Defining the “System”

Washington Thriving is tasked with developing a statewide strategic plan for the prenatal through age 25 Behavioral Health system to address the most significant and systemic gaps and disconnects in Washington State's Behavioral Health system.

When we say "system", to what are we referring?

A "system“ is a group of things that work together to achieve a common goal or purpose.  These can be people, objects, or processes, and they all interact in some way to make up the system.

For example:

• A phone is a system where different parts like the screen, battery, software, and camera work together to allow you to make calls, send texts, and take photos.

• A school is a system where teachers, students, classrooms, and books all work together to help students learn.

Systems can be complex, intersecting, and overlapping.  A school is one system that exists within another, wider, education system.  A classroom is one system that exists within the larger system of the school.  A school health clinic is both part of the system of the school and the broader healthcare system.

When we talk about the behavioral health system, what do we mean?

The Behavioral Health system is broadly defined here as the comprehensive array of services & supports, workforce, funding, and other supportive enabling factors that support behavioral health and wellbeing in Washington's children, youth, parents and caregivers.  It involves those who both receive and provide the services; as well as those who pay for them, govern and administer them at the local, regional, and state level.  It includes young people, their families and caregivers; as well as system actors from community-based and nonprofit organizations, state agencies and commissions, tribal bodies, legislators, healthcare providers, educators, advocates, insurers and managed care organizations, and more.  It looks at the places where children, youth, and young adults spend their time and seek support - in the home, in community, at schools, and in clinical settings.

Not only does the behavioral health system encompass clinical services and supports (e.g. healthcare systems), but also encompasses the intersecting factors that impact behavioral health (e.g. education, justice and juvenile rehabilitation, child welfare, housing, disability, employment, crisis response, and more). 

If systems are comprised of interacting pieces designed to achieve a common goal, why do systems - especially health and social systems - so frequently fail?

One reason is that it's very difficult to predict and control every detail, especially where humans are involved. Real-life situations are usually more messy and complicated than we expect.  Things like access to services, ample well-trained workforce, enough resources, and effective coordination are often assumed to be more optimal than what is found in practice.  Because the conditions that are actually impacting how the system functions are often hidden or unclear, the system can seem broken relative to the intended or desired outcome.

Further, who holds power and influence in the system, and how they view the world, predicts who gets left out or disadvantaged.  This can look like the system "failed" when in reality it is behaving as it was designed to.  Human systems that don't confront potential inequities and develop equity-based system structures end up reinforcing bias, discrimination, power imbalances, and unequal access. 

Why does this matter?

When trying to change a complex system, we need to develop a shared understanding and "see the same system". 

The well-known parable of the blind men and the elephant shows that while each person's experience can be true, it's limited because it doesn't consider other perspectives or the whole picture.  This can lead to wrong conclusions if we don't have a broader view.  Therefore, we need to bring together different perspectives on the same system to gain a deeper, more complete collective understanding.

By defining the Behavioral Health system at the highest level, we can zoom out enough to "see the elephant", understand how all the pieces come together to make up the system, and identify where we can make meaningful changes.

Reference:  Cartoon by G. Renee Guzlas.

What do you think?

Please share your thoughts at info@washingtonthriving.org