When we think about the Grand Canyon, we think about a vast space that is uncrossable in most places. A place where survival is challenging without support and where it is easy to feel alone. A large and deep cut in the earth that is nearly impossible to cross.
Our behavioral healthcare system feels very much like the Grand Canyon to the individuals and families it purports to serve. Once you are in the canyon, finding an island that offers treatment and relief feels impossible and scary. Treatment may be difficult to find — and after your immediate needs are met, you might find yourself right back in the canyon.
We spend a lot of time as a community, as a state, and as a nation thinking about the ways in which care is provided. We spend a lot of time working through bills and initiatives to improve care in each place or to define the responsibility of a particular place before they can send all of us back into the canyon. What we spend very little time on is the importance of the connection between those places, or lack thereof. The connection is just as important as the destination. If we don’t look at the spaces between our care systems, we miss the important stories about how folks get lost because there aren’t enough support systems to help carry them to their next stop.
Many of us are currently stuck in this metaphorical Grand Canyon. We have accepted that we may never reach the care system we need because of barriers in our path due to lack of insurance, or structural racism, or geographic limitations, or other reasons. Perhaps we reached our care destination and realized it wouldn’t be able to serve us or our family members appropriately and we don’t want to go back. Maybe there isn’t a care model that even exists for us because our needs aren’t even recognized.
The reaction of many care providers is to build up their care system because the canyon looks impassible. While this seems understandable, we see sectors of our world start to construct elaborate systems, going far outside of their areas of expertise, in order to try to be a one-stop shop. We have seen this in law enforcement, schools, and community-based healthcare settings. Another reaction is to more clearly define where a care provider’s service border lies. The problem with this is that we are then directed to our next stop without being provided with a clear path to get there that is safe and accessible. We have seen larger care organizations and insurance providers that might be reimbursed for services provided and may face financial complications the longer they wait to move people to their next destination.
All of these reactions make sense when we recognize that they’ve been built up from the system we have. All portions of these service islands surrounded by the canyon that we are all trying to reach are acting in the best way they can because the canyon feels too vast to contemplate. So, we collectively ignore the canyon and focus on our island. We might fight the other islands for territory or to avoid liability. But what gets lots in that focus? The people we serve. What gets lost is us. Our focus on the island means we never look at the canyon. We get that — the canyon is a hard place to look. There is a lot of pain in the canyon, there are a lot of lost folks in the canyon. It feels more comfortable to maintain focus on our island, where we can move people along to their next step, if we could just solve this one problem.
We can no longer ignore the canyon. We must start in the canyon we created and reinforce it.
We need to provide a path that feels welcoming, that has road signs in the languages we speak, that recognizes the value in our communities, and the experience of our families.
We know this is possible. Once you do look to the canyon, you see that it’s not all bad news there. You know what is at the bottom of the actual Grand Canyon? A river, life, plants. You know what’s going up and down the sides of the Grand Canyon? Tour guides. There are people surviving and thriving in the Grand Canyon with the help of other people.
Our Grand Canyon of service is the same way. Community-based organizations are those tour guides and they are moving that river, helping people understand the signposts, guiding people to the paths that lead them to their destinations, and working to keep people safe and cared for. These community-based leaders speak the languages of all of us who are also in the canyon because they also live there.
Another way to look at the actual Grand Canyon is as something that humans have seen as a great challenge to innovate around, where people have created incredible solutions to cross the canyon, survive within it, and view the canyon in the clearest way possible.
So, how do we better connect all of us in the canyon? That’s our challenge. We won’t accomplish this by trying to build an impossible bridge over the canyon. What we need to do is find better ways of connecting to the guides and the river to help those who need access to services, and we can do this by reinforcing the amazing structure that already exists. We can value the work of communities, not by pretending they don’t exist, but by integrating those systems into our formal care systems. We can value communities, not by trying to recreate the entire care system into each service island of our world, but by valuing community-based care organizations for their labor.
This is what we are doing. We are the guides. We stand ready to help get you to the island and we’ll be waiting when you are ready to move to the next one.