Scarcity has been in the news lately. It is something with which most in the field of mental health are entirely familiar.
Our community faces a variety of serious challenges to the health and well-being of its citizens. Last week we learned that the homeless population in Los Angeles County grew by 12%, despite the spending of voter-approved hundreds of millions of dollars in 2018. In the same week LAUSD’s measure EE failed at the ballot. The measure would have provided desperately needed funding to local schools, but may have exacerbated the county’s housing-affordability and homelessness crisis by taxing living space. In other words, two crisis pitted against one another in competition for resources.
Like access to healthcare, access to secure housing and a quality education directly impact the mental health of our fellow citizens - our friends, family, and neighbors. These issues are so fundamental and essential that it can be maddening that they are left scrounging for resources as if they were of second-tier importance. It would be hard to imagine a EE or HHH-style ballot initiative required to fund trash pick-up, or a PTA-style bake sale to support new stop signs. By some measures we are as a society more clear-eyed on the significance of things than we are of people.
If it makes you want to scream, I suggest going ahead and letting one out. It will feel good and may even be productive. But then - and forgive me for the expression - it will be time to roll up our sleeves and continue to get back to work.
Those of us in the field of mental health are experienced in operating in an environment of scarcity. It is the stark reality of our industry that there are rarely enough resources available to be able to supply our clients with all we believe they deserve. Where funds are short we fill the gaps with effort, “elbow grease”. We end up getting the job done at the cost to ourselves and our teams. It is unfair, but frequently it seems the case that those who are most passionate about their professional calling are the ones left to fight the hardest for the means to do the job they love. It is as though the intangible benefits have been factored into the ledger by the powers that be.
If scarcity in mental health were a soup, it would have three main ingredients: A willful myopia for the impact of bad outcomes long-term; an impression that the workforce is replaceable by a new crop of college graduates every couple of years; and a knowledge that even employees in the throes of burnout will continue to attempt to do their best by the clients they are so passionate to serve.
We are all familiar with scarcity, but we have given it more power over us than it deserves. When it starts sneaking into meetings to which it wasn’t invited; when it slips into company conversations as if part of a well-rehearsed mission statement; when it becomes the reason that great employees get stuck in backwater positions servicing a mission that hasn’t been assessed by leaders in years; when it keeps you from exposing your team to cutting-edge training on the business of mental health: that is when scarcity has metastasized from ‘fact of life’ to a destructive force.
Scarcity is truth but it is not the whole truth. Scarcity should never disrupt client care when there are dozens of treatment models and configurations available, as well as peer agencies, allies, and philanthropists to help fill in the gaps. Scarcity should not be the cause of high turnover, moral injury and inefficiency in teams when there are reams of data available about ways to motivate and incentivize people beyond salary alone. Do not let employees languish and be miserable just because they keep doing the work… until they don’t.
Scarcity should not keep you from running a business or being a part of a great team. It is no more than an entry in the ledger, one that must often be offset by creative means. To let scarcity claim too much credit for all that is wrong is to poison the means to make things right.
The work to fight against scarcity looks mundane at first. It involves processes like defining success for your clients in simple measurable terms, and then doing the same for members of your team. Look at things like disengagement, turnover and the rates of accidents and errors. Analyze operational and overhead expenses against industry benchmarks and use the data to identify areas where there is opportunity to become more efficient with the resources you have. Invest in people presenting long-term solutions. Conduct postmortems with your team on both successes and failures, then distill them into actionable lessons that can be included in trainings. This is what great companies do. During Steve Jobs’ waning years, Apple commissioned case studies on business decisions during his time in order to prepare future generations of leadership with the skills and decision-making processes that lead to Apple’s spectacular success. Devise and safeguard the means for employees to be heard and to hold managers accountable. Build a culture of trust and good faith to keep problems from festering in silence.
The problems of scarcity (real and imagined) can be conquered with stoic incremental improvement. You must not let scarcity keep you from what drove you to the helping-field in the first place: Hope.