But, Can We Get There from Here?

Abstract

One of the best analyses of the meandering path from the status quo in American healthcare to the promise of a more rational system was published by Harvard professor and surgeon Atul Gawande, MD, in a New Yorker piece earlier this year entitled ‘‘Getting there from here: how should Obama reform healthcare? (Gawande 2009a)’’ In it Gawande—a thinker and writer of exceptional insight and clarity—reflects on the haphazard, episodic fits and starts that produced the current ‘‘system’’ of health care, and traces a path for the future. The starting point of that path acknowledges the absurdity of where we are, and he suggests a combination of strategic and tactical shifts (not to mention political tides) that could move the system toward dramatically more equitable, effective and cost-efficient care for Americans. He suggests that the path forward will, as in the past, be neither linear nor neat. But his message is fundamentally one of hope and promise. I think that children’s mental health reflects a similar history of great hope and lost opportunities, of noble efforts and wasted time, of change and progress more honored in the breach than in the classroom or home or clinic. Reay and colleagues (current issue) place us accurately in the same context as the larger health care mess: ‘‘Despite efforts of government, universities, providers, and child and family mental health advocates, current delivery systems continue to cost too much, services are purchased in ways that defy common sense and are inconsistent with sound business practice.’’ This same theme permeated most of the other papers, as well, including some especially cogent thoughts on what we actually known about ‘‘usual care’’ (Garland, Bickman and Chorpita, current issue). And the outcomes of care remain only intermittently researched or linked to dissemination, as observed in several papers. I believe I share the concerns of many in attendance at this special conference and throughout the country when I borrow from Gawande to ask if we can even get there from here? Honored to be asked to provide commentary in this special issue, it seems germane to identify my multiple perspectives on these issues. I have spent more than four decades in the behavioral health/human services field, beginning as a child welfare caseworker in 1968, then moving to behavioral health as a ward attendant in a state hospital in 1969; 28 years later I left the same state system after a 2 year interim appointment as state commissioner of mental health. During that time, I spent more than 10 years working exclusively with children and adolescents with mental and substance use conditions. I have also been an educator, teaching as visiting or adjunct faculty during much of my career; when I left public mental health, I assumed a position as Professor of Clinical Neuropsychiatry and Behavioral Science at the University of South Carolina School of Medicine, retiring as Professor and Director of Health Policy Studies in 1997. I now work with two national not-for-profits: the Technical Assistance Collaborative, Inc, which provides consultation on human services, and The Annapolis Coalition on the Behavioral Health Workforce, which has highlighted the need for workforce improvement for over a decade. And finally, I am an advocate, proudly serving as chair of the Board of Directors of Mental Health America (formerly the National Mental Health Association), which celebrated the Centennial of its founding by Clifford Beers—who was himself diagnosed and hospitalized with a diagnosis of mental illness. All of which is to say: J. A. Morris (&) Human Services Practice, The Technical Assistance Collaborative, Inc., 1001 Barton Street, Columbia, SC 29203, USA e-mail: jmorris@tacinc.org