The System

NOTE: When we talk “ The System ” we do NOT mean the “state drug and alcohol system or state mental health system” solely. Although the government organizations are part of the system.

I focus on the system in a much larger sense.

In a manner consistent with the following definition: “An organized, purposeful structure that consists of interrelated and interdependent elements (components, entities, factors, members, parts etc.). These elements continually influence one another (directly or indirectly) to maintain their activity and the existence of the system, in order to achieve the goal of the system”. (BusinessDictionary).

Behavioral Health

In the case of behavioral health the system includes:

  • Government mental health and substance use disorder systems (providers; public payers such as Medicaid; single state authority; state mental health departments etc…)
  • Private addiction treatment providers (rehabs and such)
  • Private mental health providers
  • Healthcare providers involved with MH and SUD patients
  • Researchers and academics focused on behavioral health
  • Federal agencies: SAMHSA; CSAT; DMH; NIMH etc..
  • Private/commercial insurance payers (BC/BS etc…)
  • Accrediting bodies such as CARF, JCAHO, COA etc….

and others I am missing.

That said.

Consider The Following

A sociological fact as true as the law of gravity. Substantial change and transformation of our behavioral health system CAN NOT arise within the existing system.

The system will not eat itself. No one is going to work toward the elimination of their own livelihood.

No one is going to disavow the principles and paradigm they have promoted for decades. Rare is the person who can reverse field and change their opinion even if it means they lose power or position or prestige.

The fear is too great. The unknown is too anxiety ridden.

A great person takes the next step despite great personal risk.

However, most will play to the middle. Hoping to not ruffle feathers. Hoping to make it to retirement. Toeing the company line. (BTW, THE RECOVERY MOVEMENT HAS A COMPANY LINE AS WELL).

The Facts Are

We will only see incremental improvement. Any change MUST fit within the framework of the larger system.

This incremental improvement will be celebrated and championed as great progress and breakthrough. (See the celebration of a “Medicaid code” for peer recovery as an example).

Many in the “movement” will go along with this process as the movement is slowly but surely consumed by the legacy payers and providers. People will get positions of prominence and “stay in their lane”.

We will hear that all of this is progress and better than nothing. People will take what they can get.

Whats Next?

This leaves us with 2 logical options. In terms of next steps.

1) Accept incremental change as the norm and live with it. Accept that this behavioral health system is the best possible behavioral health system available and live with it.

2) Create an alternative system. From soup to nuts starting with “how it gets paid for”. Create it outside the system. Add value. Solve problems. And then we get some leverage with the existing system.

FAVOR Greenville


Why can’t it be done nationally? At scale.

A Good Place To Start:

The creation of a new business model, in the substance use disorder treatment/recovery space, is necessary for any substantial progress toward acceptable outcomes.

Service diversity and innovation will only come if reimbursement changes.

Follow the money.

The doers will figure this out. We need more entrepreneurs in this space.

Unless you think everything is good to go?

How long until retirement?

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Source: Recovery Cartel