A Sense of Humor
A good sense of humor is one of the most important and yet least appreciated attributes of a successful commissioner. If a commissioner cannot put into perspective the alternately ridiculous, ironic, and bizarre world of the state mental health agency-if he or she takes the job too seriously-that commissioner may not only lose the job but wind up among the clientele of the agency.
Constituency Building
The reader can infer from much of this article that a considerable amount of the commissioner's time must be spent dealing with internal and external constituencies. Skill in constituency building enhances both the commissioner's tenure and ability to carry out agency policies. A commissioner cannot avoid occasionally making some group or powerful person irate and upset because the commissioner has either taken or not taken a certain action. The commissioner's political and public relations skills are therefore taxed to the utmost in trying to ensure that as few people as possible (or the least credible people) are angry at the commissioner at any one time.
Participative Management
Dealing successfully with impossibility requires that the commissioner enlist the support of the forces that make the task impossible. A commissioner must be proficient in participative management; that is, involving agency employees, state facilities, CMHCs, and consumer and advocacy groups to achieve change and progress. In the fall of 1984, for example, the Texas mental health commissioner used a large-scale inclusive management process to gain support for a major new mental retardation policy. Since the policy entailed an increase in the number of mentally retarded people placed from state schools into the community, restrictions on admissions to the state schools, and fiscal transfers from the schools to community programs, it was expected to generate considerable controversy among advocacy organizations and agency employees. Numerous meetings distinguished by much give-and-take were held with representatives of each affected group. Their suggestions were solicited, leading to over a dozen redrafts of the policy. The final version, in spite of-many compromises, retained the essential features of the original. The policy was approved in December 1984 with a minimum of conflict.
Progress out of Adversity
An effective commissioner must be a creative opportunist. Some of the most innovative mental health programs have arisen as a response to a crisis. In Texas, for example, a cut in the budget of the mental health agency became a net increase in agency dollars when the commissioner was able to trade the moderate reduction in appropriations for greater budgetary flexibility. In another action, an adverse court order made it possible to put into place a revolutionary fiscal incentive system in which Texas's community mental health-mental retardation centers are allotted extra money for reducing use of state hospitals.
Leadership
There is no substitute for leadership skills.40 One of the most vital coping strategies for a commissioner is letting people in the agency and other interested parties know what the organization stands for and where it is going. Although, as previously noted, there is a price to pay for going in any direction, a commissioner who cannot motivate people and give them a vision, a sense of direction, and a feeling of belonging to a greater enterprise may survive for a while but will probably accomplish very little.
WHY STAY ON?
Why persevere in a position in which it is impossible to satisfy the expectations of all the various constituencies and the general public? Why subject oneself to attacks by the press, advocates, politicians, and governing boards? Why tolerate contradictory demands to provide high-quality services with inadequate budgets? Obviously, there are types of people who can withstand these unreasonable pressures, absorb the criticism, and somehow acquire the necessary strength to continue. Some clinicians might consider a mental health commissioner a mas-ochist who delights in being attacked. It is more likely, however, that commissioners learn to tolerate criticism as a necessary price to pay for the rewards of the job. Accepting such opposition becomes a modus operandi for a commissioner, a condition of life in which the censure, while not necessarily rolling off his or her back, is at least blunted and eventually adjusted to.
What rewards can possibly compensate for the gut-wrenching criticism and impossibility of the commissioner's job? Clearly the status and power of the position (as in the case of a chief executive officer of any organization) are a part of the answer. But there is also a sense of mission, a drive to improve a system of care and thus benefit the lives of thousands of people. Perhaps, as the sociobiologists would contend, there is no such thing as pure altruism. Yet mental health commissioners frequently behave as though they are motivated by an altruistic desire to help disabled people and to do so at high personal risk.
Although a cynical world may view with suspicion such words as dedication, commitment, and sacrifice, many mental health commissioners give generously of themselves to achieve goals that they believe in. Instead of being narrow-minded bureaucrats, they are often creative, far-sighted people with a vision of an improved mental health service system and the fortitude to pursue it, sometimes with both evangelical zeal and practical imagination. The willingness of the mental health commissioner to continue in an impossible job may be partly a function of what psychologists call' 'intermittent reinforcement" which means simply that the commissioner occasionally "wins" one. Such reinforcement schedules make behavior quite persistent and difficult to' 'extinguish." A small victory encourages the commissioner and staff to carry on and hope for another. Ultimately, political forces conspire to make the commissioner's position untenable and to force his or her departure, a process attested to by the short terms of these jobs.
LIFE AFTER COMMISSIONER
There is life after serving as a commissioner. Former commissioners frequently go on to more financially rewarding and less stressful positions, usually in the private healthcare or academic sectors, where their experience as human-service professionals and administrators is put to good use. Interestingly, many erstwhile commissioners mourn for their previous post and, despite the grueling battles, low pay, and high stress, are willing to reenter the public mental health arena. The reason is that many feel they were not able to accomplish their goal of improving services to the mentally disabled. Some miss the challenge; others miss being in the public eye. Since few commissioners actually return to their old position, their expertise and accumulated experience are usually lost to the public mental health systems of this nation at a time when experienced leadership is increasingly demanded and certainly needed.
