Administration in mental health: issues, problems, and prospects

The mental health field has grown larger and more complex in recent years, but this has not been equalled by increased administrative sophistication. Two problems, neither one irremediable, have contributed to this state of affairs. First, mental health organizations have generally been administered by mental health professionals with little administrative knowledge or training. And second, we have often failed to recognize the very special circumstances faced by administrators in the mental health field. These special circumstances are legion. For one thing, mental health services depend on public funding and must often deal with a high degree of government regulation. For another, the typical staff in a mental health organization is multidisciplinary, professional, and highly autonomous-a bit like a Navy with more admirals than ships. Then too, the transaction between therapist and patient is much more private and intimate in mental health than in most other fields; we are often dealing with a highly dependent patient population; our product is intangible and the success achieved is hard to judge; the boundaries of the field are very hard to define; and the enduring public stigma associated with use of mental health services, combined with the problem of confidentiality, complicates the administrative task. Finally, on top of all this, it is absolutely essential that the mental health administrator understand the need to create and maintain an organizational climate of efficacy and hope. Taken individually, many of these conditions have obvious counterparts in other fields; but taken as a group, they separate mental health from all the other human services, even ones that are closely related. To be effective, therefore, academic programs in mental health administration must reflect these conditions by developing specialized curricula and training procedures.