Monday, March 16, 2009

How to make enemies amongst the mental health advocates in NC : boundary issues & how NC DHHS/ Centerpoint LME stands to profit

Dear Mental Health Advocates and Mental Health Association folks in eastern NC:

NC DHHS is counting on us falling into a heaping, blistering mass of 'he said, she said.' So is the NC State Legislature. So is the Centerpoint LME. So is the Forsyth Medical Center. So is Old Vinehard Behavioral Health. So is Smoky Mountain Center LME.

The only LME with which I am familiar that I would venture has some scruples is Western Highlands Network LME who has people at the top who don't smile at you : they let you know that they are the regulatory agency. Don't send us candy at Christmas; we'll send it back. Don't send us get-well cards; we don't want them. You stay over there and we'll stay over here.
Boundary issues.

I salute the Forsyth MHA effort re: trying to discover if there were changes regarding providers and consumers, as per their surveys from 2006 to 2008 . However, effort does not equate to good work. And if you are being looked to in order to provide accurate information, that's one thing. If you are being looked to, with the assumption that you are attempting to put a salve on things and make things better, that is another thing.

From my viewpoint, the MHA-Forsyth 2008 report served the purpose of making it OK that the Centerpoint LME, whom the mental health advocates have labored to call to task, continue to try and get a little better every year. I expect there will be another report in 2010 which will echo something similar: we made a little progress, not much (oops: don't look at the data points please).

And so, here is where I stand pertaining to my assessment of anyone or anything's work: WHO IS SPEAKING?, vis a vis Michele Foucault, a French philosopher. Who are the powers that stand to gain? Who is speaking?

I will not engage in this 'he said/ she said.' Let us be adults and let us consider that we all could benefit from healthy boundaries.

It may be that the Forsyth County MHA is the 'best in NC.' We all work hard given the limits of what we can do. I believe that almost 100% of people who work in the arena of mental health have a desire to help people. It IS important to keep that in mind.

However ----all of us, and I include myself----make efforts that run amuck for various reasons: you don't have the time to do the task; you want to get along with others whom you perceive to protect your back; you over- or under-state what you know; you grow giddy with power.

I believe that the biggest barrier to moving mental health care ahead in NC---or any other state or country in the world----is associated with the keen desire to get along with others. This is true about any difficult agenda. You make coalitions, you create dyads----and in this way you perceive that you slowly move things ahead. Not as far as you would like to move them but slowly.

Such affiliations, while many may perceive them as being necessary, there is a role for the person who stands outside the circle and maintains boundaries that are not permeable on the basis of 'gee, let's get along.'

This is how state legislators create dyads of power: you watch my back, I'll watch yours. This is how mental health advocates create groups that have a common agenda. Again, while these coalitions may serve to alert the public to some pressing public health issues, too much of the time such coalitions fall prey to cozy relations that eschew frank comments.

To suit, from what I can tell, NAMI NC, has such an agenda. They were perfectly willing to use the 'D' that was apparently rendered by NAMI National in order to speak to the continuing problems associated w/ NC mental health. But I'll be damned if NAMI NC aren't the people who have done more to allow this train wreck to cascade into one long blistering eyesore and mental headache.

Multiply by 10 that responsibility that fell on the shoulders of the NC Psychological Association and the NC Psychiatric Association----the professionals who threw their hands up in the air and ran away. Actually, they didn't run away. They just put up gigantic fences so that nothing could get in and nothing could get out, much like Plato's allegory: gee, these shadows are reality-----AREN'T THEY?

All these groups could have held state legislators feet to the fire and yet they went along, hoping for some spot at the table. But people wanted to get along more than they wanted to speak the truth.

I submit that one of the reasons that professionals do not participate in NC mental health reform is because they are not eager to take on the irritation of the mental health advocate community.
I am very clearly attempting to make a comment about boundaries here. The mental health advocate community has an opportunity to critique what I have critiqued. Bring out your best statisticians; let's hear from your creators of surveys and psychologically oriented instruments. Let's have the data and information from the 2006 survey you did, MHA-Forsyth.
Or are you going to boo hoo and resubmerge yourselves into a collective that evades standing up and asking for what you want and desire? Are you going to ask for good reports based on sound data collection that substantiates you as significant players to be dealt with?

Let's not critique each other at the level of, 'well, don't you want to get along with us?'

Not if it means I shut up and give special favors to someone's study. This is a boundary issue. This is where you differentiate yourself from me. And to my mind, boundary issues are the biggest, most disavowed and ignored issue in mental health. Boundary issues implies respect for what the other has said. You may completely disagree and if so, state how.

People who work in academia, as I do, take no survivors. I have seen colleagues make blistering comments on someone I might assume they value and like. It is true that this can turn into oneupmanship but on the other hand there is a freedom to critique that is revered and is not associated with, "I'd rather get along with you."

There is a German tale (where the really old universities are) associated with how a dissertation is defended. Yes, that is the term: a dissertation is defended by the person who did and wrote the research. The tale outlines that you leave the knives and swords at the door for you are about to engage in a task that may make you want to kill someone else.

When I lamblasted the 2008 MHA-Forsyth report, I used my moderate amount of knowledge as associated with how surveys are created; how data is utilized; how do you compare sets of data; what you can say from your data.

I believe that what I had to say about the Mental Health Association of Forsyth county, as related to their report evaluating consumers and providers in 2006 and 2008 is, to the best of my knowledge, accurate in terms of the 2008 data information which I was given. I believe it is public information but I may be wrong. I know that advocates around Forsyth county worked long and hard to get the results.

Limitations may be in the form of : lack of funding; lack of education; lack of expertise; lack of Its all well and good to want to do right and make things better. I think that all of us who work in mental health have that as a primary initiative. And I salute the Forsyth MHA effort re: trying to discover if there were changes .

However, effort does not equate to good work. This is like a child asking that the teacher give you a good grade because you 'tried really hard.' The teachers that caught my attention and made me sit up were the ones who gave me F's. MAN: I'd better see if I can understand what you are talking about.

And if you are being looked to in order to provide accurate information, that's one thing. If you are being looked to, with the assumption that you are attempting to put a salve on things and make things better, that is another thing.

This ain't no time to sing Kumbaya, my friends.


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