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Perspectives

A Clinical Theory for the Behavioral Healthcare Executive’s Toolkit

September 21, 2020

Behavioral healthcare is a complex field in need of a unifying perspective. This need is rooted in more than an interest in organization and efficiency. The question is whether genuine coherence can be found amid the complexity. It can. We had a powerful organizing principle articulated over 40 years ago, but we lost it. We should reclaim it.

George Engel created the biopsychosocial model to integrate three aspects of our lives – biological, psychological, and social – without suggesting that one aspect had priority. Each is a source of our identity and our suffering. The model seeks to avoid slighting or exaggerating any one dimension, and Engel was a psychiatrist who especially did not want to overvalue biological factors.

Behavioral healthcare executives should take the lead in resuscitating this model. My focus here will be on points the model supports in either explicit or implicit ways. This model respects the depths of illness and the heights of recovery, as well as the diversity of people and societies. It values the full continuum of care and recommends a vantage point that gives our leaders the broadest possible view of the field.

The biopsychosocial model is a simple concept. Some might doubt its ability to guide or impact our field in meaningful ways. Yet this simplicity is essential. We need a model that is clinically rigorous and yet easily understood by non-clinical leaders. The goal is to orient our work, not develop an explanatory system. It is an elegant formulation that should not be dismissed for its clarity.

Serious mental illness and addiction

What can we learn from the extremes of mental illness? The range of clinical and functional outcomes for people with mental illness is vast. This reality is driven to a large extent by simple factors. Does a person have access to treatment or social support? Conversely, did the person experience trauma or incarceration? Medications have saved lives. Psychosocial interventions have promoted recovery.

The biopsychosocial model has great value because it recognizes all modalities and providers of care. Yet it rejects reductionistic views. Biology is not destiny. Empathy and understanding cannot heal all suffering. The passion of some proponents leads to strong positions. Executives must create a setting in which diverse perspectives are respected and limits are tested. Evidence reigns supreme.

The model is a scientific frame of reference in which we find the parameters of our field through empirical study. For example, it is still not widely known that many highly accomplished people went through a prolonged process of recovery from schizophrenia and other major disorders. The factors promoting such remarkable change should be understood.

Care for addiction involves multiple dimensions. Some programs today offer traditional treatment while others embrace principles of recovery-oriented systems of care. Executives should gain knowledge of the full range of industry services and not just their specific programs. They should be able to articulate gaps in the service continuum, as well as the critical role for both treatment and recovery activities.

Individualized care means selecting from within a broad range of biopsychosocial options. One sign of quality leadership is knowing the value of services that your program does not offer. For example, your program may not provide medication-assisted treatment for opioid use disorder, but this should not preclude knowing about this critical service or the need to increase its availability.

While there is a troubling history of overprescribing psychotropic medications for people with mental disorders, the opposite is found for addiction. The biological dimension of treatment needs improvement. We need new solutions and greater availability of existing ones. Yet these chronic conditions need a long-term focus on psychosocial factors. They drive long-term recovery.

Leadership tools for executives

We need behavioral healthcare executives to assume more prominent roles leading our field and not just their companies. The biopsychosocial model should become an important part of the toolkit for these leaders. CEOs frequently lack the expertise of program specialists, but they must incorporate that knowledge into strategy. The biopsychosocial model is executive theory. It is an industry framework.

Leaders need to get oriented to the specifics of their industry. How do executives in our industry get oriented? Many served previously as professionals in the field. Is this the answer? It hardly guarantees a broad perspective since a career exposes one to only a fraction of the field. How do we gain perspective? We need an organizing theory, and the biopsychosocial model is just that.

Our field has proponents of extreme views, perhaps like any other. You can find psychiatrists who believe that biological processes in the brain account for all the important aspects of behavioral health. We have people diametrically opposed to this work who point to how many have recovered from the extremes of illness through psychosocial solutions alone. Executives must bridge these perspectives.

A voice for a consolidated view need not claim deep expertise in every domain since the goal is to reach people widely inside and outside the field. The executive should offer a perspective on the field that is comprehensive and knowledgeable. Extreme views are accepted and situated in the overall landscape of the field. Leaders then routinely articulate the existing evidence on all our work.

Whatever route a person takes to the CEO role, their portfolio upon arriving includes their company’s mission and strategy. Strategic thinking is a skill, much like financial analysis or clinical assessment. A good strategy generally includes knowledge of all key areas of a company. Companies need strong executives to thrive, and an industry prospers when leaders openly identify best practices and outliers.

The advancement of a field depends at least as much on its executive leaders as its innovators and specialists. However, the behavioral healthcare field is fragmented and unaccustomed to celebrating executive leadership. We are more likely to extol clinical leadership. This executive theory for behavioral healthcare is geared to facilitate executive success. It is a framework for expectations.

Executives should cultivate a vision for how our field gains standing in the broader healthcare industry. We need leaders to care about our present and future. Executives are simultaneously company and industry leaders. Each company’s success can fuel industry success. Let us encourage executives to advance their business and our field together. This clinical model is a good framework for both agendas.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.

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