Principled Leadership in Mental Health Systems and Programs

Considering the role of leadership in mental health services presents many questions. Does it matter? Does change occur because of policies or people? If leadership is important, what are its ingredients? Do the qualities of leadership generalize, or are they particular to circumstances?

Two leaders in mental health, William Anthony and Kevin Ann Huckshorn, have helped us with these questions and more in their book Principled Leadership in Mental Health Systems and Programs. Anthony is the longtime director of Boston University's Center for Psychiatric Rehabilitation and is widely regarded as the most influential leader in this field. Huckshorn directs the technical assistance program of the National Association of State Mental Health Program Directors and is a champion of efforts to reduce use of seclusion and restraints in mental health settings.

This book is thoughtful, readable, and well-informed—a "must read" for those seeking or, as is often the case, thrust into positions of responsibility. Anthony and Huckshorn anchor their work in mainstream literature on leadership, but the ideas and narrative emerged from their structured interviews with dozens of individuals who have provided leadership—as clinicians, managers, consumer activists, and academics in mental health services and systems. (In the interest of disclosure, I acknowledge being one of those interviewed.)

One reason why this book is welcome is that virtually nothing has been written about leadership in mental health. With thousands of mental health organizations requiring direction and with a field that has been in constant flux for over a generation, this seems a surprise. But on reflection, perhaps this gap should be expected. Most individuals who end up in "positions of leadership" have been grounded in clinical work. Clearly there are parallels between clinical and managerial work; after all, Wilfred Bion's path-breaking work on group dynamics emerged from experience with treatment groups. However, there are also many differences between the two. It is clear that many managers are not really leaders. Assuming a position of leadership does not necessarily mean assuming the posture of a leader in mental health.

Anthony and Huckshorn organized the book around eight principles of leadership (examples: principle 1, leaders communicate a shared vision; principle 8, leaders build their organization around exemplary performers). The principles they describe resonate with contemporary thinking about leadership; the two principles cited here borrow from themes identified by Peter M. Senge in The Fifth Discipline: The Art and Practice of the Learning Organization and by Jim Collins in Good to Great.

Mainstream writing on leadership, as Anthony and Huckshorn acknowledge, has something to contribute, but not very much. It is dominated by business school research on profit-making companies. Some similarities in leadership tasks across settings may exist, but the mission, rules, and roles differ dramatically in the world of mental health care and in the world of private business.

It is appropriate that a work on leadership in mental health hews to the best of mainstream thinking and also explores aspects of leadership that may be more particular to the distinctive tasks and challenges that confront mental health organizations. This strength, coupled with the insights gained from interviews with diverse leaders in the field and a clear and readable style, make Principled Leadership in Mental Health Systems and Programs a timely, useful, and thoughtful resource.