You say you want a revolution in the county’s mental health care system?

From the Oregonian Editorial Board, April 02, 2011

If nine well-informed citizens devote more than a year’s study to your mental health care system, and effectively conclude that it’s a black box, surrounded by razor wire — mystifyingly impenetrable both in terms of what you spend and what you accomplish — well, you’ve got a problem.

READ – City Club of Portland report, “Improving the delivery of mental health services in Multnomah County.”

Never mind that there were misunderstandings and miscommunications along the way. Put all your “buts” and postscripts aside, because you’ve failed a key test of leadership:

Translation.

And you’ve also provided some strong evidence that those who operate within the system, however dedicated they may be, are to some extent inured to its dysfunction. They cannot even, clearly, explain to an intelligent group of outsiders how it works.

If Multnomah County officials cannot describe how the system is performing, to an eager audience of potential allies, how can they hope to enlist public support to improve the system?

Last week, a committee of the City Club of Portland issued a meticulous, 42-page report, lambasting the county’s mental health care system. It is a devastating critique that stops short — but not by much — of recommending that the county just start over.

The club as a whole hasn’t voted yet on whether to adopt this report. Still, County Chair Jeff Cogen and the board of commissioners must make a critical choice: They can blow off this report with a cursory “Well, yes, the system is fragmented, but we’re already doing what we can to improve it.” Or turn this into a call to action.

For at least three decades, of course, dismal studies have routinely been issued about the county’s mental health care system. But this is a moment unlike any other. Never have people been listening harder for good ideas.

National health care reform is looming, and a state Health System Transformation Team is meeting weekly to develop a new approach, integrating mental and physical health care.

As Edward J. Keenan, president of The Foundation for Medical Excellence — and a member of the City Club committee — pointed out Thursday, the county could pursue a tri-county demonstration project that integrates mental health care across county lines.

That is a big problem today, one of the reasons the report called the mental health care system “fractured.” Health care privacy laws, and the rigid way in which they’ve been interpreted, have also had an inhibiting effect on managing patients, too, as they move around the region.

Cogen and the county board could pioneer a new approach to track clients, regionally, more systematically and more effectively without infringing on their rights. “The emerging availability of the electronic health care record makes it more feasible,” Keenan said.

Cogen said Thursday that redesign of the mental health care system is an important priority for him (he is hoping to meet with the City Club committee).

He should also ask the county to take a fresh look at “translating” the mental health care system in terms that people in the community who are eager to improve it can grasp.

Consider, for example, that services for the homeless in Portland have dramatically improved since the city and county collaborated to make the system more intelligible. Mental health care is, if anything, even more complicated.

But you say you want a revolution in the mental health care system? And many, including the City Club committee, say something along those lines is needed. Then remove the barricades to understanding how it works.

Never has the moment been riper to stoke a transformation. The dynamic Cogen, aided by this report, should lead the charge.