The medical training we all need
Whether people recover from mental illness or addiction depends, in large part, on how well they get along with their therapists. Further, providers who work well with their patients are happier in their jobs and are more likely to stay—no small thing since behavioral health’s turnover rate is between 18 and 50 percent. So if a healthcare organization can foster what the literature calls “therapeutic partnerships” between patients and counselors, people will probably get better and organizations will probably be more successful. But how?
For a health organization to change the way it does business, a critical mass of its employees must want to change. They must want to do more than manage pain , listen and communicate respectfully. They must also want to meet their patients where-ever they are — homeless shelters, houses of worship, their homes. They will work with clients to get the treatment right; not try to fit patients into a standardized, easy-to-bill-for care. Where does an organization find people like that? We need to train them.
Many people go into healthcare because they feel called to do so often because they or someone they love dealt with mental illness or addiction. Unfortunately, the training they get drains that out of them. UK’s National Health Service (NHS) asked would-be doctors why they chose to study medicine. Students in their second and third years spoke of their patients; students in their fourth and final years didn’t. It doesn’t have to be this way. “All” we have to do is tweak health professionals’ education. Start with diversity. In a diverse classroom, students contextualize experiences they would otherwise only read about. When students who dealt with mental illness and addiction are well-represented, they put a face to the “clinical cases” in a way students may not have encountered either because they do not have personal experience with mental illness and addiction or because they only know their own behavioral health issues.
A few years ago, I oversaw a stipend program that changed the way schools trained train mental health professionals and so got to read student profiles. I still remember one of them. The student wrote about her addiction and homelessness; she said she sees a sister every time a woman pushes a cart up the street. And she is not the only one who, after recovering, is seeking a career in behavioral health. The number of peer support specialists (people who’ve “been there” and are now helping others) has exploded. They run their own centers and work as case managers. For many, the specialist position is the first step in their healthcare careers. They should be welcome in the classroom.
We should also change university curricula. I am not naïve. Changing a university’s curriculum is insanely difficult. We should do it anyway. We have known for well over a decade that health professionals need to partner with the people they serve and we know that teaching people to do so works.
And we should make sure students do their clinical rotations in the communities where people live and not where they are forced to go (such as correctional facilities and hospitals). Such rotations teach students non-traditional ways of providing care. When students work at schools, foodbanks, churches, homeless shelters, or homes they get to know people. They can test a Mrs. Brown’s sugar level and help her do the groceries because she lives two bus rides away from the nearest supermarket. They can provide counseling to a traumatized Billy and show him how to dribble. The more students work in the community, the more likely the care they provide will help. And these kind of rotations might begin to break down walls modern people built around themselves. A community rotation may begin to build a community.
This kind of training is not for everyone. And, if we want to attract people who are poor and have personal experience with behavioral health, we need to offer people who commit to training and working in the community stipends. Nor is this training a substitute for a well-organized behavioral health system. The best professionals will get burned out and leave if day after day, the waiting room is the best care they can offer.
This is not a silver bullet. But it could be a start.