Local control can be used to empower patients

by James Baker, MD

In public mental health care, “local control” is the mantra that describes the desire to assure that mental health policy is dictated by local communities rather than by state or federal government.

I hope that folks who insist upon this are mindful that power-hoarding in the form of “local control” is no blessing in itself, except when it is used, in turn, to empower the people we serve.

I hope that such a battle will feel unfulfilling if it leads only to local authority and control, and that folks are cognizant that true “local control” abides only in the consultation room.

Yes, we need to be advocates, including advocates for the communities in which we live. But our strongest and deepest roots in community mental health are in our role as providers of care. Genuine control follows from embracing that most fundamental role and, by extension, embracing our brothers and sisters — locally, statewide, and nationally — who are willing, like us, to venture into that consultation room with the poor, the sick, the challenged, and the disenfranchised and face what they face together with them.

I hope you will keep that in mind. Government is not the enemy of our mission. Neither is managed care, nor are competitors for mental health patients.

Whether we are working with an individual patient, or working with a team of clinicians, or working in a countywide system of care, we must always seek to keep our so-called enemies close and then work hard to ally ourselves with the part of them that seeks to do the right thing.

If we do so then, collectively, what a truly powerful force we would be in attaining “control” for the people we serve.

James Baker is a child and adolescent psychiatrist with Metrocare Services who blogs at Mental Notes.

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