Building on Arthur Evans' legacy: next steps for behavioral health in Philadelphia
After 12 years, Dr. Arthur C. Evans' steps down Friday as commissioner of a transformed department of behavioral health. Mayor Kenney and the rest of the city will need to work hard to maintain and build on his accomplishments.
Dr. Arthur C. Evans steps down Friday after 12 years as commissioner of the city's Department of Behavioral Health and Intellectual disAbility Services – the name is one of myriad changes, large and small, that came under his watch. Evans brought tremendous vision and led a system-wide transformation effort focused on recovery, resilience, and self-determination. He embraced everything from prevention, early detection and intervention, to a variety of treatment types for the most serious mental illnesses while infusing the use of evidence-based practices throughout the agency's work.
Philadelphia will need to work hard to maintain and build upon his accomplishments. Much is at stake. The city's rate of drug overdose fatalities, driven by the opioid epidemic, is the highest in the state and increasing. External threats to the city's budget are rising as well. It is critically important to protect the current $1.12 billion annual budget for the Department of Behavioral Health and Intellectual disAbility Services (DBHIDS). This budget produces a total economic impact of nearly $4 billion in the city, and supports 25,400 jobs.
Evans brought a public health approach to behavioral health and worked to expand DBHIDS' focus beyond the safety net – its main responsibility is for the poor – to try to improve the behavioral health and well being of all Philadelphians. To do this, he helped build collaborations with a broad array of partners and community leaders to address social determinants of health such as food, housing, and safety, while also focusing on stigma and raising awareness of the importance of overall health and wellness. Yet Evans would agree there is still much work to be done.
Behavioral health disorders are among the leading causes of disability, and the resulting disease burden is among the highest of all diseases. Mental health and substance use disorders do not discriminate; they affect all types of people and have a significant impact not only on individuals but also on their families, workplaces, schools, and communities. Philadelphia is a tremendous city but unaddressed behavioral health issues threaten the health and economy of any community.
With Evans now taking his vision to a national platform, as CEO of the American Psychological Association, the leaders of his old agency must work intentionally to further advance that vision. They will need Mayor Kenney's support. Based on my experiences as both a behavioral health service provider and a funder that works closely with the city, DBHIDS should prioritize the following objectives:
Evaluate the existing provider network for quality, adequacy, and accuracy of the service delivery model, while being sensitive to the demands placed on providers. Evaluating programs through a systematic process can help us understand what we're doing and make changes as necessary to improve practices, including guiding prevention and early intervention efforts. A significant number of children in Philadelphia face elevated risks for mental health challenges due to neighborhood disadvantage. The behavioral health system's capacity to treat and support children and families in collaboration with other partners and to measure impact is vital.
Build capacity for a data-driven behavioral health system in collaboration with other partners. Using data can help guide our decision-making and track progress towards goals, including measuring the cost-effectiveness of programs. This will require data to be aligned and integrated with other city entities, research partners, and health plans, and will enable the city to compete under possible coming changes to health care funding for the most vulnerable Philadelphians (e.g. block grants favored by some Republicans in Washington), as well as inform citywide initiatives such as community schools and Rebuilding Community Infrastructure.
Create an advisory board made up of people who use services, family members, behavioral health provider agencies, city and private employers, the city's workforce development agencies, physical health partnering agencies, and academic and community partners to provide transparency and oversight to the system. This will ensure that diverse perspectives can be voiced and innovative solutions can be generated to address complex and persistent needs.
The city must continue to fund trauma-informed prevention and treatment services and leverage Philadelphia's momentum of being a national leader in trauma-informed practices and policy. Adverse childhood experiences (ACEs) and trauma are regrettably common nationally and further elevated in Philadelphia; they can have a significant impact on individuals, families, and entire communities. But they can be treated and prevented.
Develop deeper relationships with the business sector to address the issues of substance use and safety in all public spaces, and to increase access to behavioral health care for all Philadelphians. We need to ensure that employers in Philadelphia play a leading role in reducing stigma for their workers as well as the broader community, and work to implement collaborative solutions.
Joe Pyle, MA, is president of the Thomas Scattergood Behavioral Health Foundation in Philadelphia.
@PyleJoe
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