by Peter Cornish

It is what we do at Stepped Care Solutions. It is the way we work with organizations. It is what we do when engaging health care decision makers and mental health providers. We inspire new thinking and new ways of organizing and delivering mental health care. For those we work with, the extent of change can sometimes feel overwhelming. I recall a fifth-year psychiatry resident commenting, eyes wide, at the end of an introductory session on Stepped Care 2.0, “What I heard from you today, turns everything I learned during my training on its head.” She was experiencing the disruption. She was intrigued but felt a little lost. Now what do I do?

This is where the diplomacy comes in. To succeed with bold transformation, support through the anxiety, fear, discomfort, confusion, uncertainty, anger, resistance associated with the change process is crucial. Acknowledging this with empathy is important. But we chose not to use the term “empathic disruption,” not just because we preferred alliteration. Who doesn’t? Diplomacy, in contrast to empathy, evokes both sensitivity and steadfastness. John Norcross, in his foreword to the book Stepped Care 2.0: A Paradigm Shift in Mental Health, cautioned, “If you intend minor tweaking of your mental health services, then this is decidedly not the book for you…, [because Stepped Care 2.0]… is a bold, big plan for personalized population health.” We expect reactions, both negative and positive. We pause to acknowledge both, but we don’t let this slow us down because help seekers, providers, and payers all are counting on something better than what we have right now.

At our not-for-profit social enterprise, we work with anyone who wishes to engage us, even those who are sceptical or in some way misaligned with our values. Diplomacy means finding a way for everyone to win. We work hard to understand the agendas of funders and health decision makers. We appreciate the agendas of middle managers and clinical leadership. We value the interests of the many professions and providers that deliver the mental health care. And, of course, we attend very closely to the interests of those seeking or needing mental health care. The agendas are almost always at odds. As is the case with political diplomacy the objective is to look behind existing positions taken by the parties to discover the underlying shared interests. Often the shared interests will be different, and this is okay as long as they are compatible. For example, a funder might want to see higher productivity or return on investment in terms of health outcomes. A provider wants some autonomy through work that is meaningful, sustainable. Help seekers want streamlined, rapid access. Stepped Care 2.0 does all these things. The role of the diplomatic disruptor, then, is to find a solution that fulfills expectations of all stakeholders. In building and iterating the Stepped Care 2.0, we are constantly attuned to the interests of all parties, ensuring that the various solutions are compatible. We look for synergistic solutions. Stay tuned for a piece on what we mean by synergy in the next post from one of our own at Stepped Care Solutions, Dr. Gillian Berry.