System? for Mental Health Care

A System Approach to the Care of Persons with Schizophrenia

Stein, Leonard I, M.D.; Ronald J. Diamond, M.D. and Robert M. Factor, M.D., Ph.D.   Pre-publication Chapter for Handbook of Schizophrenia, Vol. 4, Pyschosocial Therapies (Elsevier, 1989)[1]

Notes and quotes I (Jayne) made from article filed in CMHA Sask archive collection:

Dr. Leonard Stein spoke in Saskatchewan in 1989, talking about the Dane County model, but even more important, setting out a philosophy of mental health service delivery that has been proposed to offer coordination, collaborative, comprehensive care to persons with long-term, and severe, mental illness.  Although it proposed that for people with schizophrenia, “If in doubt, give the support”, the guidelines for decisions about levels of support also recognized the limitations of financial and human resources for mental health support. 

Thus, the county provides only those services that each patient requires in order to make a stable adjustment to community life, and it uses the lease expensive service or combination of services to accomplish that goal.  Obviously, the intent is not to give everyone the same service but to give as little as necessary in order to achieve the goal.  It also means that priorities must be carefully set, so that those resources are available for patients most in need.  If resources were limitless, the goal would be expanded to help everyone achieve his or her highest potential of social and vocational functioning and to help everyone maximize the quality of his or her life.  If resources are extremely limited, the goal might be simply to ensure that people were adequately fed, clothed, and housed and that they were not harming themselves or others.  … If goals were not kept in mind and resources were not conserved carefully, just one segment of people with psychiatric disorders could use all the resources and other people with high needs would be left with no services at all.

Sometimes, especially for someone who is already what the system sometimes calls “high functioning”, the restriction of help to the bare minimums can be frustrating as they recognize that they could achieve their potential and improve their quality of life with more support, therapy and resources.    On the other hand, society is aware of the many people who are falling between the cracks, without the bare minimums of food, clothing and shelter, and the basic prevention of harm.  When examining the successes and failures of the mental health system, it is useful to see the values so clearly outlined.

[1]  Communication to Dr. David L. Keegan, Saskatchewan Commission on Directions in Health Care, July 31, 1989.