Innovative Thinking in Mental Health Delivery

In Clackamas County, Oregon the mental health and substance abuse program was serving 1.3% of its 380,000 residents. Research shows that 27% of people experience mental health problems...
by | February 23, 2010 AT 3:00 AM

In Clackamas County, Oregon the mental health and substance abuse program was serving 1.3% of its 380,000 residents. Research shows that 27% of people experience mental health problems every year and, for the poor, 40%. National research also shows people with mental health issues die 25 years earlier than their peers.

The county, like most jurisdictions, faces constrained finances. But their model for mental health services relied entirely on county employees and there was only one location in the county where services were provided.

The Clackamas County Board of Commissioners directed its Department of Human Services to look at better ways of meeting the critical needs of people with mental health and substance abuse issues.

The county chose to work with the Public Strategies Group to conduct a Design Lab innovation exercise. This is a structured method of creating breakthrough ideas for delivering services and meeting customer expectations. These sessions are intensive, and participants engage in techniques aimed at "inventing" new approaches or designs starting with a blank sheet of paper.

The designers are 6-8 people chosen because they don't have a stake in the outcome, although most have subject matter knowledge, most importantly, they are curious people willing to explore creative solutions to problems. The goal of a Design Lab is a set of breakthrough ideas that are challenging but implementable. It is then up to the sponsor organization to transition from ideas to concrete plans for action.

The technique encourages both divergent and convergent thinking. Divergent thinking is a thought process used to generate creative ideas by exploring many, many possible solutions. Divergent thinking typically occurs in a spontaneous, free-flowing manner, so that many ideas and solutions are generated in a random, unorganized fashion and unexpected connections are drawn. Following divergent thinking, ideas are organized and structured using convergent thinking.

Stakeholders are asked about their interests at the front end of the process and asked to comment on the results of the Design Lab, but are not part of the design team. In the Clackamas County case the department received input from over 150 stakeholders, employees, and consumers of the system from individual interviews and in a large stakeholder and consumer meeting.

Stakeholders and consumers were adamant that they wanted increased access to services with more consumer involvement, fewer crises, more stable housing, better employment opportunities, connection to families, peers, and the community, and improved health.

At the end of the three day session, the group proposed a set of ideas for a redesign of the system to achieve the outcomes the stakeholders and consumers were seeking. They proposed the following ideas to shape the new system:

1. Public campaign for Health - lowered stigma and early awareness

2. More Front Doors - early detection and connection to physical health systems

3. Know Thy Customer - identify need, motivation, and availability of supports to target interventions

4. First responders - reinforce natural supports including families and peers

5. Right care the first time - formal systems integrated, decentralized and connected to primary care

6. Health-e Clackamas - new technologies open the door to expanded access and support with the county serving as an innovator in development

7. Performance drives it all - regular assessments of progress with adjustments to improve success

Based on the results of this innovation session, the County is well on its way to redesigning its behavioral health system with the support of the Board of County Commissioners. In addition to establishing committees that include community members to move forward each of the ideas, the county has already moved ahead with some concrete changes.

For example the county expanded the pool of supported employment providers, created a prevention/early intervention campaign for seniors with addictions, applied for a grant for peer support, prioritized prevention in its request for state funding, and decided to reverse its decision to terminate its Federally Qualified Health Center.

The county also has launched a Network of Care website which is a tool for individuals, families, and agencies interested in behavioral health. The website has a wealth of information about behavioral health specific to Clackamas County as well as state and national resources and has a social networking function.

The Design Lab method gets around the problem often faced in the public sector --- being stymied by vocal stakeholder groups with diverse interests and deep passions who are seeking to meet their interests. Stakeholders are listened to carefully in this process but the design is entirely targeted at reaching specified outcomes, not the interests of stakeholders, allowing for more far reaching, breakthrough concepts to emerge for consideration.

As fiscal challenges continue to plague government, there is a huge opportunity to use this technique to encourage innovation.

Beverly Stein is the President and co-owner of the Public Strategies Group. She was the elected county executive for Multnomah County, OR for eight years and was selected as "Local Official of the Year" by Governing Magazine in 1996. Design Labs ä were developed by PSG and have been used with clients over 25 times in the last 18 years. For more information see