Change versus bureaucracy in mental health

Why things don’t change

If you’ve been alive long enough you may be getting an uneasy feeling in the last few years that modern civilization is not working too well. Where the turning point came is somewhat hard to determine but the gears seem to be grinding to a halt as more and more problems go unrecognized and unaddressed. My observation is that this is true in virtually all sectors of society but, since my experience of things is in the mental health and public health fields, I notice this phenomenon more in these spheres.

For practitioners in the mental health field who want to practice effectively the bureaucratic red tape and redundancy is fairly overwhelming. It is discouraging for seasoned professionals and new practitioners alike to face these roadblocks limiting our effectiveness especially if you keep in mind the original reason why many of us went into the field in the first place – to help people.

What is the bureaucratic brick wall?

Simply put, it is the red tape that we must struggle through every day to serve our clients. This includes all kinds of documentation requirements that are handed down from the federal, state, and local levels. The intentions are good. This paperwork is meant to help us understand the client, provide the appropriate treatment and maintain safety for the client. It often works at cross purposes, however, since all the questions and answers often place the client in a diagnostic box which, frankly speaking, the client is unlikely to be allowed to emerge from.

Because documentation requirements are overwhelming, many clinicians tend to not have the time to assess the client without depending on the old paperwork. Documentation supports a diagnosis which follows the client everywhere. Documentation makes a “case” for a diagnosis. It’s ironic that to “get better” a client needs to escape the past in fundamental ways but this proves to be virtually impossible when they carry the weight of a diagnosis and a mountain of paperwork to support it on their shoulders.

Solution anyone?

How can we do a better job of assisting clients without putting them in an impossible bind? From my experience here are a few things that might help.

For administrators

*Standardize and simplify required assessment forms across settings.

*Involve clients and direct service professionals in the development and roll out of any new clinical paperwork requirements.

*Require that every new piece of documentation replace a pre-existing from or be incorporated into a pre-existing form.

For direct service professionals

*Invite the client to be a partner in the assessment and diagnostic process.

*Assess the client without prior documentation or diagnostic information initially. If necessary review prior documentation after the face-to-face assessment.

*Provide the client with a copy of the documentation for review and possible amendment before finalization.

For the client

*Be proactive about wanting full participation in the process with access to the resulting documentation.

*Ask to review the factors involved in diagnosis if this is not clear.

*Challenge any inaccuracies in the assessment or the previous documentation.

Many of these recommendations are in place now, in my experience, but are poorly implemented in many settings. This is primarily due to time constraints and staffing levels. Improving things would require better funding to lengthen the assessment process. More time and money spent on the front end would result in better outcomes on the back-end as the focus would be on current problems and possible solutions. After all, wouldn’t this be a start to help clients emerge from the diagnostic stranglehold? How can people change when the bureaucratic tangle weighs them down?

I am interested in what you have to say. Please comment!