One evening in March 2018, I was standing in the kitchen of my house and had a moment of clarity. I turned to my wife, Amanda, and said, “I think the next issue I’m going to tackle is mental health reform.” She knows how I get and believes in me, so she simply replied, “Go for it.”
Why Mental Health Reform?
After years of being the main contact and advocate for a sister suffering from mental illness and drug addiction, I had grown tired of a system that seemed intent on placing every conceivable barrier in my way. Even for me, as a health care executive who specializes in health policy and outreach, it was nearly impossible. For the average person trying to navigate the system—good luck.
I also had this quaint and somewhat idealistic notion that people with a clear vision, a unique skill set, enough contacts, and a little luck, can actually move the needle on longstanding and seemingly intractable issues.
It’s not that idealistic, though.
Past Experience
First and foremost, many people have faced down seemingly insurmountable challenges throughout history. Heck, even I have had the opportunity to play a role in addressing significant issues within our region and our state.
We did it in 2008 with the creation of the Prescription Drug Abuse Task Force of San Diego County. That effort was a game changer that brought together a wide array of partners focused on a common goal. It was fairly ahead of the curve—a novel concept for a prevention organization—and remarkably successful despite initial opposition behind the scenes from the government agency that was responsible for public health, dismissiveness from several reporters, and a lack of accurate and timely data.
Then it happened again in late 2013 with the publication of the San Diego Union Tribune’s three-day expose titled “Deadly Neglect” which uncovered more than two dozen questionable deaths of vulnerable seniors at assisted living facilities in San Diego County. My grandmother, Hazel, was one of those seniors.
I founded Hazel’s Army out of frustration with a failed state bureaucracy that didn’t prevent it and seemed indifferent to it after it happened. Our goal in 2013 was this: Pass meaningful assisted living reform—an effort that had been tried and had failed countless times over the years. But this effort was different: We had media coverage, engaged elected officials, and a slew of motivated stakeholders. What followed was the RCFE Reform Act of 2014, the most comprehensive assisted living reform effort in decades, which resulted in more than a dozen new state and local laws and policies to protect seniors.
New Challenges
Fast forward to where this piece began: March 2018 and my frustration-born interest in mental health reform. Little did I know that only a month later I would accept a new job, and that shortly after starting that new job we’d be thrust into the middle of a politically-charged behavioral health debate.
But there was light at the end of the tunnel, or so I thought. Thinking back on the past two successful reform efforts in which I played a role, my initial reaction was to think that as difficult as the politically-charged behavioral health debate was, it would ultimately provide us with an opportunity to get to the heart of the decades-old society-wide failure that is our mental health system.
At the time, I also believed that the facts would eventually win the day, and the debate would soon be level set. In hindsight, I can see how that was a naive and faulty assumption.
But at the time, in those circumstances, I turned to what I do best: Meeting with people, gathering reform ideas, and putting them into a clear format that other people can understand. I met with over 150 behavioral health stakeholders, individually and in small groups, over the course of six months and gathered dozens of policy and practice reform ideas. There were 30 such reforms that were consistently mentioned.
The challenge was that behavioral health reform is a complicated issue: Various points along the continuum of care, different stakeholders, and complicated funding mechanisms for diverse impacted populations. It is a complex puzzle and most people are ill equipped to decipher it.
Deciphering the Puzzle
One night in the middle of this information gathering process, I was home and putting my son to sleep. He has high-functioning autism and is quite fond of puzzles, including the Rubik’s Cube. As I laid there with him as he dozed off, I glanced over at the Rubik’s Cube on his nightstand and suddenly realized that the cube itself could be used as a model for creating a rubric under which behavioral health reform concepts could be categorized—and owned by responsible parties.
Imagine an extended Rubik’s Cube. Along the bottom or y axis, each cube represents a point along the behavioral health continuum. Along the depth or x axis, the cubes represent key stakeholder groups. The height or z axis is where we find cubes representing impacted populations, simply broken down into youth, adults, and seniors due to different funding mechanisms. Laid over those cubes you could have prisms representing different socioeconomic, racial, ethnic, and other groups and subgroups. As such, each individual cube within the puzzle represents a point on the continuum, a stakeholder group, and an impacted population.
Policy ideas impacting that particular junction could be placed within that cube, or attached to that piece of the puzzle. All a stakeholder group (or group member) would have to do is own their piece of the puzzle.
When an elected or government official inevitably says, “Tell me the one thing that I can do to help this situation,” the ideas will be there.
This model, now affectionately know at our house as the “Byzak Rubrik’s Cube”, was born.
With this new rubric in hand, I took the 30 policy and practice reform concepts and categorized them on the cube accordingly. I then set about writing one-page briefing papers for each.
The goal for this document: Simplicity. Make it simple enough that nearly everyone could understand it. Don’t weigh it down with data. There will be plenty of time for that later. For now, just get to the point.
Each briefing paper describes the concept, the problem it seeks to address, who would likely support or oppose it, and includes a four-square cost to benefit chart. The points on those charts were placed through a less-than scientifically rigorous process: Me and several other policy nerds with lots of professional experience looked at it and decided where the point should go. Although not scientifically rigorous, I figured we have a better than average chance of being more accurate that the Congressional Budget Office (CBO) which uses static assumptions and is rarely, if ever, correct.
Packaging for Public Consumption
Once the briefing papers were produced, I made sure the document looked pretty (thank you, Canva.com) and was ready for dissemination. All I needed was a break in the action—a point where the political rhetoric had abated enough to where an actual discussion could take place. So I waited. And waited. And waited. Days turned to weeks. Weeks turned to months.
Now, after seven months of sitting on this document, the political rhetoric has yet to abate, and the true story remains largely unwritten in the media.
Meanwhile, people continue to suffer under a broken system. Now, in my estimation, is the time for action and to get to the root of the challenges facing mental health consumers and their families.
We’re now going live with Mental Health Policy and Practice Reform: A Local, State, and Federal Perspective. You can download the PDF at the link below:
Hazel’s Army: Mission Expanded
To ease the report’s dissemination and to bring together the various efforts I’ve been part of over the years, I have decided to revive Hazel’s Army with an expanded mission. Don’t get me wrong: Hazel’s Army has been active all this time—it just has done so under the radar for the last few years.
For instance, since 2015 we have done free presentations on the Greatest Generation to more than 5,000 students at local high schools and provided their teachers with free, Common Core-aligned curriculum for conducting oral history interviews with seniors and developing ideas for making society better for seniors.
However, in our new, emboldened form we will broaden our focus to include policy reform, advocacy, education, and inspiration not only to help seniors, but also for other vulnerable populations, including the mentally ill and at-risk youth, among others.
I will also be folding into these efforts my Strategic Career Planning (SCP): A 10-Step Guide to Realizing Your Potential program. This is the program that I created to transform myself from who I was when I started (a 24-year-old EMT with no formal education and limited career options) to who I am today.
Over the past decade, several thousand people have attended this program and benefitted from its organized approach to professional, educational, and personal development. While I will continue to provide SCP one-on-one for my proteges and certain industry groups, I will focus our pro-bono SCP efforts on at-risk populations including disadvantaged youth, homeless individuals and, if I have my way, the incarcerated.
We are also debuting a new website — https://www.hazelsarmy.com — to make sure that our programs and documents are available to everyone, including our Fact Sheets and the free, Common Core-aligned Middle and High School curriculum from our GreatGen 2.0 educational program.
My hope is that this multi-faceted effort:
Kicks off a wider debate over policy and practice reform in mental health and elsewhere, including an exploration of the more complicated and time consuming solutions that exist
Causes key stakeholder groups to take a hard look at the policies that warp the market and reduce access for our most needy patients and community members
Inspires elected officials to reduce the rhetoric, to seek non-politically motivated answers, and to practice collaboration that puts us on the path to helping people
Encourages other community members to get involved and to help lead reform of the system
Reduces stigma associated with mental illness and helps those in need
Brings additional educational resources to those who seek to find a new or better way forward to improve their lives and those of their families and communities.
When I launched Hazel’s Army back in 2013, I ended it with a simple statement that bears repeating now:
Let’s do this.