A Change I Would Like to See

By Melissa McKinstry, Board Member for the Right Door for Hope, Recovery and Wellness & Serves on Board of Directors for Community Mental Health Association

Following Melissa McKinstry’s first writings, Ideas for Certified Peer Support Specialist and Some Musings on Stigma – Transparent and Personal, on previous ‘Connections’ publications, she continues sharing her experience saying, “A person in crisis is not a good source of information about anything other than their current experience…As someone who lives with psychosis, I can tell you answers to questions asked of me while I am out of touch with reality are very different from those I would give when I can think clearly.”

I’ve been thinking about how our Federal and State governments gather information from those of us who because of poverty use services that they fund. I have come to the conclusion that they could do it differently than they do at present and thereby increase the quality of the data captured while making the assessment process easier for persons served.

Since it is funded by Federal and State governments, the public behavioral health system is required to gather a good deal of demographic information. In the private system, taxpayer monies aren’t involved, so such information is not as important.

The government needs good data to analyze the population using its services.  If their data is of poor quality, the results of whatever analyses they do are faulty. Because of this, I wonder why they insist that this data be collected in the initial assessment of a person seeking services. A person in crisis is not a good source of information about anything other than their current experience. High levels of anxiety, deep depression and psychosis are not conducive to clear thinking. Persons dealing with such conditions tend to be operating in a world of internal stimuli, not necessarily that shared by those around them. Because of this, until they are stabilized, they are not reliable sources of data. As someone who lives with psychosis, I can tell you answers to questions asked of me while I am out of touch with reality are very different from those I would give when I can think clearly.

Other circumstances also can influence the quality of data received from assessments. One is the desire to end a lengthy interview.  Assessments are not short affairs. A distressed person may have difficulty sitting through it. One way to move it along is to make up answers to questions about which one is unsure. Also, a well-intentioned person served might say whatever comes to mind when he or she doesn’t know the correct response. Other persons may be uncomfortable with being questioned by a stranger.

I was trained in research and know the dangers of using bad data to form conclusions. Data collected during assessments is not of a quality that I would use myself. I don’t understand how governmental bureaucrats don’t realize that data obtained from people in distress is not reliable. Since this demographic information is important, I think it should be collected after the person served is stabilized and has formed more of a relationship with their clinician.

Persons served by the private behavioral health system are not required to provide non-clinical information in order to receive services. I don’t think it is fair that those of us in the public system must supply a great deal of information having nothing to do with our presenting problem before we can begin treatment. I feel as if we are penalized for being financially depressed, and all for nothing because the data we provide is of uncertain quality.

I am not against the collection of demographic data: I realize its importance. I simply would like it to be collected at a different time in the journey of the person served than it is now. It would be better for persons served as well as for the those who use the information.