William A. Anthony, PhD, has been talking about recovery since the 1970s. He also has been wondering why some mental healthcare organizations are able to achieve a recovery-oriented culture and others are not.
This led Dr. Anthony, executive director of Boston University's Center for Psychiatric Rehabilitation, to start teaching a class in the 1990s on leadership. “The reason I was teaching the class was because I always thought, in my travels around the country, that the thing that differentiated organizations from trying to do new things and innovate, and especially work toward a recovery-oriented program or system, was leadership,” he says.
As part of his class, Dr. Anthony interviewed mental healthcare leaders nationwide, later realizing that the interviews would make a good book. So Dr. Anthony enlisted the help of Kevin Ann Huckshorn, RN, MSN, CAP, ICADC, who had been developing a curriculum to help inpatient mental healthcare organizations prevent violence and reduce the use of seclusion and restraint.
“She has the same perspective about programs she has seen around the country, that leadership was making a tremendous difference in differentiating the programs that were innovative versus the ones that were just going along with the status quo,” he says.
The result of their collaboration, Principled Leadership in Mental Health Systems and Programs, is a treatise on leadership in public mental healthcare. Dr. Anthony and Huckshorn, director of the Office of Technical Assistance for the National Association of State Mental Health Program Directors, combined their interviews with their own experiences as well as principles derived from leadership books in business, education, and other fields.
Principled Leadership is constructed around eight principles representing actions that public mental healthcare leaders need to take to transform their agencies into recovery-oriented, outcomes-focused organizations serving clients' and employees' needs:
Leaders communicate a shared vision.
Leaders centralize by mission and decentralize by operations.
Leaders create an organizational culture that identifies and tries to live by key values.
Leaders create an organizational structure and culture that empowers their employees and themselves.
Leaders ensure that staff are trained in a human technology that can translate vision into reality.
Leaders relate constructively to employees.
Leaders access and use information to make change a constant ingredient of their organization.
Leaders build their organization around exemplary performers.
Interviewees represent the highest public health levels of federal and state government, associations, advocacy groups, academia, and the private sector. “There is a critical mass of leaders who are moving toward a recovery-oriented, value-based system or operation,” says Dr. Anthony. “This book gives some examples of what leaders have done to try and affect that system.” He notes that many of the interviewees have psychiatric disabilities and have shown tremendous leadership in helping systems and programs develop a recovery model.
A Learned Skill
One of Principled Leadership's basic premises is that leadership is an acquired skill, not divinely bestowed. “We think that leadership is just like any other competency—you can learn how to do it,” says Huckshorn. “We can measure people's efficiency and effectiveness in certain kinds of leadership roles, and I think that's what this book starts the discussion about.” With the proliferation of evidence-based practices and related expectations placed on staff, the authors believe that leaders' competency should be measured too.
Dr. Anthony and Huckshorn believe that principled leaders are committed to a vision bigger than themselves. They possess a validity bestowed upon them by their staff, and they possess a capacity for leadership. “Leaders who have leadership commitment, credibility and the capacity to make change have a better chance of making their vision last,” they write.
Building credibility with staff includes ensuring that an organization's vision is shared, clearly communicated, and inspiring. The leader must live a life compatible with the vision. A leader must give responsibility and authority to operational staff, as well as identify and communicate outcome expectations.
The authors point out that learning to become an effective leader often has been taught through mentoring, but they urge organizations to take time to invest in “human technology—teaching employees how to be leaders, how to set their own goals and learn new skills, and how to relate to clients.
“You can be as principled as you want to be, but if you don't have the tools and training to know how to implement organizational change, how to treat your staff, and understand the incredible hard work it takes to be an effective leader, you're not going to be very effective,” explains Huckshorn, who credits several mentors for her development as a principled leader in the public mental healthcare field.
“Part of principled leadership is being a mentor and having an organization where someone is paying attention to succession planning and building champions,” she continues. “Mentoring and supervision are really important in learning how to be a competent and effective leader—very little is book knowledge.”
Starts at the Top
Achieving long-term changes in public mental healthcare is very difficult without leadership at the top, notes Dr. Anthony. While the authors believe that the resources to invest in staff and enact lasting change exist, principled leaders will have to find ways to train staff and develop their workforce in a time of stagnant or shrinking resources.
“I think we have the resources to do what we need to do in terms of developing our workforce, having the right people on the job, and being able to train people while they're on the job or even off shift,” says Huckshorn. She suggests that leaders carefully examine their budgets to make sure that every full-time employee is needed, performing the correct role, and doing the amount of work called for every day. A leader has to have the courage to make these kinds of changes, Huckshorn adds.
Dr. Anthony says that with these sorts of actions, principled leadership will continue to transform the field into a recovery model. “The good news is that a lot of people are looking at this, a lot of people are writing about it,” he says. “The book is a step toward having leaders in our field scientifically look at what they do and how effective it is.”Brion P. McAlarney is a freelance writer. Principled Leadership in Mental Health Systems and Programs is published by the Center for Psychiatric Rehabilitation.
For more information, visit http://www.bu.edu/cpr/products/books/titles/leadership.html.Behavioral Healthcare 2008 August;28(8):29-30