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Tough times call for tough decisions

March 01, 2009

We know times are tough. Budget cutbacks have forced many organizations to lay off staff and reduce services. But we can use tough times to further organizational transformation.

“Transformation?!” you probably are thinking with disbelief. “How can we transform when we're going backward with funding and services?” Well, history shows us that tough times often are the backdrop for heroes to emerge and teach us how to not just survive, but thrive, in difficult circumstances. After all, who needs a hero when things are going smoothly? So we might as well step up and make some heroic efforts to continue the transformation to recovery-based services. The “survival mentality” isn't going to get us very far, so let's look for ways to thrive!

Transitions (code for “chaos”) are great times to move in a recovery direction. The ground is shaking the structural foundations and loosening up the status quo, leaving many things up in the air so they can be moved around more easily. In their own difficult times we ask the people we serve to embrace recovery, and we must do so too.

The best place to begin a transformation is in our own heads. If we are filled with doom and gloom, if we feel helpless and hopeless about the state of our programs, we need to make a major adjustment in our mind-set. We need to clear some “mind space” where we can have better ideas about creating recovery programs.
Trauma survivors have a lot to teach us about surviving tough times. Trauma often causes paralysis, fear, and anger. Survivors stop trusting themselves and others. Their sense of self is weakened, and they wonder who they are and how they fit into society. Interestingly, two people experiencing the same traumatic situation can have very different reactions. One person can be devastated and paralyzed with fear while another learns, grows, and validates his strengths. As leaders, we need to shake off the paralysis and use these challenging times to further the transformation of our programs into better vehicles for wellness and recovery.

Let's start by looking at the big picture. If reductions are severe enough, it may be time to rebuild the whole system. Tinkering-cutting off a little here and there-may work for minor reductions, but for major reductions tinkering leaves us with only program components that don't connect to each other and don't work very well.

Whether you're going to redesign the entire system or tinker with what you have, take a close look at the components you have in place. Determine which programs have the best recovery outcomes and those consistent with the recovery vision. Don't cut those! Richard Surles, PhD, president of APS Healthcare's public-sector division and one of the country's most influential mental health leaders, reminds us that during budget cuts the organization's vision is critical in deciding what to cut and what to grow. 1 This sounds like a no-brainer, but as we look around the country, we see that recovery-based programs often are the first to go because they are not viewed as “core services.”
So what is a “core service”? Interpretations vary, but a common thread that runs through them is that “We can't live without it because we've been doing it forever.” We challenge you to rethink the core service concept, especially because most of these services were established long before we knew that people can recover from mental illnesses. Another term for these services might be “sacred cows.” They usually are designed to manage and control people instead of helping them recover. Yet this is the time to question the viability of every program, “core” or otherwise. With every program component, ask yourself if different services could lead to better outcomes.

We are so sentimental. We hate to let go of our long-standing services even when they aren't working. So here's another question to ask yourself before making cuts or redesigning programs: If someone held a gun to your head and demanded recovery outcomes, what would you do? Would you keep doing the same old things, or would you do something more inspiring that could result in recovery and wellness outcomes?

Since no leader can do much on his/her own, you'll need to bring your staff along with you, so start giving them hope and encouragement. Let them know you're about to begin a new era of service delivery that will take everyone's cooperation and participation. This is a time when good leadership is critical. Even if you don't feel like it, pull yourself together and get out there and talk about this being an opportunity to redesign programs to produce better outcomes. The current economic climate either is a window of opportunity or a very depressing and polarizing situation. You'll be more successful by seeing things in the light of their potential instead of the dimness of despair.
Challenge your staff to rise to the occasion and develop creative ways to redesign programs for recovery and wellness outcomes. We like to say “breakdown before breakthrough” because when things are breaking down, we know that the opportunity for a breakthrough is just around the corner.

We encourage you to accept the challenge to improve services during this time of change and challenging budget restraints. Yes, you'll have to pay attention to reimbursement issues, so see if you can find ways to maximize reimbursement without compromising recovery outcomes. For too long we have allowed financial issues to limit our thinking. We have used them as an excuse for tolerating mediocrity long enough. Surely new and better ways of assembling a service system, large or small, exist, employing programs that reflect recovery. In fact, there couldn't be a better time to explore them.

Lori Ashcraft, PhD, directs the Recovery Opportunity Center at Recovery Innovations, Inc., in Phoenix. She is also a member of Behavioral Healthcare's Editorial Board.
William A. Anthony, PhD, is Director of the Center for Psychiatric Rehabilitation at Boston University.

To contact the authors, e-mail


  1. Anthony WA, Huckshorn KA. Principled Leadership in Mental Health Systems and Programs. Boston:Center for Psychiatric Rehabilitation; 2008:44.
Behavioral Healthcare 2009 March;29(3):14-16
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