Ashley’s Blog

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Marijuana and the Movement Toward Legalization

I was fully in favor of the legalization of marijuana for recreational use…until recently.  This might come as a surprise to some.  For the past 25 years, I’ve worked in the behavioral healthcare field and witnessed the adverse effects of various substances (both legal and illicit) on vulnerable individuals.  Why would I support any policy shift that would make marijuana (or any other harmful substance) more readily available? I suppose the libertarian in me always drew a bright conceptual line between the roles of public health and law enforcement authorities.  I believe it’s generally ill-advised to consume a gallon of ice cream in one sitting, but I would never support legislation to prohibit it.  And so the logic goes. But marijuana isn’t mocha almond fudge
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A Word About the Words We Use

The behavioral health field has become more sensitive to the impact our language has on vulnerable persons.  This promising, but still relatively recent, development reveals our emerging awareness certain words, phrases and labels betray pejorative beliefs and perpetuate stigma.  They also shape and reinforce the identities of those to whom they are applied.  How many of us have referred to individuals entrusted to our care as “schizophrenic,” “bipolar” or “borderline?” Thankfully, we have dispensed with such appellations in favor of “person-first” language that no longer equates individuals with their diagnoses.  A “person with schizophrenia” is not defined by his condition any more than a “person with blond hair” is defined by his.  (That is not to suggest there is not something inherently insidious in the
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Care Coordination (It is Often Anything but Coordinated)

In recent years, our health and behavioral healthcare systems have begun to embrace alternative provider payment models designed to enhance the value of the services they deliver.  That such an approach is considered an “alternative” (or even innovative by some standards) is truly remarkable.  Imagine purchasing a car, dishwasher or gym membership without any consideration of their value (i.e., the benefits they confer relative to the resources expended to acquire them).  In no other domain would we commit our capital to goods or services with such little regard for their utility or impact on our welfare. So why has this peculiar exception prevailed within the healthcare industry for so long?  One could easily fill an ocean liner with actuaries, economists, policy specialists, industry insiders (and
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The Media Exposes Neglect of Adults with Mental Illness…Again

The New York Times and ProPublica recently published articles that exposed some of the failures of our supportive housing and community-based systems of care for individuals with serious behavioral health conditions.  These articles detailed the plight of some who have “slipped through the cracks,” so to speak.  Although most occupants of Office of Mental Health (OMH)-funded supportive housing programs manage their health conditions with relative success and enjoy a greater quality of life than would be available to them within institutions, there are surely some who are unable to secure the services needed to survive, much less thrive, in independent settings.  In recent decades the locus of care for our most vulnerable citizens has moved to the community, and alternatives to institutionalization in all its