Think and Act Strategically

My commentaries almost invariably address a key problem or a desirable development in the mental health or substance use care fields. This month, however, my focus is different. I think our fields lose many significant opportunities because we don't think and act strategically.

Allow me to explain. When an exceptional opportunity arises—a legislator offers unexpected support; a new report outlines advances for the field; a new solution arises to address a longstanding problem—we need to identify the opportunity, discuss how to make the best use of it, and plan an implementation strategy. We should not get lost in the forest because a particular tree impedes our view. Such “trees” might be compulsively editing a document about the opportunity, refusing to compromise about a particular word, arguing with those whose support we need to implement the opportunity, etc.

In the mental health and substance use care fields, examples abound of major areas in which we need new opportunities. Let me cite just a few national examples. We need opportunities to:

• provide mental health and substance use care coverage for the uninsured and underinsured;

• implement a national service benefit package for mental health and substance use care;

• adjust Medicare ambulatory care co-pays;

• coordinate Medicaid benefits with other federal and state program benefits;

• develop and implement modern training models for our providers;

• coordinate mental health and substance use services with primary care;

• increase consumer and family direction in our care system;

• implement a behavioral health component for electronic health records;

• implement national performance measures;

• etc., etc., etc.

I have no doubt that you, too, can add to this long list. Yet will we actually recognize and accept an opportunity when it arises? Unfortunately, the answer is probably not.

What can we do about this dilemma? Here I offer just a few beginning thoughts. Please feel free to embellish this discussion.

We need to train ourselves to be more strategic in our thinking and action. Our self-help to achieve this new point of view can be guided by several principles outlined below. I have included an example—a proposal for a new federal mental health and substance use outpatient service benefit—to ground these ideas in practical experience.

Suspend Biases

Do recognize that we approach anything new with particular biases that may prevent us from fully appreciating its value. Identify these biases; write them down if necessary; and suspend them when considering the new opportunity. These biases frequently define the traditional fracture lines in our fields: mental health vs. substance use, public vs. private, family vs. consumer, adult vs. child, treatment vs. prevention, etc.

Don'tsimply conclude that the opportunity isn't any good, won't work, or will have bad effects.

Example: A prominent federal legislator proposes legislation supporting a new outpatient service benefit for mental health and substance use care. Don't assume that this is an effort by mental health to “take over” substance use care. Do ask yourself whether your biases are coloring your opinion about the benefit.

Focus on the Opportunity

Do thinkcarefully about the new opportunity.

Don't engage in narrow thinking. Such thinking is frequently invalid. It may reflect looking only from the outside in (Does this opportunity support my current overall agenda?) or looking only from the inside out (Does this whole opportunity relate only to…?).

Example: Do investigate how the new benefit will relate to other benefits. Does it complement them? Does it overlap? Don't simply examine the benefit from your own or your organization's point of view. Don't simply write off the benefit because it “should be three times as large as what is proposed.”

Analyze the Pros and Cons

Do outline the opportunity's pros and cons.

Don'tdebate a particular word or phrase.

Example: Do examine the populations, services, and settings to which the benefit will apply. Don't debate a particular word like “outpatient” or argue strongly that the word should be “nonresidential.”

Listen Carefully to Others

Do listen to what others have to say about the new opportunity. Hear everything that is said, not just what you want or expect to hear.

Don't perform conceptual editing. Usually, this involves either cutting the opportunity down to size or, perhaps more frequently, building it up into something the originator would not recognize.

Example: Do listen to what leaders in the field are saying, and note their biases as well. Don't discuss the opportunity as if it were less (or more) than what the federal legislator actually proposed. This includes trying to load up the opportunity with our favorite wish list.

Develop an Action Plan

Do work with others to develop a joint action plan to implement the opportunity once good consensus is developed that the opportunity should be pursued.

Don't get highjacked by length and complexity. No one will read, let alone use, an action plan of dissertation length with complex concepts that require interpretation by others.

Example: Prepare a short plan about how you will use the benefit, either as a consumer or provider. Don't develop an elaborate plan to try to make your organization totally reliant on the new benefit.

Go for It!

Finally, stick with the action plan. Be very careful not to get distracted or sidetracked into blind alleys along the way.

From personal experience, I am convinced that many people want to extend a helping hand. These opportunities may come from almost anywhere—legislators, business leaders, community leaders, family members, consumers, or other sources that may seem very unlikely. It really surprises these people (or, perhaps more aptly, takes them aback) when we debate a term rather than the opportunity or, even worse, go on to another topic without even considering the opportunity. Clearly, this is not a good way to foster effective partnerships.

Opportunities to move these fields forward are far too rare to be frittered away, trivialized, or ignored. Thinking and acting strategically will help us open our minds and devote our energy to these precious occurrences.

Ronald W. Manderscheid, PhD, currently Director of Mental Health and Substance Use Programs at the consulting firm Constella Group, LLC, worked for more than 30 years in the federal government on behavioral health research and policy. He is a member of Behavioral Healthcare's Editorial Board. To contact Dr. Manderscheid, e-mail rmanderscheid@constellagroup.com. Behavioral Healthcare 2008;28(7):39-40.