SAMHSA defines health homes as “a team-based clinical approach that includes the consumer, his or her providers, and family members, when appropriate.” Done right, they could provide a needed “home base” for people with chronic health conditions or impairing mental health conditions to coordinate care. This includes organizing multiple services from multiple providers. But as with any new major system, there are challenges.
One risk is of fragmented models of care and belief systems among providers. Organizing care then becomes a political football game to see who can sell or coerce adoption of their way. For example, a provider who is committed to a biological brain disorder model of mental illness will underplay the role of ecology and environment (overwhelming, traumatic experiences). Another who narrowly defines “trauma” as combat, abuse or neglect may require the person receiving care to only focus on these three as causes of behavioral issues at the expense of the person’s history. A third, sold on the benefits of medication, will over-focus on the need for the person to make sure they “take their meds.” It’s all about who has (or can wrest) the power.
Another challenge, in faith based communities of care, is the overlay of spiritual dogma. Service providers may wrestle with this depending on the culture where they work. How people wrestle with what they cannot see, the meaning they apply, the power they assign, is vital in healing. Yet the classic injunction—and with good cause—is for clinicians to avoid matters of spirituality and faith. Addressing these can cause conflict to emerge if doctrines and dogma conflict; it certainly calls into challenge the spiritual formation of the clinician. From a practical side, if I am required to act like I believe what you believe in order to receive care (for example, listening to a sermon to receive a meal), then power is automatically misused. The quid pro quo is no different than in sexual harassment.
There is likely to be no spiritual care or fiber in this process, as the realm of spirituality (not religion) is often excluded from care, and if included, is often patronizing and demeaning, focusing on separating “those people” from others because they “have a history.” It is laden, in general, with shame, misogyny, and exclusion if not overt then covert.
Finally, the provider who is burnt to a crisp from over work or their own history will push away and defend. Burnout and vicarious trauma cause us to need to protect ourselves. In this case, like others, and whatever happens is because of the person’s “mental illness.” There is no room for the service provider’s mental distress in this.
This disconnection within a care network can be especially challenging to someone struggling with the aftermath of trauma. And when inconsistencies within a care team develop, they do so at the expense of the person it intends to serve—who is often absent from conversations that include decisions and choices that affect them. The “whole-person” philosophy specifically espoused by Medicaid in the context of Health Homes may be specifically lacking in many of these systems.