a different example, in which partners “have each other's back” no matter what-a good principle to keep in mind. Then there are the classic Westerns, in which one cowboy might say to another: “Howdy partner. Let's go round up some cattle.” This example speaks of friendship, collegiality, and mutual working relationships.
If we roll them all together, what do we come up with? “A partnership involves close cooperation between people with joint rights and responsibilities; people who work hard to earn the privilege of being a partner; people who look out for each other; people who value and enjoy their relationship.”
Unfortunately, there are not very many good examples of this type of partnership in behavioral health. At least, not yet.
Avoiding the “downhill” battle
There are two examples in behavioral health where the term “partnership” is used liberally-partnerships that funders have with providers, and partnerships providers have with the people they serve. The fundamental flaw in both of these examples is the imbalance of power between the partners. Let's take a closer look:
Partnerships between funders and service providers: A funding source often refers to the relationship it has with contract providers as a “partnership.” Yet, from the provider's perspective, this relationship certainly doesn't feel like a “we've got your back” relationship or one that promotes friendship and joy. Providers may characterize this partnership as “do what we say or get out of Dodge,” instead of the “Howdy partner” concept of collegiality. This sounds harsh, but let's be honest. This is just one side of the story, and maybe in another article we'll get the other side from funders. Nonetheless, this is not a model to be emulated.
Partnerships between service providers and people who use services: Service providers often refer to people who use their services as partners. With a few exceptions, service providers make the same errors (described above) as funding sources do-they do not operate on a level playing field. They assume they know what's best, and they make decisions for people without empowering the person to make their own decisions.
This is pretty interesting, don't you think? It illustrates that yucky things really do roll downhill. The mistakes around partnerships made at the highest level are replicated at the lowest level of our system. We can't expect to do what we've always done, so we need to prepare ourselves for real partnerships with primary care and learn new models.
We would give you a perfect recipe for developing successful partnerships, but alas, we're still trying to figure it out ourselves. We do have some ideas, though, that might help you avoid some of that stuff that's rolling downhill. Here are a few ideas to get your partnerships off to a good start:
Develop a relationship and protect it with your life. This will be your vehicle for maintaining a good foundation. Gain a good understanding of what's important to each of you. Share your fears and hopes.
Develop a shared vision statement-not yours and not theirs, but a new one that you share that guides your work together. Make sure it causes your hearts to sing, inspires you and those you serve, and has meaning and purpose for all involved.
Talk about the strengths of each partner. How can they be applied to the shared vision? How can you bring out strengths in each other?
Talk about the limitations of each partner. How can you support each other to compensate for weaknesses?