A young man came to marriage counseling and reported that he had two panic attacks in his life. One occurred years ago, and the other happened on his way to our session. He knew he needed to more effectively merge with his wife, but he did not know how that was possible; and moreover, he feared that the marriage counseling process may make matters worse.
That story reminds me of a recent public forum I attended where people were invited to provide comments on the proposed merger of the New York State Office of Mental Health with the New York State Office of Alcohol and Substance Abuse Services. As with the marriage counseling situation, it seemed to be understood that a merger should take place, but the question of how that could be accomplished, and done so in a way that did not make matters worse, was an often expressed concern.
It was initially puzzling to hear speakers say that, while they understand that mental health and substance abuse care should be integrated, they were opposed to creating an organizational structure that would facilitate the delivery of that needed care.
During the marriage counseling session and during the public forum, it quickly became apparent that the prominent issue was fear. As any competent practitioner knows, one of the first things that must be conveyed to a client is that the counseling process is safe, and the reasons for that need be made clear. In fact, this should occur in any merger situation, whether we are discussing the merger of people, the merger of companies or the merger of organizations.
The fear related to a merger of mental health with substance abuse services needs to be debunked. In part, this can be accomplished by reassuring the substance abuse providers that their value will not be diminished. These providers should be recognized and validated for the good work they have performed, and they need to know that their status and influence will not be diminished by a merger.
A similar allaying of fears had to occur when the NYS Division of Substance Abuse Services (DSAS) was merged with the Division of Alcoholism and Alcohol Abuse (DAAA). Back then, the argument was made that drug and alcohol abuse are distinct conditions and should be treated separately. A similar argument is made by some that mental health and substance abuse care should remain separate; and this is based on the experience of having a mental health practitioner miss the fact that one had a co-occurring substance use disorder. The reverse complaint is also made of substance abuse practitioners who did not recognize when a mental health condition was present. Such experiences, however, should not be interpreted to mean that mental health and substance abuse treatment should remain separate, because just the opposite needs to happen. It is a disservice to those we serve when mental health and substance use issues are not addressed simultaneously. Having said that, it is clear that the first thing we have to address is the fear.
Substance abuse providers must be reassured that the purpose of a merger is not to reduce their funding. Further, they need to know that their ability to influence the trajectory of public policy on health matters would be enhanced, and certainly not lessened. Furthermore, the life-saving contributions they have made, and will continue to make, should be roundly acknowledged. It is only after meeting these requirements that we will be able to effectively move forward and achieve the type of synergy that occurs in a successful marriage.
