Start with a Solid Foundation


How are we going to do this?  That’s the question we asked ourselves when a few likeminded bureaucrats sat down and said, our current mental health and substance use system is broken and causing immeasurable harm to many.  If you have ever set out to change a culture in a given system, any system, be it family, work, neighborhood, school, etc. you know this is a daunting undertaking.  Starting with a solid foundation of individuals committed to a shared purpose, set of principles/guidelines, and then “building outward” is the approach we are taking in Ashland County Ohio.

As I mentioned in a previous blog, Mental Health & Recovery Boards have the ability to influence the types of care that are available in a localized area for persons diagnosed with mental/substance disorders (a series of blogs on how we’re approaching DSM, Diagnosing, labeling is forthcoming).  This ability comes from the Board’s statutory authority to direct federal, state and local funding based on local community needs.  While federal funding sources are largely being removed from Boards, state and local funding remain.

Boards are comprised of 18 local citizen volunteers (including persons in recovery from “mental Illness” and family members of persons diagnosed with “mental Illness”).  The Board hires an Executive Director to run the operation and empowers the Executive Director to hire additional staff as needed to accomplish the mission of the organization.

For Ashland County then, the solid foundation began with convincing Board members of the need for serious reform in the way we (1) conceptualize “mental illnesses” and (2) operationalize “treatment” If you are considering doing something similar let me encourage you to be patient and thorough with these beginning steps.  Our Executive Director says repeatedly that without the support of Board Members we would not be able to pursue the reforms we are engaged with.  Once a decision is made to proceed down this path of reform, criticism, skepticism, disdain, hostility, etc. will likely be directed at the organization.  Therefore, I encourage you to get this foundational step right so you can weather the opposition to come.

There are different approaches available to help convince groups of the need for reform.  The approach we’ve taken is to provide educational materials (SAMHSA Recovery Consensus Statement, Medication Optimization, Choice, and Alternatives: A Statement from Peers in the Consumer/Survivor Recovery Movement) and bring in well-known advocates and international speakers that espouse the change we’re pursuing.  The educational materials must not be overly “technical” as most volunteers do not have the time (or stomach) to digest this type of information.  It is the responsibly of the Executive Director and his/her staff to faithfully translate this type of information into “plain English”.  Exposing Board members to consumer-survivors and their stories was also critical to put faces to the current challenges, hope for a better future, and a sense of urgency.

Get this step wrong and two years down the road of “reform efforts”, you will find the whole thing collapsing, your job on the line and vulnerable people still at risk.  Take the time to establish a solid foundation!

Next Time:  “Nothing About Us Without Us” How meeting Pat Risser changed my life!


Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.


  1. David,
    Thanks for your essay from the front lines of changing systems.

    Clear, specific directions on how this can occur gives my heart hope that change is possible.

    The movement to re-make mental health care needs leadership and input from all kinds of people from many backgrounds.

    Good writing. Thanks for being here.


  2. Thanks Dr! We’re not neglecting the psychiatrists in this process. Some have made the decision to resign from our system but those that remain are clear about the changes we’re trying to make.

    I “pushed” you in my comments on one of your earlier posts because I really want input on what the role of psychiatrists can be. In the short term I think we still need psychiatry if for no other reason than to help those who are desirous of tapering of their medications do so safely. Long term, I’m still not sure. I look forward to your posts as well as Drs Steingard and Foster to help me see the possibilities.


  3. David,

    Thank you for all you’re doing to make a difference.
    I apologize for storming-off with your last post.

    I need to take a break for a while, and will be doing mostly quiet reading, while sitting on my hands.

    But I do want to say, “Thank you.”