I got good care from my county mental health system when I was poor. Once I finally got through the waiting list to see the psychiatrist, he prescribed meds that helped me get functional enough to get a good job with health insurance and no longer need care based on "ability to pay."
The county mental health in the county I lived in helped me get my life back together and on track for where I wanted it to go.
The therapist was a bit of an idiot, but the psychiatrist was competent.
And they didn't come to me, I went to them.
I'm glad they were there.
I guess that's one of those "your mileage may vary" things.
Maybe what we need are computerized, anonymous client satisfaction surveys at county mental health facilities. If you use one computer program nationally, you can ensure computer based surveys are more anonymous and tamper-proof than any other kind of survey, because there's no handwriting or piece of paper to potentially be identifiable and able to be associated with a particular client.
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All you really have to do is make the survey data inaccessible to the facility staff and have it extracted and tabulated centrally when they pick up the survey's detached hard drive. Keeping them out of the data is simple. Use Oracle, stick it on a detachable hard drive, password the system, use the card system they use for computerized voting, with signed stubbs, to ensure the surveys are only filled out by the clients--do random audits since the clients' signatures are on the privacy documents in their files and available for comparison--it will keep the facilities honest with the stubs. Then only provide a data input interface program to the facilities and no data reporting interface. Only a decent database programmer could figure out how to query the system and tabulate the data themselves, they *still* wouldn't get individually identifiable data unless they ran a query immediately after every single client completed the survey, and even a database programmer or DBA at the client facility (which they won't have) couldn't get on the system because they don't have the system manager password--which you can make a long string of random characters, and log intrusion attempts, because you can write down the system manager passwords at your centralized location that none of the facility staff ever have access to.
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Use the customer statisfaction surveys to identify what the good facilities are doing right, and the bad ones are doing wrong, to fix the bad ones. Give states money in block grants contingent on their scores on client satisfaction.
Obviously, you'd put in safeguards to keep them from turning away the harder-to-please cases. Like tabulating satisfaction sorted by demographics like diagnosis, etc.
Rather than just complaining about county mental health, work to fix it.
I've been part of successful efforts to get legislation changed. It really *can* be done.
You *can* fight city hall. And win.
You just have to know how and be willing to put the work in.
Timoclea