Book Reviews


Review by Richard Van Horn*

In a word, Bill Anthony and Kevin Huckshorn have put together, with the help of a myriad of interviews, the ideal text for future leaders of behavioral health programs and institutions.

I first met Bill Anthony nearly thirty years ago when I was a newly minted executive director for Mental Health Association (now Mental Health America) of Los Angeles. We were just getting involved with consumer self-help and looking for leadership as we pointed in new directions. In Bill Anthony we found it. Anthony and his program at Boston University have been the guiding light in mental health transformation from the beginnings of consumer self-help, to integrated services, to consumer run services, to an egalitarian collaboration among varieties of professionals, consumers and families. Unfortunately transformation of the entire mental health system has been spotty at best: there are still vast territories to be converted and developed if we are to have a mental health system that truly leads folks toward recovery and wellness.
Why is there a need for a book about developing leadership skills? While the transformed portions of the mental health system attempt to practice principled leadership, it has been a "seat of the pants" version - not as systematically laid out as in the book building on the stories, interviews and practicum. The interviews are with real leaders who work in the trenches every day and communicate their points with brief stories and examples of principles they do employ, or should employ:

Communicate a shared vision. Without this nothing of value happens and organizations flounder. The vision is simple, clear and to the point. Mental Health America "envisions a just, humane and healthy society in which all people are accorded respect, dignity and the opportunity to achieve their full potential through meaningful social inclusion that is free from discrimination." This is the ideal state in the future, but may take a lifetime, or more, to get there.

Centralize by mission and decentralize by operations. The mission particularizes an overall vision for the organization. The leaders serve as role models for leaders at the operational level. Leaders at the operational level have real responsibility and authority for they are, after all, mission level leaders in training.

Create an organizational culture that identifies and tries to live by key values. In short, values drive organizational decision-making. As Bill Anthony puts it, "Values are the organizational 'Velcro' that binds vision to operations." Well-stated underlying values -- consumer choice, recovery as the expectation, work opportunities for all, egalitarian relationships between staff and consumers, individual empowerment, -- will help weed out staff who don't fit the values of the organization. They will not be comfortable if there is a real mismatch of personal values.

Scott Graham (who wrote the trainers guide) said it was his job to make sure his staff "had the tools to do their job, a guiding framework provided by the mission and values, and then to get out of their way." When I hired Martha Long (also interviewed in the book) to run the newly established MHA Village in Long Beach, CA, it was critically important to give her freedom within a broad but clear outline. My role was to cheer her and the new staff on. "The more people in the organization who possess the necessary information to do their jobs and know how to use the information to generate new ideas," the better off the organization will be, and the better off its leadership will be. Leaders understand that by giving power away, they gain. Paulo del Vecchio said, "By empowering others, we empower ourselves." As it should be, empowered followers will at times lead their leaders. Del Vecchio is the Associate Director of Consumer Affairs at the Center for Mental Health Services.

Anthony and Huckshorn introduce a radically different concept: train human technology. All of us are accustomed to continuing education units to maintain licensure, stay up to date, hear the latest in treatment protocols. They normally teach concepts and facts. The authors turn this on its head: teach actual skills rather than concepts about skills.

Some of us are old enough to remember the National Training Laboratories in Bethel, Maine, from the 1960s. We all became enamored with the circular process of learning: identify an issue, project a change, practice, evaluate and adjust, re-practice. This exercise of practice and re-practice can teach us specifically how to translate vision into reality. We need to train to skills - concepts alone won't do the job.

We talk endlessly about the virtues of collaboration with the client or consumer. Skill training for this will mean role playing, fishbowl sessions with staff playing different parts, observed sessions with feedback time, etc. All of these help develop the actual skill - moving beyond concept. It is generally agreed that this is much more difficult than the traditional staff training program. But then the principled leader emphasizes staff expertise as more critical than credentials and roles.

Leaders relate constructively to employees through compliments, introductions to visitors, a word of praise for an idea or action, or singling out exceptional performance for reward or recognition. Giving credit is part of that positive relationship with staff. Lori Ashcraft of META Services in Phoenix, AZ, said: "I believe that the relationship with staff is the strongest management tool a leader has, and the more positive it is, the better the result will be for the employee as well as the person being served and the company as a whole." Or as others who have watched organizations grow, "trust is the emotional glue that binds followers and leaders together." As trust accumulates, leaders are seen as more legitimate and staff become more empowered.

Leaders use information to make change a constant ingredient of their organization. Too much raw data, untested in the crucible of values, only confuses the organizational direction. On the other hand, appropriate information can set an organization on a true path to the future. Appropriate information comes in two major types:

    (1) Information about the environment: 'What is happening around us?' 'Are we seeing the total reality, or just one of the elephant's legs? Is the leader getting full disclosure, or is staff saying what they think he/she wants to know.

    (2) Information about the program: Are we producing the outcomes that were desired originally in our mission and values? And what are we going to do about it if we are not getting the best outcomes?

Effective and successful organizations have a culture that thrives on change. But it must be change that continuously moves toward quality and improvement.

Leaders build their organization around exemplary performers and are known by their followers. We often forget that a key characteristic for a leader is to have followers! Without them, a leader has little effect. However, followers must have say about where they are being led.

If a leader forgets this basic point, the leader will soon be without followers, especially the exemplary ones, the organization's exemplars who bolster effective leaders. While they may move on, eventually, to lead their own organization, exemplary staff seems to have organizational staying power. And, to bring it full circle, the reason many exemplars stay is their leader.

I realize that I have known twenty-two of the fifty-one people Bill and Kevin interviewed for the book, and two have worked directly for me. During that time we have all been attempting to lead from principles. Still we do well to "read, mark, learn and inwardly digest" the text and the rational process it puts forth.

These eight chapters and a brief conclusion provide an excellent primer in leadership that is absolutely devoid of fads or artificiality. Scott Graham's companion study guide, is a great companion piece and illustrates "skill training" talked about throughout the book. A great read and a great tool for all of us in the mental health field.

My recommendation: buy the book, download the "Guide for Teachers and Trainers," and use them and disperse them throughout your staff and peers.

*Richard Van Horn retired as President & CEO at Mental Health America of Los Angeles after 30 years. Under his leadership The Village in Long Beach. He is currently on the boards of Mental Health America and the National Council of Behavioral Health Community Healthcare.

Comments (1)
Catherine Bond:

As someone who believes that a values-driven organization nurtures the kinds of leaders that Principled Leadership describes, I was delighted to learn of this book. I've long admired the work Bill Anthony does. As a member of the Los Angeles County Client Coalition and as a consultant and trainer, I appreciate the truth that "leaders are known by their followers." The Coalition is currently exploring the ways in which our advocacy efforts need to be informed by a shared vision and to "lead from principles" that are based on individual choice and recovery for all. Hopefully, the mental health system acknowledges the value of "Nothing about us without us." Now we need to work together to achieve the outcomes, both individual and systemic, that will reflect our commitment to quality and improvement.

Posted by Catherine Bond | November 13, 2009 1:38 PM
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