I had to laugh when I read The Washington Post piece, "Language lessons for Democrats, from the political brain of Drew Westen." Dr. Westen is the psychologist and neuroscientist at Emory University who wrote the 2007 book, "The Political Brain." His advice to Democrats is to quit using the terms "the environment," "the unemployed" or "the uninsured." I love his comment, "There are a few things if you know about the brain, they change the way you think about politics... If you understand we evolved the capacity to feel long before we evolved the capacity to think, instead of barraging people with facts (the standard Democratic way of talking to voters), you speak to people's core values and concerns. His basic advice is to quit communicating with "reason and facts" since people respond more to "emotional appeals."
I guess this is consistent with some of the new writing about change and leadership. I am particularly taken with the metaphor of the rider and the elephant by UVA psychologist Jonathan Haidt in his book The Happiness Hypothesis. Dr. Haidt's premise is that our emotional side of change is the Elephant, while our rational side is the Rider. Perched atop the Elephant, the Rider often seems to be the leader that holds the reins – but the Rider’s hold is precarious because it’s so much smaller than the Elephant. Any time the Rider and Elephant come to blows about which direction to go, the Elephant (our emotions) wins.
All that said, it's a sad reflection on the state of advice for politicians or managers. I'm reminded of the words of Justice Felix Frankfurter, "Fragile as reason is and limited as law is as the institutionalized medium of reason, that's all we have standing between us and the tyranny of mere will and the cruelty of unbridled, undisciplined feeling…"
The future of institutions as long-term residences for persons with mental illness is certainly an integral part of the discussion about mental health policy. Usually those discussions focus on state budgets and Medicaid reimbursement and compliance with Olmstead. But, I was intrigued with a recent piece on Scott Hensley's blog on npr.org “A Peaceful War on Mental Institutions”—coverage of a different chapter in the history of mental institutions.
I never realized that many conscientious objectors in World War II were assigned to mental institutions in lieu of military service. Their experiences are documented in a recent piece on NPR ("WWII Pacifists Exposed Mental Ward Horrors") and in two books—Acts of Conscience: World War II, Mental Institutions, and Religious Objectors (by Stephen Taylor and published by Syracuse University Press) and The Turning Point: How Men of Conscience Brought About Major Change in the Care of America's Mentally Ill (by Alex Sareyan and published by American Psychiatric Press).
As I read this tale of the evolution of human conditions within our mental institutions, I was first struck by how much had changed. Then my thoughts wandered to the millions of Americans with mental illness in our corrections system. If we had the same undercover reporting of conditions of these citizens, would the photos be far different?
For more information on mental health in the corrections context, check out:
If your organization is looking at increasing its private pay services, a new study, “Money or Mental Health: The Cost of Alleviating Psychological Distress With Monetary Compensation Versus Psychological Therapy” published in Economics Policy and Law and summarized in Science Daily’s "Psychological Therapy 32 Times More Cost Effective at Increasing Happiness Than Money" provides some powerful ammunition. The study found that four months of therapy increased "happiness" (as defined by the researchers Christopher J. Boyce and Alex M. Wood at the universities of Warwick and Manchester) as much as a $40,000 raise. The researchers concluded that "The research therefore demonstrates that psychological therapy could be 32 times more cost effective at making you happy than simply obtaining more money."
Despite the happy news for psychotherapy practices and the many vagaries of calculating well-being and happiness, the study speaks to the struggle of government policymakers in determining the 'relative value' of funding health services. "The researchers further draw on two striking pieces of independent evidence to illustrate their point—over the last 50 years developed countries have not seen any increases to national happiness in spite of huge economic gains. Mental health on the other hand appears to be deteriorating worldwide. The researchers argue that resources should be directed towards the things that have the best chance of improving the health and happiness of our nations—investment in mental health care by increasing the access and availability of psychological therapy could be a more effective way of improving national well-being than the pursuit of income growth."
These cost-benefit analyses, in health care analyzed through the lens of comparative effectiveness, will become more frequent as we have more data available through inoperable EMRs and there is greater pressure to reduce health care costs.
September 9, 2009
It was inevitable, I guess. Americans want everything in a hurry. And now we've gone from speed dating to speed shrinking. The August 31 edition of The New York Times featured an article, "Answers to Life's Worries, in Three-Minute Bursts". It talks about "speed shrinking gatherings" featuring three-minute sessions for people needing fast advice—or those who find their regular professional on vacation. One interesting comment in the piece was a woman who said it was great to see multiple therapists in short order because “It was a great way to learn which of them I had the most chemistry with.”
What does this mean for the field? For a certain cohort of consumers, 'short sessions' don't seem to be a problem—and viewed as a convenience. And speaking of convenience, I can see the 'speed shrinking sessions' moving from bookstores to on-line meeting places. For professionals in private practice or looking to attract new clients, 'speed shrinking' is a marketing opportunity.
Matrix Mindset, in Australia, for instance, is already capitalizing on this new phenomenon:
Related Resources from the OPEN MINDS Circle Library:
- Consumerism in Health Care: What's Your Next Move
- Current Trends in Consumer-Directed Health Plans
- Technology as the Next Disruptive Innovation in Behavioral Health: Thoughts on How Consumerism and Technology Will Define Our Future
- Getting Your On-Line In Line: Issues & Considerations for Behavioral Health Professionals Contemplating Internet-Enabled Therapy
