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March 1, 2007
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Leadership in America no longer comes from the top down—it comes from the middle out in all directions

Every one of us in behavioral healthcare—executives, clinicians, researchers, government officials—has spent our entire career in an environment defined by a profound lack of national direction and by injustice, inefficiency, fragmentation, and chronic underfunding. Despite our decades-long efforts to convince government leaders to invest more in the services we provide and the constant stream of news stories documenting our case—such as the recent heart-wrenching 60 Minutes piece chronicling the tragic death of a mentally ill inmate inappropriately handled in a Michigan prison—our progress seems agonizingly slow. President Bush's proposed FY 2008 cuts to mental health and addictions treatment programs serve as a recent reminder.

Isn’t it ironic that experts in human behavior have not yet figured out how to use good, clear communication, solid information, and education to impact the behavior of those we elect? Almost everyone else seems to have figured out how to fare well in the American political process to achieve public policy goals. And not just large corporate and big-money interests have long enjoyed special status in Washington and our state capitols. Those concerned about breast cancer, gun owners, car dealers, convenience store operators, barbers, gas station owners, and a thousand more groups all seem to do better at protecting and advancing their interests.

The time has come for those of us in the behavioral healthcare community—the mental health and addictions treatment community—to get better focused and organized to get the job done in Washington and in all 50 states. While our issues have bipartisan appeal, we expect the new Democratic Congress to be more receptive than was the House of Representatives dominated by Tom DeLay (R-Tex.) for more than a decade (He was perhaps the most powerful politician in Washington during this time other than the President). And I have been most encouraged by recent discussions with Republican leaders in the Senate and House with regard to a number of our issues.

But many difficulties lie ahead. And money will remain tight. President Bush's $2.9 trillion FY 2008 budget proposal calls for cuts to mental health and addictions treatment programs, Medicaid, and Medicare. Will these cuts be moderated, restored, or even turned into increases in spending by the new Congress? Will those serving in the military and their families be provided the mental health services that they need? Will parity finally pass and become law?

Who will step up to the plate and lead on these issues in Washington in 2007, 2008, and beyond? Will it be long-time Sen. Ted Kennedy (D-Mass.), Sen. Tom Harkin (D-Iowa), Sen. Hillary Clinton (D-N.Y.), or Sen. Chris Dodd (D-Conn.)? Will it be new Speaker of the House Nancy Pelosi (D-Calif.) or House giants John Dingell (D-Mich.), Charlie Rangel (D-N.Y.), or Henry Waxman (D-Calif.)? Will Republican leaders like Sen. Kay Bailey Hutchison (R-Tex.), Sen. Gordon Smith (R-Ore.), Sen. Orrin Hatch (R-Utah), or Sen. Olympia Snowe (R-Maine) play a significant role given the new party breakdown?

Frankly, while each of these national leaders exercises great power and will play an important role on our issues during the 110th Congress, it is us, not them, who must lead. We’re the ones who must provide the insight, ideas, education, encouragement, prodding, support, and vision necessary to motivate and guide these and other elected leaders so they can accomplish what we all know must be done. It is our job to lead and to participate in shaping national policies related to the people, families, communities, and the public- and private-sector payers that we serve.

Tom Peters has a small but important book on leadership in his Tom Peters Essentials series. A graphic design aficionado, he puts his two major points on leadership on the inside flap and on the back cover so that even the most casual of bookstore browsers can’t miss them:

  • Leadership Point #1: A key, perhaps THE key, to leadership is the effective communication of a story.

  • Leadership Point #2: Nobody gives you power, you just take it!

Do we have a story? Of course we do. In fact, no one has a more compelling story of tremendous unmet needs and wonderful stories of recovery. In every town in America, we see unmet: young pregnant women with untreated depression; the elderly living alone, isolated, anxious, and at risk for suicide; seriously mentally ill men and women released from jails and prisons without housing and into a community mental health and addictions treatment system that desperately needs to be expanded and better funded; or worse. And in every town we see our successes, such as men and women living in the community who 50 years ago would have languished a hundred to a ward, and children and families that just a few years ago would have been separated by residential placement and left to struggle alone under the weight of guilt and confusion. We see people recover, families kept together, communities made stronger.

Learning to tell this story more effectively—and creating opportunities to tell it—is our responsibility. And we must inspire others to help carry the message—not just those who are part of our “traditional” advocacy community but also clergy, law enforcement, prosecutors, judges, doctors, community leaders, and others who care about their communities and know the cost of shortsighted and inadequate approaches to human services.