Wednesday, February 10, 2010

The System, Defined

The following content is copyrighted ©T.H.Pyle 2009. All rights reserved.

So, what is "The System"? What is this beast, this behemoth, this bureaucratic mountain that the psychiatrically disabled must battle?

To tackle this institutional challenge, it is helpful to break it down into its various parts and then to show the interrelationships among all its elements. (The following graphics describe The System in the state of New Jersey. Elements and linkages of The System in other states may be different, although the complexity is similar.)

First we will start with the basics. We will add elements as we go. Beware: the result will look complex. Think about how it will look to someone with a mental illness... daunting? This is the reality that the psychiatrically disabled and their advocates are up against. (Could this be why, as some experts attest, half of all schizophrenics are on the street and homeless? How can such poor souls without advocates possibly manage The System?)

Components

The System has four components. The first component is Needs, both immediate needs and ongoing needs. These are
the many needs that all people have. But regularly capable people don't really have to think so much about these in the course of their lives. They just unconsciously act to fulfill them as they go along. When in recovery, the psychiatrically disabled and those who help them must think about these needs specifically. Services of The System tend to be strictly need specific. To find, secure and sustain these services takes specific planning and persistence. The second component is Services, being the actual services of The System that provides to address particular needs. The third component is Providers, those individuals, agencies and institutions that provide the services. The fourth component is Funders, those entities which finance the service providers.

Aspects of Need

Let's look more closely at the first component, Needs. In the graphic below, fifteen needs are arrayed in a circle. Those in blue represent needs of a more immediate nature: Psychiatric, Medical, and Functional. These are the needs arising most frequently and urgently, especially for an afflicted soul who is florid, cycling, or actively psychotic. But another immediate need is Financial. Many mentally ill are deemed disabled. As such they live meagerly on disability and supplemental income from government sources, currently only about $8000 p.a. They must also secure other supplemental financial services like food stamps, utilities subsidies, prescription drug assistance and Medicare and Medicare. (More about all these in later posts...) Financial need is immediate because the various financial supports and supplements derive from different sources, and they never seem to be either enough of timely.

Then there are the regular, recurring needs. These are Legal, Residential, Occupational, Educational, Political, Recreational, Cultural, Mobile, Emotional, Social, and Spiritual. Each of these will be described in more detail as the PsychoSystemics blog evolves.

Addressing the Immediate Needs

With the Aspects of Needs as our framework, let's investigate how The System addresses immediate needs. The bubbles in white indicate specific services which address particular needs. The blue bubbles represent agencies providing the services. The funding sources are designated at the top of the graphic. For the sake of simplicity, this example shows the funding relationship between a local entity of Catholic Charities ("CathCharities"), a service provider being funding by the Division of Mental Health Services (DMHS) within the New Jersey Department of Human Services ("NJDeptHumServ"). Catholic Charities provides its Program of Assertive Community Treatment ("PACT") to address an afflicted individual's Psychiatric need.

Addressing Subsequent Needs

Now let's add elements addressing three more needs, Financial, Legal, and Residential. needs is a critical step for the psychiatrically disabled. Financial support services come in many forms. Securing some, like Supplemental Support Income ("SSI") opens the door to securing others, like Medicaid (and, later, Medicare), utilities supplements, and additional prescription drug support. Note the geometrically increasing complexity of The System when the funding, now from Federal, State, and County sources, is included.


Addressing All Needs (?)

And so it goes, as The System morphs and complexifies into...



...which leads us to ask some important questions:

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