For a long time, our nation’s behavioral health care systems have been focused on treating people after they become unwell. It has sort of been like waiting for the leaves to begin falling off of a plant before rushing in to provide any nourishment or care. This approach has been problematic in many ways, most notably because there has far too often been an extraordinary amount of unnecessary suffering experienced at the individual, family and community levels when a person is not treated until acutely unwell. We know that the longer an illness progresses, the more difficult it is to treat and the more severe the adverse impact on an individual’s life becomes. A close second in terms of this approach being problematic is the financial cost – the United States spends more money on healthcare than any other country in the world yet ranks the lowest in terms of positive health outcomes in many categories. It is clear that the current way of doing behavioral healthcare in our country is not working – so what do we do about it?
If we continue to use the analogy of a sick plant, our current paradigm is situated perfectly to wait for a plant to become unwell, remove that plant from its soil and then place it into an expensive incubating environment for treatment. Unfortunately, this incubating environment is not designed to treat all of the different kinds of plants that exist in the world and additionally, many plants are unable to gain access to these incubating environments. For the plants that are privileged enough to gain access to and receive individually relevant treatment in an incubating environment, sometimes there is growth and signs of getting better. The plants become a little healthier and then are removed from the incubating environment to be placed right back into the soil from which they came. Also unfortunately however, the very soil from which the plant initially came was never treated – it is still the same soil which failed to nourish and sustain the plant to begin with. As a result, even those plants that gained access to and experienced improved health from treatment received while incubated will often go on to become unwell again a short time after being placed back into the same untreated soil. Our current paradigm treats the plant, not the soil. We must shift to begin to treat the soil at the same time as the unwell plant.
Treating the soil to sustain returning plants that have become unwell is not enough though. We need to go a step further. We need to nourish the soil and pump it full of the nutrients needed to prevent plants from becoming unwell to begin with. In this regard, our current behavioral health systems need to shift to serve as greenhouses of sorts. With the knowledge that lifestyle and environmental factors are responsible for 70% of good health outcomes, there is no reason why behavioral health systems should not move toward fostering improved access to these positive social determinants of health. Additionally, with the knowledge that many behavioral health challenges have known risk factors and early warning signs which make prevention and early intervention a very real possibility, there is no reason why behavioral health systems cannot move toward fostering environments equipped to respond early. If we are truly to see any significant changes in positive behavioral health, our systems need to serve as greenhouses in which good health is promoted and sustained, early warning signs of becoming unwell are detected and addressed, and the environment is made rich with the nutrients of resources and supports needed for all inhabitants to maintain good behavioral health overall.