Best hopes for 2018

The much-loved festive holidays have departed rapidly. So too will the year’s end of a period filled with exceptional “Sturm und Drang”. Both events signal a need to take stock and to set a clear course for our New Year, 2018.

The festive holidays always emphasize what we all hold dear in our hearts: our families, our friends, an inviting warm hearth, much gaiety, a shared, happy dinner, gift exchanges, and close camaraderie. I am sure that I speak for all of us when I say that these are the same values we do want to emphasize in our behavioral health community. After all, we are very much like a close family.

At the same time, the current annum has confronted us with many unique threats: proposed, but defeated congressional legislation would have decimated state Medicaid programs and adversely impacted state insurance marketplaces for those who are near-poor. Other proposals to eliminate the health insurance mandate, reduce the essential health benefits to a state option, or dramatically cut federal resources will have similar dire consequences. Clearly, we must continue to respond effectively to these ominous threats going forward.

Here, I would like to propose three guideposts for our joint action as we step quickly into 2018: 

Preserve Progress:  Through our collective efforts during the past half-decade, we have been able to achieve milestones that we only could have dreamed about a decade ago. We have been able to reduce the number of persons with mental illness who do not have health insurance by half, from one-third to about 16%. Similarly, principally through the Medicaid expansion, we have greatly increased the number of persons with substance use conditions who do have any health insurance coverage. As a result, many more people have access to needed care. For example, the percent of persons with substance use conditions who now receive care has grown from 10% to 20% during this period.

To preserve this essential progress, we must remain very vigilant to each new threat as it arises. This year, we learned that joint political action can achieve remarkable results. The entire health community—insurers, states, counties, cities, providers, and peers, joined by all community members concerned about health, acting collectively—was able to defeat very bad federal legislation. We need to continue to work with this coalition in 2018, and we all need to be activated politically to engage every step of any new threat to the inalienable human right to good health.

Protect Person-Centered Care: Undoubtedly, the most remarkable achievement by the behavioral health field has been our willingness to embrace the promise of recovery. Today, we offer the true hope of recovery to millions of person with mental health or substance use conditions. Just a generation ago, that would simply have been unthinkable. Consumers and peers taught us about recovery via their own personal experiences—regaining one’s voice, reconnecting with friends and community, becoming strong. They also taught us about the corrosive role played by trauma, and the need for trauma-informed care throughout the entire behavioral healthcare system. We have listened, and we have learned.

To protect person-centered care, we must continue to make consumers the center of our behavioral health universe. We can do this by adopting self-directed care and promoting self-determination in the community. We also can join the groundswell growing outside of behavioral health that already has embraced the principles of self-determination.  We will need to engage with the broader health community in the difficult work needed to build the service and financial structures that can lead to true self-determination. We won’t want to be late to this important table.

Defend Principles of Justice and Equity. All that we do in this field is founded upon the bedrock of social justice and equity. Simply stated, social justice means that we should do most to help those who are most disadvantaged—persons who are poor, persons who are disabled, children, and those of advanced age. Almost universally, these groups are exposed to serious inequities: worse health status, worse access to health care and other services, and worse lives in our communities. A fundamental guiding principle of social justice is that we value all people equally and work to overcome these inequities.

To defend the principles of justice and equity, we must first embrace them in own lives: Do we value all people equally? If we do, we should then ask whether our work and our advocacy embody justice and equity. Also, if there are obvious instances in which these principles are being violated in our community, our state, or our nation, we should speak up and take action. Our nation was built upon the foundation of helping one’s neighbor, a key demand of social justice.

Please do enjoy the festive holidays. However, at the end of the day, when your family members and friends all have departed, please also think about what we need to preserve, protect, and defend in the new year. You do have an exceptionally important role to play in that effort.