Human Services Hunger Games
by Andrew Malekoff © 2012
I am gradually losing step with the pop culture juggernaut. By the way, juggernaut refers to a relentless force, movement or object that trounces whatever is in its path. The term originated from the Unstoppable Juggernaut, a fictional character who first appeared in Marvel Comics’ X-Men. I share this only to establish that I do have some pop culture street- cred.
Nevertheless, I thought Hunger Games was an eating competition until I discovered that it was a post-apocalyptic science fiction novel written by Suzanne Collins. The book features 16-year-old Katniss Everdeen who volunteers to take her younger sister Prim’s place, after Prim is chosen by lottery to participate in a government-mandated, nationally-broadcast, fight-to-the-death battle among 24 teens and pre-teen “tributes” living in 12 districts of the nation of Panem. The goal of the games is to be the last one standing.
I read Hunger Games with a dual consciousness. I was absorbed in the fabulous and chilling story and I was tuned in to the story as a metaphor. The last-man-standing theme reminded me of the struggle for survival that community-based mental health agencies in Nassau County face. I have addressed this extensively in my published commentary and testimony before legislative bodies for years. For instance, in a 2009 piece that appeared in the Albany Times Union I wrote, “More low- and middle-income families than ever are in need of low-cost, high-quality community-based mental health care. Yet, the state Office of Mental Health, along with the state Health Department, is aggressively pursuing a "reform" plan that will assure continued access to care only to children and families with Medicaid fee-for-service insurance coverage. This will leave a significant number of children and adults in the lurch.”
Just to show that I wasn’t “blowing smoke,” if you fast-forward to 2012 you will find that there are community-based outpatient mental health providers in our backyard that closed their doors, were taken over by larger corporate entities with no community roots, transformed their operations into per diem factories with little capacity for dealing with complex or crisis situations or restricted their clientele to a residual population of Medicaid-insurance carriers.
Others are working diligently to preserve the integrity, character and culture of non-restrictive, universal community-based care. When our children, and their families, face the worst of times they need a place to go that is easily accessible and available to respond to emergencies, offers a continuum of care and feels like home and not like a factory.
For many community-based mental health centers, from a family’s first contact to their last, the work requires collaboration, most of which is not fee-producing, with a variety of service providers. Hours are spent with school personnel, hospital-discharge staff, probation officers, preventive workers, case managers, family advocates and child-protective service workers, to name a few.
The children at highest risk need a continuum of outpatient-based triage and emergency services that allow for seamless, timely and successful discharges from hospital to community. Experience has shown that hospitals will often not discharge children to private practitioners. Families, particularly those with children who have serious emotional disturbances or are in psychiatric crisis, require more assistance than can be provided by private practitioners.
To continue to provide these vital services and keep children from needing higher and costlier levels of care, many local agencies have been making every effort to streamline service delivery while maintaining the best standards of care.
Although it is an uphill battle, it is a fight that we must continue and, hopefully, with a different outcome than the Hunger Games; one where we all remain standing and the character and culture of true community-based mental health centers remains strong.
Published on May 31, 2012 in the Anton News chain of 18 Long Island newpapers.
