Dr. Chris Cline is the former Medical Director for the Behavioral Health Services Division of the Department of Health for the state of New Mexico. During her tenure, she observed higher outcomes of death for people who had complex medical conditions. The morbidity and mortality reviews indicated that some people living with co-occurring disorders were dying within four to six weeks of “knocking on” what she calls “the behavioral health door.”
Most of the deaths documented in the reviews were a result of complications with poorly managed chronic diseases. They did not tend to be related to suicide, or other behavioral health matters.
Chris posed the question, what is behind the “behavioral health door”? “There is a large population of people who are extremely vulnerable. They struggle to just make it through day-to-day survival. A person in this situation will get to a point where they think, ‘perhaps I should ask for help?’” says Chris. Within this desire for help is the hope that someone at a behavioral health center will offer inspiration.
“The first interaction has the potential to be a lifesaving one. People must feel welcomed. They need to feel like they have help to make it through,” says Chris. The work of welcoming is not simply about healthcare access. “We may have many practices that work. But if we haven’t inspired people to stay, then we haven’t helped anyone,” says Chris.
Chris now works with her partner, Ken Minkoff, at ZiaPartners. They help public behavioral health systems build welcoming, recovery oriented and integrated systems of care to support both providers and people who live with co-occurring substance use and mental illness disorders.
Recently Chris was asked if welcoming is an evidenced based practice (EBP). She says that she believes in the importance of EBPs, but she feels they cannot live in a vacuum. “For an EBP to help someone, the person must first feel welcomed. EBPs must live in the context of people wanting to work in partnership with each other. The more a person needs services, the less likely this person will be welcomed. He or she may not be in control of behaviors. He or she may not be able to request help in a way that will be heard,” says Chris. If a person does not feel welcomed, there is no opportunity to build a long-term relationship in which evidence based practices could be effective.
Chris explains that it is vital that systems do not add to the challenges faced by people experiencing co-occurring disorders. “We can hold high and hopeful expectations that everyone we meet with can have the life they want. If we don’t believe in people and don’t believe in their capacity, we become a hindrance,” says Chris. This is the essence of welcoming. “How do we help people to live with dignity and meaning in everything they do? How do we do this even when it is difficult to see this potential?” says Chris.
“We are teaching providers not to fix people in need of services, but to get to know them.” The concept of welcoming must be replicated at every level of every agency within a system. “It is about coming to work in the right spirit. How people are treated at work and how they feel at the job they do, affects everyone in this community of care.”
“Many providers tell us, ‘the paperwork is killing and crushing us.’” In response, Chris asks providers to examine how to change policies and paperwork that are not welcoming. Systems transformation for integrated treatment for people with co-occurring disorders duplicates the process of recovery for the individual at the systems level. “We make a parallel between systems recovery and individual recovery, and we cannot lower our standards in terms of what we hope for either for individuals or systems,” says Chris.
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