In the late 1970’s, the long running television show, Happy Days, ran an episode where Fonzie tried to jump over a shark on water skis. This ill-fated episode spawned the popular phrase, “Jumping the Shark.” The phrase has come to refer to circumstances where a heretofore popular and well-established program, service, or product senses a loss in its appeal and feverishly tries to renew its status. Jumping the shark also contains an ironic component. In desperation, the tarnished program, service or product tries to regain its consumer approval with bad ideas that result in untoward consequences. Behavioral health care is at a crisis point and clinicians, researchers, administrators, and policy makers are well-advised to avoid jumping the shark.
Behavioral health care should adhere to Triple A rated ideas. In my opinion, these initiatives involve increased Accountability, Affordability, and Accessibility. Accountability is absolutely critical for good patient care and the sustainability of our field. We must work diligently to achieve good outcomes for patients. Accordingly, embracing measurement-based care that tracks treatment progress and provides real-time feedback to clinicians as well as patients is essential. Adopting genuine evidence based approaches to assessment and treatment is also an imperative. Competent practice which applies these treatments with both fidelity and flexibility is another necessary ingredient in the recipe for clinical accountability.
Services cannot be delivered without consideration of costs to patients, institutions, payors, and providers. A powerful evidence based approach is diluted if it is too costly to implement. If patients cannot afford to receive services, the protocol lies dormant. Finally, if hospitals, clinics, and agencies cannot afford to hire competent practitioners who authentically apply evidence based treatments, the quality of care suffers. Therefore, we have to be increasingly cost-conscious in our research and clinical activities. Economic savvy and business know-how are fundamental for growth in our specialty areas.
Access is the third A. True access is dependent on accountability and affordability. More access to ineffective to poor care meets the standard of jumping the shark. Greater access to unaffordable behavioral care is another painful irony. New service options should be developed but only if they meet accountability and affordability standards.
I call on contributors to and readers of Contemporary Behavioral Health Care to join me in facilitating a commitment to greater clinical accountability and financial affordability of services to propel greater access to vulnerable populations.