Improving Access to Care

The Maze

In a society where there is still such stigma attached to mental illness, it is a tremendous challenge just to be able to seek care. Weaving through the process of care for mental illness can often seem like a labyrinth sometimes frought with dead ends and with no clear end point. Even though mental illness is conceptually no different from a disease like cardiovascular disease, one must sadly first “admit” they are mentally ill. The fact that it seemingly requires an admission highlights the initial obstacles to care. Accepting help is not a “shining light” turning point in the process however, for a second obstacle to care lurks just around the corner.

 

Symptoms of mental illness can include disorganization and limited focus ability. Yet, we ask those that suffer to manage a complex system of healthcare that can require multiple appointments lumped together in just one week. Scheduling, coordinating and attending those appointments, along with managing multiple medications and tracking progress are all tasks that can be nearly impossible for a sufferer to successfully master. Missing one cog in that machine can cause a delay in the overall process, sometimes resulting in delayed care for weeks.

 

Chad’s story illustrates how those delays can actually be the difference between life and death. Even with support at home, there are limits to the effectiveness a loved one might have in the role of a care coordinator, especially for an adult patient. Clear care pathways, often a standard of care for most diseases,  are not currently available for those with mental illness.  Tangible progress in care is the ultimate goal that provides hope to those that suffer. Hope is a critical motivating factor in a patient's commitment and continuation of care.

 

Improving Access and Outcomes

Another key aspect of our goals within Chad’s Legacy is to push for the development of closer care coordination and follow up with those in the mental health treatment system. It is unrealistic to assume a mental health patient will effectively manage their own care, once care has been established. For that reason, a care coordinator is needed in a social worker role to proactively track appointment attendance, the patient’s constancy in taking medication dosage and collecting feedback on progress and side effects. Today, this information is often gathered only bi-weekly during outpatient care, if the person is able to make their appointments. We support King County Government's current efforts to expand a Peer Bridger program that pairs an individual new to the mental health treatment system with a trained peer with lived experience in navigating the care system and recovery process.

Coordination of mental health care in the early stages can only be truly effective if done no less than weekly and ideally more frequently than this. These “check-ins” can be performed by phone, but must be a regularly scheduled occurrence, with this collected information flowing to the Psychologist or Psychiatrist for regular review outside formal appointments. by providing this level of support, adjustments to care plans can be quickly adjusted and patients can get critically needed care in a timely fashion, perhaps even averting trips to emergency rooms or prolonged hospital stays. As symptoms improve, coordination can relax, but early treatment must have frequent and regular support with this new treatment component. It suffices to say that this coordination should be covered in all health care plans for mental health.

 

Needed Study and Current Opportunities

It's no secret that the proposed solution would be a substantial investment added to the cost of care for the mentally ill. It is our hope that studies in data, perhaps even supported by the Chad Crooks Memorial Fund for Psychiatric Research, can help prove a positive return on that investment, not only in cost, but in lives.

The emergence of a trained peer support service is showing promise in these needs. More information on Peer Bridger counseling and care coordination and efforts to expand services can be found here.

Washington State now has a robust training program for what Chad's Legacy Project regards as the new front line of care, especially among those first navigating the complex system of care in mental health. The Washington State Healthcare Authority provides a 40 hr course by which individuals with lived experience can be trained as Certified Peer Counselors. These CPC's are able to work within the Behavioral Health workforce as a billable service, aiding in the trust between patient and provider and instilling hope through example in powerful ways other professionals cannot. We are committed to the growth of this workforce and offer the Chad's Legacy CPC Scholarship Fund to those that may otherwise not be able to afford the time off to attend the training.

​© 2019 Chad's Legacy Project. Seattle, Washington

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