Just about 43 years ago, Don Hevey, MSW, a 1968 graduate of nearby Florida State University, was wrapping up his second year as a clinical social worker at the Leon County mental health clinic (now the Apalachee Center for Human Services) in Tallahassee. And, like any young man, he was eager to make his mark in his chosen field.
At the time, a bold new national initiative—the formation of federally-funded “community mental health centers”—was still taking shape. The new CMHCs, as they were called, were the product of the Community Mental Health Centers Act, which President Kennedy signed into law in October 1963, only weeks before his death.
So, when the state of Florida’s Office of Mental Health began looking for individuals that could help the state develop its vision for a statewide network of CMHCs, Hevey applied for and got the job. This 3-1/2 year assignment took him around the state and brought him face to face not only with the challenges and the opportunities, but also introduced him to dozens of people and personalities who were to shape the behavioral health field in Florida—and around the country—for years to come.
The heyday of the movement
In 1975, Hevey shifted from helping develop CMHCs to leading one when he was named the CEO of Manatee Mental Health Center (now Manatee Glens), a newly opened CMHC in Bradenton, Manatee County, on Florida’s Gulf Coast. The 1970s were the heyday of the CMHC movement, a time when CMHCs faced the challenges of deinstitutionalization, but did so with a secure source of funding—direct from the federal government. It was a time when “mission trumped economic concerns” and “people were really excited about the notion of accessible mental health care in the community.” It was also a time of unprecedented activism that saw a record number of lawsuits filed on behalf of better services and supports for people with mental illnesses and disabilities.
The activism reached even to the White House, where President Carter and First Lady Rosalynn Carter championed the interests of people with mental illnesses. The Administration’s efforts gave birth to an important new piece of mental health legislation, the Mental Health Systems Act, which passed in 1980. The Act represented a substantial upgrade to the original CMHC Act, addressing not only the original limitations of the CMHC Act, but augmenting services and further strengthening the partnership between the federal government and the CMHCs. The future of the field appeared bright.
A change in fortune
But the reforms developed in the Carter Administration were never implemented because, in November 1980, Ronald Reagan won a landslide victory over President Carter, taking office in early 1981. At the same time, Bob Graham, who had recently been elected Florida’s governor, asked Hevey to step in as the Program Director of the Alcohol/Drug Mental Health Program of the State Department of Health and Rehabilitative Services, a move that brought the Hevey family back to Tallahassee.
From his new post, Hevey had a bird’s eye view of a sweeping shift in the country’s support for mental health programs. The Reagan Administration launched the largest non-defense budget cuts in the nation’s history and, in the Omnibus Budget Reconciliation Act of 1981, repealed the Mental Health Systems Act. The CMHC Act funds that had been earmarked for facilities and staffing—and paid direct from the federal government—suddenly vanished.
“The shift to block grants significantly altered the way we were working. Basically, the dollars that used to go direct to CMHCs were rolled together with other funds, then reduced by 25 or 30%, then given to the states,”
Hevey explains. “The notion was that you’d replace those fees with community-generated funds and levies, but it was very difficult, particularly in the inner cities, because the revenue base just was not there.”
The heyday of community mental health—the time when “mission trumped economic concerns”—was over.
By 1985, when Hevey became MHCA’s first CEO, the Reagan Era was well underway, and MHCA members had come to realize that federal budget cuts were hardly their only significant concern. They had to build new relationships with local and state officials, cope with the challenges posed by diagnostic review groups (a predecessor to managed care organizations), and figure out how to develop and fund their businesses.
Although MHCA’s membership was relatively small compared to that of other state and national organizations, the members didn’t mind, says Hevey. “Our role was to be different. The focus was on business, not policy or advocacy. We had to cultivate an entrepreneurial spirit,” he continues, noting, “the feeling among members was, ‘if we stand alone, we’re toast. We need to attract others who can help us survive and thrive.’ That was the basis of MHCA—to pull together talents and resources for the good of the whole.”
Because the CMHC era of the 1960s and ‘70s tended to attract “mission-focused” leaders with clinical backgrounds, Hevey quickly realized that the first order of business was to teach member CEOs “a business orientation.” That meant bringing in a lot of different people and topics—marketing, leadership development, training programs, funders, change agents. “The message was that you’ve got to know how to run a good business, that you’ve got to stay profitable to stay in business.”
At times, it was a lot to swallow. “We didn’t want our CEOs to lose their vision or passion for working in their communities,” Hevey remarks, “but there was a realization. Our CEOs saw that they were stewards of a system that received investments of dollars and hopes from the greater community.”