When it comes to Oregon State Hospital, everyone's talking about culture change.  If you listen to government officials, state hospital management and personnel, advocates and the media, they all talk about this thing called "culture" and the need to change it.  And it's not just the hospital.  Last week, I was at a meeting of "stakeholders" discussing a state initiative to change how group homes are used.  Most everyone agreed that the "culture" of this service must change.  This is one of those very useful phrases that everyone can agree with as long as the details remain murky.

The two words "culture change" describe a process and destination.  The destination is "recovery."  The process is how the state hospital and group homes can change their thinking and actions to better promote recovery.

Changing habits of thought and action can be difficult.  A reformer might think that getting an new idea announced as a federal policy will lead to quick implementation.  Such a policy was announced for "recovery" in the report of The President's New Freedom Commission on Mental Health.  It's Vision Statement reads:

We envision a future when everyone with a mental illness will recover, a future when mental illnesses can be prevented or cured, a future when mental illnesses are detected early, and a future when everyone with a mental illness at any stage of life has access to effective treatment and supports — essentials for living, working, learning, and participating fully in the community.

This report was released in 2003.  It's ideas were not new to leaders in Oregon's mental health system.  But we are still trying to get some traction on the ground level where people with psychiatric disabilities are housed and treated.

In the worlds of physical and intellectual disability services where I also advocate, there are certainly lingering prejudices, paternalism and the imposition of external limitations on individual development.  People are still inappropriately stashed in nursing homes, sheltered workshops and self-contained classrooms.  But you don't hear too much about culture change.  More frequently, you hear concern that people from outside the services systems will not properly understand the existing culture. 

As Oregon's new Governor and legislature start to tackle our very severe budget crisis, there will be a lot of talk about what and how much to cut.  We must make sure that we always ask whether a program, a service or a facility will help to change the cultures that need to change and expand the cultures that need protecting.  Every dollar spent should promote recovery, choice, self-determination and maximum integration.