Right out of school, Dale Shreve represented the type of business-focused leader that MHCA sought to develop among its earliest members. Though he holds an MSW (University of Michigan), Shreve’s studies focused on administration and management. In 1979, Shreve says that he was hired by Chuck Thayer, the clinically-focused head of Lucas County’s West Center (the predecessor to Harbor of Toledo, Ohio), “to do the administrative pieces that Chuck didn’t enjoy.”
“My appointment there was a realization that the organizations coming out of the CMHC movement needed administrative expertise to ensure long-term viability,” he maintains. Given its location in a prosperous segment of an urban county, Shreve says that the center “never had any direct federal funding.” And, while this was a disadvantage at the time, he believes it ultimately “may have put us ahead of the game.”
Minus federal support, the center came to rely on a mix of funding from its local mental health board, Medicaid, and from commercial insurance claims. This already diverse funding stream minimized the impact of Reagan-era budget cuts, while enabling the center to exercise some entrepreneurship. One effort involved creation of an EAP program whose revenues subsidized the center’s hard-pressed indigent care programs in the mid- to late ‘80s.
When Thayer retired in 1999, Shreve became CEO of Harbor, which has grown into a multi-disciplinary behavioral health services provider with a $22 million annual budget and a staff of 360. In his 14 years as an MHCA member, he served as an MHCA board director, as Chairman of MHCA’s for-profit subsidiary company, Mental Healthcare America, and as a board director for the Mental Health Risk Retention Group, the professional liability insurance company founded by MHCA in 1987.
Shreve, who moved with his family to Tallahassee in early 2013, shares his predecessor’s belief in MHCA’s value, calling his new post “a dream job.” But, he warns, the field must confront many very real challenges. One is health reform: “All of our members are struggling with health reform. How does the ACA get implemented? What role do a CEO and an organization have in ensuring that behavioral health services are delivered in local market?”
The process—and the answers, he says, have been “anything but clear.”
Another challenge, for many members, involves the service/funding mix: “Some members are more or exclusively ‘public-focused’ in their business and revenues. The challenge for them is—without ignoring the traditional market adults who need chronic care—how do you address the needs of a general population with physical health issues? How do you integrate behavioral health in health and medical homes? How do you expand and balance services so you can be more available to youth, serve the subset of those with autism, and other needs?”
And finally, there is the original challenge—the one that helped to launch MHCA, yet continues to vex it and every other national organization within the field: Shreve describes it as “working with a national group of providers, coming to grips with how best to implement programs locally, though each state and local implementation is totally different.”