Fixing Health Care through Education

It has been five decades since President Kennedy signed the passage of the Community Health Care Act. The goal of that federal legislation was to end the practice of institutionalization of people with developmental and psychiatric needs in our country. It was intended to return people with mental disabilities to their families by creating needed services in their home communities. But comprehensive community services have not developed sufficiently across the U.S. Mental health care has become increasingly marginalized from general health care and education. Silos of specialized care have been erected. Health care has become managed by for-profit insurance companies. Big Pharma has been allowed to market medicine directly to consumers. The rate of undetected and/or inappropriately diagnosed mental health disorders is growing in alarming ways. There is a better way than building taller silos and allowing for-profit insurance and drug companies to shape health care. Building collaborative teams of support for families with special needs across communities can provide a more potent alternative to our fragmented health care system in America. Here are four suggestions.
First, start with primary prevention. Universally screen children early for the presence of health, mental health and educational needs, as some pediatricians and school systems are beginning to do. A proverbial ounce of prevention screening is worth a pound of remedial cure when children reach adolescence and their symptoms escalate.
Second, offer preventive services in or near schools, where children spend the bulk of their time outside of the home. Co-location helps prevent the slippage that can occur in the current specialist-driven health care market, where referrals are made to distant locations and compliance often suffers.
Third, create or strengthen teams of co-located health and educational professionals. Schools are mandated to have certified health professionals (counselors, nurses, school family therapists, psychologists and social workers) to address the special education needs of students. Those teams are well equipped to assess, track and coordinate mental health needs within schools and across communities. But schools are woefully underfunded and understaffed. Schools often operate with skeletal crews of special service staff to support students and teachers. Preventive planning and more collaborative investment across systems can avoid “too-little-too-late” remediation.
Fourth, involve families in collaborative planning for children’s health and education. Family-friendly, wraparound support boosts the competencies of all team members in the long run. Collaborative support saves energy, time and money across a child’s school career, especially for children with chronic illnesses and disabilities. It can prevent burnout, parental disputes about plans, and possible violence.
There is a growing health care conversation about the concept of medical home, where services are coordinated. Prevention is emphasized and communication between patients and providers is paramount. Preliminary research suggests that collaborative practice boosts compliance as well as satisfaction rates for patients and providers. I recommend that “educational homes” be created in schools to promote the same health and mental health goals that exist in medical homes. For many children from distressed and impoverished families, schools are their de facto health care setting. Why not provide needed services in an educational home for children and families who need it most?

Dr. Laundy is the author of the book Building School-Based Collaborative Mental Health Teams: A Systems Approach to Student Achievement, TPI Press, In press.

Kathleen C. Laundy, PsyD, LMFT 2-11-15 kathleen@laundy.net