State Mental Health Plan Too large, Complex to Succeed?
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6 responses to “State Mental Health Plan Too large, Complex to Succeed?”
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The basic flaw in the Commonwealth’s mental health services system are the community mental services boards (Chapter 10 boards). They are not run by the state mental health agency, but by local or regional boards or agencies. State statutes set out minimum standards and requirements, but the implementation is up to the Chapter 10 boards. And there is no uniformity in their operations. For example, in my experiences as the DOC analyst at DPB, I quickly learned that some Chapter 10 boards had good working relations with local probation and parole offices in providing mental health services to offenders on probation, while other Chapter 10 boards were largely uncooperative.
Furthermore, there is little accountability for all the state appropriations to the local Chapter 10 boards. At DPB, several of us came to the conclusion that putting more money into those entities was like pouring money into a black hole.
In recent years, there has been movement toward making the system more accountable. It is called STEP-VA. JLARC has specific responsibiity for analyzing these efforts. There is a series of JLARC reports which will probably be more useful to you than that gigantic report to the feds. http://jlarc.virginia.gov/hhr-health-and-human-resources-landing-2.asp
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Thanks, Dick.
The program I assessed is STEP-VA.There is a big hole in the middle of STEP-VA.
My professional opinion is that unless legislation brings the Community Services Boards (CSB’s) under the operational control of the DBHDS, there is no chance or the “plan” to work.
That is an old government hand and enterprise architect talking. I respect your more specific experience with the players here. It seems we are in violent agreement.
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Yes, we agree.
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As someone whose family has worked with this system for 35+ years from the role of supportive family members of a client/constituent/patient of this system, as well as occasional testifier to the legislature (sibling of mine), I can attest to the complexity and challenges of the system. And, we mostly have worked with the Central VA CSB for Henrico/Richmond and Harrisonburg.
I used to work with many Enterprise Architects, and I have always appreciated their work because as James knows, before you can design IT systems that are efficient and optimal, you must first understand mission and business processes.
This is an attempt to do this and not surprisingly, you have layers upon layers of government agencies-programs at multiple levels (local, state, federal) with differening programs and NGOs also included in the mix.
I’m glad I am not attempting to “fix” this, just learning how to navigate it for a loved one is enough of a challenge.
Thanks for the post.
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Thank you. We both wish them well.
Your point about using a systems engineering approach to describe an architecture for this entire enterprise is on point. After reading 409 pages of program description, I found no evidence of it. If they had done that work, they would have proudly claimed and published it.
The systems engineering can be done retroactively and the plan changed as necessary. That would mean admitting that DBHDS had spent 9 years not doing it right. That realistically can only happen under a new administration.
I have forwarded to both DBHDS and Secretary Carey my suggestion for the state to take operational control of the CSBs. My assessment is that the plan has no chance of broad success without that. You can open the diagram linked in the column and see it with your own eyes. That is a copy of DBHDS’ own diagram.
Currently, of course, the state – DBHDS in this case – has no experience in operations management. That is why they could not see the problem presented by their own program description.
They will have to build an operations center and hire experienced ops managers to staff it. Then all of those dashed lines in the diagram will turn to solid lines.
Only then can they face the other monumental challenges with some hope of success.
If you want to weigh in with DBHDS and the Secretary, let me know with an email to Jim Bacon [email protected] and I will sent you the contact addresses. With your personal experience, your input would be valued. After all, the 409-pager is labeled a discussion draft.
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Completely agree with your point about the CSBs. My adult son has lived in Fairfax, Loudoun, and Prince William counties over the past few years. Not surprising considering his poor track record of complying with rental housing rules and the difficulty of finding affordable housing in the greater DC area. He’s worked with the CSB in all 3 areas and each one requires a separate enrollment process, different treatment approaches, and different levels of service. And each is more than happy to pass responsibility (i e. the cost) for his care to the other. The result is a lack of seamless care for someone who desperately needs it.
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