It is stuff like this that probably should make me happy but instead make me want to cry.
I am getting close to the end of a 36 year career as a Psychiatric Social Worker which was practiced for the most part in hospital and community mental health center based settings. For 18 years I was a "psychiatric assignment officer" in three large urban emergency rooms. I have evaluated and made dispositions on more alcohol, substance abuse, psychiatric, and suicidal patients than anyone in the United States.
In the late 60s, 70s, and 80s I worked hard to build up behavioral health services that comprised a system of care that offered continuity and a continuum of care for patients. In the late 80s, and 90s I have watched that system disintegrate as funding diminished, managed care rose up to erect barriers to access to treatment, and it became increasingly difficult if not impossible to continue to link patients with the care they needed. Services were curtailed, programs were closed, and patients were left to fend on their own, went to jail, or started to clog up medical practices and services. I have argued for years that decreasing behavioral health services drives up the cost of medical care, but short sighted bean counters wanted to save the immediate bucks by declining authorization for behavioral health services and closing programs. Of course, it has been a decade now, or a decade and a half, and low and behold a new generation of bean counters have taken over and what have they discovered ladies and gentlemen? They have discovered that the very services they denied and closed could actually save them money. WOW! Now there's a discovery.
"Offering brief alcohol counseling to injured patients in emergency rooms could save U.S. hospitals almost $2 billion a year, researchers estimate.
Researchers at the University of Texas Southwestern Medical Center used prior studies to analyze how much money hospitals could save by preventing future alcohol related injuries through counseling. In 1999, for example, they found hospital admissions declined by about 50 percent over the following three years for patients with alcohol-related injuries who received just one 30-minute counseling session."
And so, I am happy, really. I don't want to be cynical and bitter. I'm not. I just feel like a wise old man who has been there and done that, and I wonder at the human folly of the high and mighty who make decisions affecting the lives of millions of people for short sighted gains to further their careers and the bottom line which a decade later they discover were poor, ignorant decisions after all.
Hopefully, behavioral health services will get the recognition and support they deserve in contributing to community health. Rather than looking at our health care system in a linear, reductionistic kind of way, a systemic appreciation would lead to better decisions and judgments. In the day of specialization and special interests, it is rare to find policy makers, managers, and practitioners that have a systems wide appreciation of how the health care system inter - relates to produce overall the best possible outcomes, in the most customer satisfying ways, at the most efficient costs. It is the comprehensive systems view that will keep us from robbing Peter to pay Paul and then realizing that impoverishing Peter has made Paul a very expensive player in the health care game.