Beyond Babel: Establishing system-wide principles of collaborative care for adults with serious and persistent mental illness

Abstract

Serious and persistent mental illness has posed a significant social problem for a majority of cultures across most historical periods. Most recently in the United States, the aftermath of the deinstitutionalization policies of the 1950–1970s has resulted in many individuals who in the past might have spent the majority of their adult lives living in hospitals roaming city streets homeless, impoverished, and vulnerable to victimization or to being arrested for minor offenses. This paper reviews the changes both in the population of individuals with serious mental illness and in the systems that care for them over the last 25 years, and suggests that a “Tower of Babel” scenario has resulted inadvertently from the shift from hospital to community care. Following the dissolution of the monolithic hospitals (i.e. Towers of Babel), mental health providers have been dispersed among a myriad of community agencies, each with its own vision and standards of community care. Without a shared map to guide their work, community systems have become characterized by disarray, paralysis, and a lack of integration and coordination of care for a population of individuals who typically require more than one service from more than one provider at any given time. To address these issues, we offer a core set of “principles of care” developed by one local service system in an attempt to (re-)constitute a common map for their shared territory. We closed with a discussion of the issues that remain unresolved despite this collaborative process, and with suggestions for future directions to explore.

Citation

Davidson, L., Nickou, C.M., Lynch, P., Moscariello, S., Sinha, R., Steiner, J., Jacobs, S. and Hoge, M.A. (2001), "Beyond Babel: Establishing system-wide principles of collaborative care for adults with serious and persistent mental illness", Hartwell, S.W. and Schutt, R.K. (Ed.) The Organizational Response to Social Problems (Research in Social Problems and Public Policy, Vol. 8), Emerald Group Publishing Limited, Leeds, pp. 17-41. https://doi.org/10.1016/S0196-1152(01)80004-1