Arm Chair Reflections

In 2006, the Board of Directors formalized the longstanding direction and tradition of the College to not take positions on public policy. In doing so, then president Dr. Eric Goplerud drafted an Arm Chair Reflection explaining why. The College continues to serve as the place where we wrestle with difficult ideas and seek to inform one another, without creation of a policy agenda.

Most acts of violence are committed by people who are not mentally ill. And people with mental illness are more likely to be victims of violence than perpetrators. But tragedies like those in Newtown, Aurora, and Tucson nevertheless tend to jumpstart vital conversations about mental health services and policy.

I was in a meeting today in Washington, DC sharing the podium with a wonderful physician from Deloitte’s healthcare group. One of his observations was that many healthcare providers are moving away from becoming Medicare-approved Accountable Care Organizations (ACOs) because the potential rewards pale in comparison to the cost and complexity of playing in the Medicare ACO game. He predicted that we will continue to move toward “accountable care” in the United States, but it may not take the form of a Medicare ACO.

Together with the noisiness of the Greatest Recession, governmental deficits, and national health reform, a quiet and little-noticed revolution is taking place in our notions about the role of one’s community in health and well-being.

Terrible fiscal times create the political will to implement big changes, including some long overdue ones that involve changing how and where we serve people with psychiatric disabilities.

Here is the dilemma: health care, predominantly a service industry, today takes up 16 percent (Organization for Economic Cooperation and Development, 2010) of our GDP and we can’t really expand that percentage much without hurting our international competitiveness – or so we are told and believe. We are, therefore, in a conundrum.