InvisALERT Solutions – ObservSMART

The Economics of Recovery: Who’s Driving the Bus?

There appears to be an incredible variety of people guiding our journey of recovery; elected and career government officials, all manner of professionals, academics, health insurers, providers, family, labor unions, big pharma, etc. If recovery takes a village – then it seems they all made it on the bus!

But who’s driving? Is it the person with the most education? The most votes? The most money? The most legal authority? The most raw power? Who determines which route to take? How fast we should go? When we’ll get there? If we are lost, who do we throw off the bus? Do we have the authority to elect a new driver? Most importantly, who has the map? (Tell me there is one)

SAMHSA’s “map” lists six strategic initiatives or goals. NYS’s Commissioners of Mental Health have over a dozen priorities for 2010-14. But the problem is, there’s only about one-third overlap between the two agendas!

Let’s hope Governor Cuomo and the next round of Commissioners and Committees can agree to a single set of priorities.

Recently, the CDC’s Dr. Friedan published his short list of six priorities for keeping the nation healthy; long standing, major challenges which he characterizes as “winnable battles.” Dr. Friedan (NYC’s former DOH Commissioner and a Mayor Bloomberg appointee) believes, “If we are all on the same page and working in the same direction, we can create a lot more momentum.”

Similarly, the Bill & Melinda Gates Foundation, the most generous foundation in the world having given out over twenty-three billion dollars in grants since its inception sixteen years ago, pioneered the linear, quantitative, results oriented for-profit approach to delivering social services. Their website,, succinctly describes the “who, what, when, where, and how” of each grant.

Assuming our newly elected officials can agree on their agendas, then we’ll need to find a way to determine the priorities of our recipient population. Historically, convenience samples have been used to poll Recipients at community meetings, conventions, rallies, etc. Focus group verbatims and anecdotes are often pasted together as a kind of inclusive “kitchen sink” of Recipient opinion. Democracy in action, yes, valid quantitative evidence yielding actionable priorities, no.

To achieve a scientific evidentiary level of data validity, we’ll need to first define: our universe – e.g. “the three-hundred thousand plus persons in New York State currently receiving SSI/SSDI disability for mental disorders,”; a sampling frame – e.g. “persons currently attending OMH programs”; and a method – e.g. a fifteen minute self-administered questionnaire to every “Nth” person distributed and processed via OMH’s Patient Characteristic Survey Staff, next October, 2011. This approach, I believe, will fulfill the prerequisite probabilistic sample selection, yield a robust sample size (1K plus), and be cost effective.

To efficiently meet the challenge of measuring the complex, multi-dimensional and subtle nature our Recipients’ needs, we offer for consideration and refinement the “Center’s Peer Problem and Solution Survey Questionnaire” consisting of over one-hundred fifty variables. (Email me for a copy at

In compiling the list of eighty-six “problems,” we drew primarily on our one-on-one intake interview notes. This method yielded a greater depth and breadth of issues than either focus groups or community meetings. Just as in psychotherapy, privacy and rapport can uncover valuable research content. (I can’t imagine a community meeting where folks shout out; “I’m fat and I need love”)

As any therapist knows, most of our folks are adept at articulating their problems. Effective solutions, however, are much harder to come by. Our list of sixty-nine solutions is a compilation of three types: opposites to the problem – e.g. “Never be depressed,” components of the American Dream – e.g. “Find my true love,” and pure Hollywood fantasy – e.g. “Be a rock star.”

Twenty-one respondents rated all eighty-six problems on both importance very/somewhat/not at all and frequency (often/sometimes/not at all). Then, they rated sixty-nine solutions on effectiveness (very/somewhat/not at all).

The output is a list of the most important problems, to most of the consumers, most of the time.

We believe these are excellent criteria for developing any agenda because we’ll never have all the resources to solve every body’s problems. While setting priorities requires courage, it is essential to our success. Like the Rolling Stones said: “You may not get what you want – but if you try real hard – you’ll get what you need.”

While the solution’s data confirms the importance of offering programs on health (nutrition, dieting, exercise, smoking cessation, etc.), the data also highlights the desire for more social activities and outings. Other implications include groups about woman’s social and spiritual issues, coping with suicidal thoughts, money management, beauty tips and pet therapy.

There were two problems we didn’t ask about because the answers seemed so obvious yet incredibly, they both belong at the top of anyone’s Mental Health agenda:

  • Early death due to the side effects of psychiatric drugs
  • Defiance of the U.S. Supreme Courts’ Olmsted decision to release inpatients into the community

If Big Pharma can make billions selling drugs whose side effects can take twenty to twenty-five years off our lives, as studies in the US, Canada, and UK have reported, then “BP” must be the most powerful person on the bus. “Early death” has become just another side effect. It is even mentioned in TV ads.

But if some Labor Unions have the strength to defy the highest court in the land and keep thousands of our folks locked up in state-run institutions (and Nursing Homes) for the sake of “preserving jobs,” then couldn’t they also be the most powerful person on the bus? Hopefully the recent court decisions in Chicago, Georgia and New York will force the institutions to release folks out of the psychiatric hospitals and nursing homes and into the community.

Governor Cuomo’s strategy is to “isolate, destabilize, and ultimately defeat the tangle of entrenched interests that has left state government bankrupt, infamously dysfunctional and mired in scandal” (NY Times 10/24/10). He has my vote.

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