Study explores New York State behavioral health service delivery reform

Matthew SpitzmuellerScholarship suggests that behavioral health outcomes improve when healthcare consumers and their family members are involved in key decisions affecting the services they receive. An ethnographic study by Falk College assistant professor of social work, Matthew C. Spitzmueller, is taking an in-depth look at this premise specifically in New York State. The study’s findings have potential positive implications for mental health service delivery statewide and across the country.

Ethnographic research methods study individuals in their own environments through participant observation and face-to-face interviewing. “The value of ethnography is that it allows you to get under the hood of the process,” says Spitzmueller. Since 2014, he has observed meetings, conducted informal and structured interviews, and analyzed documents provided to Regional Planning Consortiums, or RPCs, including one in Central New York. Understanding how effectively consumers and family members are integrated into the mental health service delivery process and what obstacles are encountered will help to inform an effective model for collaborative governance, which policy makers believe can improve mental health care through consensus building and local participation.

In April 2014, New York State was awarded one of the largest Medicaid waivers approved by the U.S. Centers for Medicare & Medicaid Services to improve patient care and overall health while reducing public costs to do so. The state’s governor-appointed Medicaid Redesign Team identified mental health services as an area in particular need of reform. People with serious mental illness place an onerous financial toll on the system yet have among the poorest health outcomes.

The New York State Conference of Local Mental Hygiene Directors built a regional structure to provide oversight and troubleshooting of mental health service delivery reinvestment and reform that includes 10 RPCs with local state officials, managed care organizations and health homes, service providers, and consumers and family members. The RPC model’s design purposefully involves local stakeholders to ensure they have a voice in mental health system reforms as they are implemented.

The hope of collaborative governance is to strengthen and broaden the public behavioral health system allowing more individuals with mental illness to be supported with high-quality, cost-effective services within home and community-based settings vs. costly inpatient psychiatric stays. As the process unfolds, RPCs will use data sharing and service system planning to assess and provide input into reinvestment, establish local priorities, and share best practices both within the region and statewide.

This study, with support from a seed grant from the Falk College Research Center, fits Spitzmueller’s background and trajectory as an ethnographic researcher of mental health policy and organizational practice. Spitzmueller earned his Ph.D. from the University of Chicago’s School of Social Service Administration. His research examines direct service provision to adults with severe and persistent mental illness, strategies community and mental health workers adopt as they negotiate their changing work conditions under Medicaid reform, and policy reform’s impact on the nature and distribution of mental health services. In the School of Social Work, Spitzmueller teaches courses in fundamentals of social work practice and mental health policy. He uses his research to help students develop skills for directly engaging underserved populations and to conceptualize the linages among public policy, organizational context, and street-level practice.

Spitzmueller’s published findings from this study will assess the use of collaborative governance for steering behavioral health reform, the means by which different stakeholder groups exercise voice and influence, and the nature of representation in multi-stakeholder decision-making. “New York State is a laboratory for the rest of the country. By increasing opportunities for voice and allowing people to be agents in their own care, it is at the forefront of overhauling behavioral health,” concludes Spitzmueller.