Achieving progress from the ground up: Veteran behavioral health advocate Ronald W. Manderscheid, PhD, tackles the issues at the local level

It’s a widely accepted idea that all politics is local, but if you ask Ronald W. Manderscheid, PhD, all healthcare is local, too. And with more than 30 years of experience in working for the government-both for the National Institute of Mental Health and the Substance Abuse and Mental Health Services Association, among other organizations-Manderscheid knows best.

Having just begun his newest governmental role as the Executive Director for the National Association of County Behavioral Health and Developmental Disability Directors (NACBHDD) on December 1, 2009, Manderscheid is working “where the rubber meets the road” to advocate for county behavioral health directors who are responsible for innovating, delivering, and ensuring behavioral healthcare for their communities.

With the recent implementation of the Parity Act and healthcare reform legislation just around the corner, Manderscheid has plenty to advocate for. “They [the counties] are all very concerned about healthcare reform and how the counties will play a role in that,” Manderscheid says. “It’s a wonderful opportunity to work on a very, very important issue here.”

NACBHDD represents county directors from 400-500 member counties in the U.S., ranging from large counties like Los Angeles County to the tiny, rural counties in Ohio who, according to Manderscheid, “are all confronted with a major series of issues.” NACBHDD works on behalf of the directors of these counties to promote beneficial national policies in Congress and federal agencies and to advocate for efficacy at the national level.

“I’m absolutely thrilled to be in this position for two reasons,” Manderscheid says. “Number one, because I know that the counties are at the point where action occurs in terms of care…and secondly, because I want to work with the counties in implementing health reform and helping them address some of their current crisis issues around Medicaid and so on.”

Manderscheid identifies three key roles that the county directors play in the local behavioral healthcare system-they are payers, system managers, and system innovators. With these roles, the county directors bear responsibility that is unrivaled even by the state and federal governments in many respects, and Manderscheid has wasted no time in developing a plan that will support these directors over the next 12 months.

“My first steps are to work very closely with the executive committee and the state association directors to define a very clear policy agenda for 2010,” he says.

Manderscheid will also be looking to these groups to help outline NACBHDD’s major technical assistance activity in the first few months of the new year. “I think in coming here and looking at the situation, there is a major need for us to develop a technical assistance program with the counties-technical assistance focusing on very practical things to help them adapt better to their environments,” he says. “And then I think there is a wonderful opportunity here for us to partner with others.”

If there is any hope for improvement in the field, Manderscheid says that crossing traditional boundaries and forging new partnerships is key. “If we’re going to make progress getting and implementing evidence-based practices, we have to partner with the people developing these things,” he says. “We have to partner with the people who are developing performance measures; we have to partner with our primary care colleagues.”

To do this effectively, Manderscheid has reached out to his vast network of colleagues to recruit experts in the areas of demonstration, planning, evaluation, and peer to peer learning. “I’ve begun outreach to key people who I want to work with us, people I’ve known and have great respect for in the field,” he says. “I’ve also begun outreach to people I want to be our partners. I want them to go and apply for demonstration and development grants, and I want to be their partner and work with them and actually do some of these things to generate innovation in the counties.”

Luckily for Manderscheid, this outreach effort hasn’t been too challenging in the first days of his new role. “Some people have literally come forward to me and volunteered their services, and I greatly appreciate that,” he says. “That says there’s a lot of interest and goodwill out in the behavioral health community.”

Beyond forging new alliances amongst the county directors and the rest of the players in the healthcare industry, Manderscheid is also looking to develop the online organizational capacity of the county directors and their systems. “Having a viable online library, having a viable online capacity so we can have chat rooms, doing very recurrent webinars-all of these things become very important in moving the agenda forward,” he says.

This online capacity will also help to increase the communication across public and private sector organizations at every level of government, as well as with the outside partners Manderscheid has recruited to his cause. It is Manderscheid’s goal that, by the end of his first year as Executive Director, he can work with all of these groups, as well as his executive board, to implement his plans and show significant, measurable progress.

“That’s my goal, having come into this job and been here seven days now,” he says. “That’s why I say the honeymoon is over.”

Behavioral Healthcare 2010 January;30(1):48