Aug 10, 2009

Why We Need a Systems Approach

Today's NY Times has a truly sad article about mentally ill juvenile offenders. Tracking the state budget cuts to community mental health resources, the article discusses the increased burden to prison systems as they deal with rising numbers of mentally ill young people. Since young people are mandated to receive necessary mental and physical health services when they are wards of the state, court systems often sentence them to detention, where they are assured to receive required treatment, instead of releasing them to the community, where there is no guarantee of treatment. Often, these seriously mentally ill young people are on multiple strong medications and without access to regular therapy, causing disruptions in the continuation of care.

One of the most poignant quotes from the article is the following:

"Joseph Parks, medical director for the Missouri Department of Mental Health and a national expert on pharmaceutical drug use in corrections facilities, said many juvenile offenders are prescribed multiple psychiatric drugs as they move from mental health clinics to detention halls to juvenile prisons. A decade ago, it was rare to find juvenile offenders on two psychotropic drugs at once, Dr. Parks said. Now, many take three or four at a time, often for nonprescribed uses like helping the youths sleep.

'If you just give a kid a pill, the prison administration doesn’t have to do anything differently,' he said. 'The staff doesn’t have to do anything differently. The guards don’t have to get more training.'"

What jumps out from this comment is the need for a systems approach to problem-solving. From Wikipedia:

"Systems thinking is any process of estimating or inferring how local policies, actions, or changes influence the state of the neighboring universe. It also can be defined, as an approach to problem solving, as viewing "problems" as parts of an overall system, rather than reacting to present outcomes or events and potentially contributing to further development of the undesired issue or problem. Systems thinking is a framework that is based on the belief that the component parts of a system can best be understood in the context of relationships with each other and with other systems, rather than in isolation. The only way to fully understand why a problem or element occurs and persists is to understand the part in relation to the whole." [Click here for a more detailed discussion of this idea.]

The need for this kind of thinking can be seen in the mental health demands of juvenile detention facilities. While a psychotropic medication will soothe an episode of mental illness for a certain period of time, it does not address the set of actions and consequences that led the young person to a detention facility. What is needed is a broader set of assessments about how systems of care are (or are not) responding to the needs of mentally ill youth and their families. It is tragic that the current budget cuts are affecting already limited community mental health resources -- but wasn't this a problem before our economy hit rock bottom? We'd love to hear your thoughts on this issue.