©T.H.Pyle 2009. All rights reserved.
So, what is “The System“? What is this beast, this behemoth, this bureaucratic maze that those with psychiatric disabilities must battle?
To tackle this institutional challenge, it is helpful to reduce it to its various parts and then to show the interrelationships among all its elements. (The following graphics describe The System as it appears in New Jersey. Elements and linkages of The System in other states may be different, but their character and complexity are similar.)
First we will start with the basics. We will add elements as we go. Beware: the result will appear complex. As you analyze it, consider how it looks to someone with a psychiatric disability… daunting? (Could this a reason be why, as some experts attest, half of all those with schizophrenia are on the street and homeless? How can such poor souls without advocates possibly manage such a System?)
The System has four components. The first is Needs, both immediate needs and ongoing needs. These are the many needs that all people have. But regularly capable people don’t have to think so much about these in their course of life. They unconsciously act to fulfill them as they go. But those with psychiatric disabilities and those who help them must think about these needs individually and specifically. Services of The System tend to be need-specific. To find, secure, and sustain services requires considerable planning and persistence.
Flowing from Needs are the other three components. 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, Functional, Financial. The first three are needs arising most frequently and urgently, especially for an individual who is florid, cycling, or actively psychotic. But another immediate need is Financial. Many who are psychiatrically disabled live meagerly on disability and supplemental income from government sources, currently at the lowest level 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. [NB: For a clearer PowerPoint version of these images, click here.]
Then there are the regular, recurring needs, such as: Legal, Residential, Occupational, Educational, Political, Recreational, Cultural, Mobile (or Transportational), Social, Emotional, and Spiritual.
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 of these services are designated at the top of the graphic. 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 individual’s Psychiatric need. [NB: For a clearer PowerPoint version of these images, click here.]
Addressing Subsequent Needs
Now let’s add elements addressing three more needs, Financial, Legal, and Residential. 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 funding support. (Note the increasing complexity of The System when the funding, from Federal, State, and County sources, is included.) [NB: For a clearer PowerPoint version of these images, click here.]
Addressing All Needs?
And so it goes, as The System morphs and complexifies into… [NB: For a clearer PowerPoint version of these images, click here.]