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My Turn: In health treatment, as in insurance plans, there’s no one-size-fits-all



Last modified: Friday, November 29, 2013
If we have learned anything from the recent debates over health care, it is this: There is no one-size-fits-all approach to providing quality and affordable care. It is critical for lawmakers to realize, likewise, that there is no single treatment solution for many of those in need.

At Riverbend Community Mental Health, our primary task is to assist those in need of mental health services. That’s an oversimplification, but that is the starting point to much of the care we provide. From there, treatment takes a complicated path of figuring out the best care for each and every patient.

Here is an example of the challenges we face: Most studies indicate that 75 percent of individuals who have a substance abuse disorder have a co-occurring major mental illness. No real surprise then that evidence-based practice urges that treatment for both 
these disorders is also 
co-occurring. Often only one of the two problems is identified. If this is the case, individuals may bounce back and forth between services for mental illness and those for substance abuse, or they may be refused treatment by each of them. Fragmented and uncoordinated services create a service gap for persons with co-occurring disorders.

Providing appropriate, integrated services for these people will not only promote an environment for their recovery and improve overall health, but it can help the effects that their disorders have on their families and friends. By helping these clients stay in treatment, we can begin to address some of the more costly societal problems that accompany these diseases.

In the past, New Hampshire Medicaid has not provided reimbursement for treatment of substance abuse and thus made it very difficult to provide proven treatments to individuals suffering with addiction. (Late next year, that rule is expected to change.) The recovery choices for them are few, and often hospital emergency departments end up providing detoxification protocols for them in inappropriate settings, only to discharge them to the street, where the likelihood of continued substance abuse is high.

Mental health and addiction have strikingly similar characteristics. They are both biological illnesses; they are both hereditary in part; they both have a profound effect on families; both diseases progress without treatment intervention; symptoms can be controlled with good treatment and facing up to the consequences of the progression of the disease can lead to depression and despair.

Just think about that sequence for a moment. It could well describe the early onset of diabetes, ALS, cancer and many other devastating disorders. These diseases always attract compassion and care from the majority of people, because the condition is considered the result of an unfortunate gene pool lottery.

Mental illnesses provoke a different reaction. Society views these afflictions through the lens of moral failure. Those who wrestle with substance abuse and mental illness are keenly aware of the way they want to feel. They, too, have an urge to health, a drive to be productive, a desire to contribute to the collective good of society in the same way the person battling cancer does! Shame and stigma are additional obstacles to overcome in their own personal recovery stories.

We can all help by increasing awareness that these diseases are not personal failures and that, with treatment, there is recovery, happiness and the possibility of a fulfilled life. The majority of our citizenry is touched by mental health diseases. It is not an abstract event that happens to others because of bad decisions they have made. We must acknowledge that treatment works, that people get better and that resources must be made available to support recovery through treatment.

We should never be embarrassed to offer a word of optimism and hope, no matter how gloomy the outlook. And we should never underestimate the power of a human being’s capability for recovery and self-assessment.

Once I read a satisfaction survey of an individual who had completed a seven-day medical detox for heroin. Asked about the quality of the food, he replied: “The food is terrible but that begins with me and the reason I am here in the first place.” In a setting where you often see people multiple times in their personal nonlinear journeys to wellness, I never saw him again. It clicked. He recognized his responsibility for his own recovery and was launched on a path to wellness and human prosperity. And it began with his own acceptance of his disease and a system of care that worked.

I urge lawmakers to keep in mind the need behind the type of care we provide, as they take the final steps toward creating a new system of health care coverage for our state and our nation. Our community’s mental health depends on your good decisions.



(Peter Evers is the new CEO of Riverbend Community Mental Health in Concord.)