Bureaucratic Boundaries

by Bob Bennett

The President’s New Freedom commission, which focuses on the need to transform the mental health system - a system in shambles - identifies bureaucratic boundaries as one of the issues that prevents people with mental illness from receiving the help they need.  But, what are bureaucratic boundaries, and why are they so bad?

Simply put, they are obstacles to recovery placed in the way, usually to increase the power or influence either of a department, an individual bureaucrat, or a contracting agency.  While these bureaucratic boundaries exist in all bureaucracies, they are particularly insidious in the mental health field as the people they are supposed to serve have the least power of any group in America, and the bureaucrats often justify their actions with “Well, they’re mentally ill, so you never know what they are going to do.”

As stigmatizing and erroneous as this statement is, it is typically all that is needed to maintain the discrimination and prejudice against the individual with a mental illness.  It is accepted as fact by almost everyone, including policy makers and upper level bureaucrats.  Lower and mid level bureaucrats rest comfortable in the knowledge they will never have to change the way they do things.  Maintaining the status quo is, after all, the primary purpose of a bureaucracy.

“Who’s going to believe you, you’re mentally ill” is something I’ve heard more than once, even from the other side of closed doors.  Too many care givers who work with the mentally ill population, admittedly a sometimes difficult population, are at best, burnt out. 

What follows is really just skimming the surface of the problem; a complete treatment of bureaucratic boundaries would likely take three or four large volumes.

One problem with bureaucracies is that the larger they get, the more they tend to support the dominant players in the field, and regulate the people they are supposed to serve.  They do this by limiting options and providing hoops for their clients to jump through.  The more hoops they provide, the more important the hoop handlers believe themselves to be.  Handling the hoops becomes the purpose for their existence, not facilitating recovery and reducing dependence on government.

Independent fair minded people are needed in every bureaucracy.  They are needed in every field of endeavor, but despised, particularly at lower levels of large organizations, like bureaucracies.  This is because they are willing to upset the apple cart and act for the benefit of clients.  Many mid and low level supervisors excel at sticking knives in people’s backs; usually to cover up their own questionable activities.  Like a fiefdom, once in power, they are extremely difficult to remove.

In California, they actually have a law, which requires that those who despise independent thinking and are good at mimicking behavior, including bad behavior, be hired first and without testing in the State system.  Of course, the law was intended to give a leg up to ‘A’ students, but overlooked how many college professors complain about the students who get straight A’s by flattering various professors and avoiding the ones who are tough.  In Nevada however, we do it the old fashioned way.  If you show a streak of independence and fair mindedness, you just won’t get hired.  Dependency is valued.  After all, the goal of bureaucracy is to make as many people as possible dependent on you.  Bureaucrats rule, and there is little elected officials can do about it.

Another area is confidentiality.  Many consider it very stigmatizing to be hospitalized, especially to a hospital designed for psychiatric care.  So hospitals and agencies have very strict rules about not giving information about their patients or clients, even to family members unless a release is signed.  On the surface this is very good.  Dig just a little deeper, and find out how it is abused for the benefit of the bureaucrats, not the clients.  At one time, releases were signed and good for one year.  Some agencies took it upon themselves to reduce the time the release is valid down to six or even three months.  Family members get angry when their family member being treated hasn’t signed a release, but the person is usually unaware that the release he signed a few months earlier is no longer valid.  Releases should be valid until revoked.  Just another unnecessary hoop designed to increase paperwork and increase cries for more funding.

One thing elected officials could do, is take a page from certain industries and implement process audits.  While some companies who perform process audits, and those rare government agencies that occasionally do something similar, just check to see that everyone is following the rules, a true process audit includes making recommendations – and follow through - about the rules which need to be changed to facilitate the purpose of the organization.  Often rules and laws are intended, such as the California law cited earlier, for good purpose, but they fail the reality test.  Many laws and regulations actually obstruct good citizenship and promote deception, evasion and dependency on government.  We need to pare down the number of rules and regulations the people are forced to live under and consider how it will affect people in all walks of life, not just those who push a pencil for a living.      

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To contact Bob Bennett, go to bob@approach2balance.org.

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Mental Illness: A Guide To Recovery is available from Trafford Publishing Company. For more information, or to place an order, click here http://www.mentalillnessrecoveryguide.com

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