3 Comments
Apr 23, 2022Liked by Ben Miller

I'm a retired mental health provider (LPC). In my experience, most patient feedback, for both inpatient and outpatient treatment, is not considered and patients who complain are often labelled as resistant, hostile, or difficult. The most responsive system I worked in was run by a tribal health care organization. Tribal members had direct access to board members in their communities and let them know if they were satisfied with medical care, mental health and addiction treatment. Our programs and staff were expected to improve our services to meet the needs of the community - and because mental health services were highly valued, we had resources to do so. We used some of Scott Miller's material - not necessarily to rate every session, but to help our counselors develop a framework for assessing their work and staying client-focused. I think that there's an understandable but unfortunate tendency for therapists to blame clients for poor outcomes or premature termination of treatment, often because most mental health programs are not staffed to provide adequate clinical supervision. For instance, it may be hard for a therapist to be aware of their reactions to certain clients, or difficulties they may have with particular diagnoses or issues - unless they have good supervision. Some people are difficult, hostile or resistant, but it's our role as mental health providers to do our very best to form a trusting relationship and help that person engage & get the best possible benefit from treatment.

Expand full comment

Dr. Miller an excellent share here and one that has been on a loop in my mind since starting as a volunteer crisis counselor. I question if the outcome I've achieved with someone in crisis raises to a standard of care? Is it quality? Does an evidence based standard of care for a crisis intervention exist? Yes I've helped people ride out suicidal ideation to safety. Yet to your point, is the MH infrastructure in place to continue what I just did with them for an hour?

"Sadly, this is indicative of a much broader issue: our standards on mental health care in America are depressingly, frighteningly" This sentence went yard and overshadows my limited insight in the MH domain.

I came up though marketing, advertising, and CME working for pharma launching drugs, helping set up clinical trials, running advisory panels, and more. All of this was done based on a building of data/evidence from the basic science of a molecule through to clinical trials based on standards of care and outcomes. None of it was left to chance since the FDA demanded evidence prior to approval. And Mr. Cynical me will say my working with pharma in 20/20 hindsight is not my proudest memory, they do what they do for dollars.

In this fragmented MH system offering quality is the critical part of the battle. How do standardize quality care in MH when fragmentation is only getting more fractured with technology bringing application after application to MH. Have these new applications run trials to measure outcomes? How do their outcomes compare to standards of care for treating MH? Can that even be done?

Those I've helped in crisis intervention when we've closed our chat have the option of completing a survey. Of my 1,798 conversations I'm at about 8% who've left a comment about my efforts. This self reporting is not an outcome, though I do bask in validations, since it is immediately post chat--they liked me. My idea of an outcome would be, did they find additional help/support? Were they able to find good quality of continued care? Are the larger issues and fears they had which manifest itself in the immediate crisis were addressed? Which begs the question, can we take quality and quantify it so there are measures? Can we?????

I may be all off here since MH is beyond my IQ and expertise. A lower A1C can be measured easily with an associated outcome. The molecule that achieved that has data to prove it. Perhaps there is no reasonable way to show positive outcomes in MH similar to A1C.

You've shared negative outcomes in MH. The negative is a measure of what is not there. What is there, in that institution, or ED, or app, or service? What are the MH nutritional labels with each. I know how much salt is in my quarter pounder. Do I know if that thing will help my MH?

IDK All I do know is thank you for the thoughts, the space to share, things to consider, and achieve.

Expand full comment