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March 24, 2009
by Terry L. Stawar, Ed.D.
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In the movie Tommy Boy, Chris Farley starred as hard-partying Tommy Callahan. As the film opens Tommy has managed to graduate after seven years at Marquette University, by finally getting his grade point average up to a D-. Proud of his dubious achievement, Tommy tells his friend, “They don’t like to give a lot of them.”

The National Alliance on Mentally Illness doesn’t like to give many of them either, but on their 2009 report card, America, like the feckless Thomas Callahan, has again received an overall grade of D. My state received the same D it obtained on its last report card back in 2006. Three years later, they say they haven’t seen much progress. While maybe not much has been done in improving the financing of public services, a lot has been done in service provision.

I not sure whether these public chastisements help or hurt us. What do legislators and the public really hear? The sound bite is simply “The nation’s mental health system is woefully inadequate”. I don’t think very many folks, without some vested interest, read between the lines and comprehend what it means when NAMI says that a state has a “strong network of community mental health centers” or “many centers have successfully implemented evidence-based practices”. All they see is the grade. Positive developments apparently have little impact on the overall grading in any event. And things haven’t improved much since NAMI started these reports.

Of course, we will all try to spin the report so that it strengthens our perpetual plea for more funding. But working for the past 35 years in community mental health, I have only known a few instances where a community had much more than 50% of the resources it actually needed to adequately meet the entire demand for services. 

Occasionally the reports seem to provokes state governments go on the offensive and attack its credibility, rather increase support for services. NAMI also runs the risk that their constant nay-saying will portray the system as a lost cause, undeserving of any further investment.

I would like to see a clearer distinction made when giving grades, between quality of service provision and the amount of public support a state provides. I know that conflict is the engine that drives public interest and newsworthiness and maybe that such inflammatory indictments are necessary to get the public attention. But how about some specific standards for state funding or maybe a model financing scheme for adequately support services nationally?




Terry, your comments mirror my own concerns about how providers might be viewed in light of this report. People and the popular media zero in on the "D," and can miss the great work being done despite the *huge* challenges.

Reducing the state of affairs to a letter grade might be quick and easy, but it fails to capture the essesnce of the need and does not create a better public understanding of need. That would seem to be one of the goals of the study. In Oregon if you qualify for disability, the treatment is passable. However if you do not qualify for treatment as disabled, there is no treatment whatsoever. None, that is unless you think "treat 'em and street 'em" via emergency rooms is a treatment "system." I guess that grading is done on a type of perverse average system. Perhaps a one word grading system might be more in order such as "inconsistent." If that were true, the most common grade would be 'Incomplete" or "Inadequate."


Terry Stawar

President/CEO (LifeSpring, Inc.)

Terry Stawar


Terry L. Stawar, EdD, is President and CEO of LifeSpring Health Systems, a community behavioral...

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