During the past twenty-five years, the legislatures of many states have restructured their state agencies in an effort to save money and achieve greater efficiency and uniformity in state government operations. The reorganization takes two general forms: establishment of centralized administrative service agencies, and consolidation of groups of related agencies into larger umbrella agencies. Both developments restrict the commissioner's ability to direct the employees and programs of the mental health agency.
Centralized administrative service agencies (for example, state personnel departments, budget agencies, and centralized computer operations) control resources essential to the day-to-day management of every other state agency. As a result, these centralized agencies become extremely powerful, protecting that power by husbanding the resources they control and dispensing them with great care and selectivity to client agencies. For example, the state personnel agency must approve the salary and position description of every classified state employee. If the commissioner wishes to establish a new position within the agency, he or she is required to submit to the personnel agency a request for approval of the position, which includes a position description and compensation level as well as evidence that funds are available to pay die salary. Depending on the state, the personnel agency may have the authority to modify the position description, reduce the compensation level, or deny the position entirely. The personnel agency also controls employee grievance procedures and may be authorized to make the final decision in cases where an employee challenges a personnel action of the mental health agency.
State comptrollers or budget agencies may have the power to restrain the commissioner from spending funds already appropriated by the legislature or to actually reduce appropriations. Commissioners rarely have the flexibility to move money between line items (for example, between institutional and community budgets) but must seek approval from the budget agency. Finally, a commissioner who wishes to automate an agency function must first convince the chief of the centralized computer service that the mental health agency's needs are at least as important as those of other agencies.
It should be obvious that under these circumstances a mental health commissioner is not free to manage the agency's human and financial resources in accordance with his or her policies and the needs of the mental health system. The commissioner must allocate time to lobby the chiefs of centralized administrative service agencies in competition with the commissioners of every other state agency. A mental health commissioner who is successful at this task will win some favorable decisions from the centralized agencies, but at a high cost in time taken from the commissioner's primary responsibilities. Even under the best of circumstances, the commissioner must endure lengthy delays while administrative service agencies process the commissioner's various requests.
The commissioner of a mental health agency that is a part of an umbrella human-services agency faces a unique set of problems. Secretaries of umbrella agencies are likely to be political appointees who usually cannot and need not understand mental health services or their inherently controversial nature. When the going gets tough, the mental health commissioner may discover that he or she is receiving less than the complete support of the secretary. Also, it is not uncommon to find intense competition between the mental health agency and its peers within the umbrella for resources, power, and the approval of the secretary. Finally, in addition to losing the resources under the control of centralized administrative service agencies, a mental health commissioner may forfeit to the umbrella agency secretary such vital functions as planning and employee training.
The weakest mental health commissioners are those in states like Florida, where a deputy secretary for operations supervises all of the umbrella agency's programs (including mental health) through substate regional or district offices. The mental health commissioner is essentially staff, reduced to writing proposals, giving advice, and commenting on programmatic issues. If there is a bright side to this arrangement, it is that the commissioner is spared many of the conflicting and unrealistic political pressures discussed in this article, since it is well known that he or she is little more than a figurehead.
Even if a commissioner is a "commander-in-chief" who has formal line authority and is able to develop a reasonable base of external support for a policy, carrying out a program requires the cooperation of the superintendents of state institutions and the directors of community centers. To obtain that cooperation, the commissioner must rely primarily on leadership and persuasion, for these people almost always have an independent power base with which they can oppose the commissioner's policies.
We have already mentioned the statewide political alliances of CMHCs that can effectively lobby state legislators and the governor. One of the most difficult tasks of a commissioner is to convert the various programs managed by the agency into a true mental health system, in which CMHCs play a major role by diverting to community care some patients who would otherwise be admitted to state hospitals and by providing after-care to patients leaving the hospitals. The prerequisite is that the community centers have to yield to the commissioner some of their traditional prerogatives-namely, deciding which programs to operate, which patients to serve, and how to serve them. Since in almost every state CMHCs retain a considerable degree of autonomy, a commissioner must be skilled in managing large-scale change if he or she is to achieve these vital agency goals. Successful commissioners usually engage the CMHCs and their statewide alliances in a participatory process in which CMHC leaders work together with state mental health agency staff in planning for change and designing the specifications of new programs.
Institutional superintendents may technically answer to the commissioner, but they can be almost as independent of the state mental health agency as CMHC directors. The superintendents may occasionally work through informal statewide alliances resembling the councils of CMHCs, but their power comes mainly from their local political connections. As major employers, superintendents of state hospitals and state schools have substantial influence with local government officials and legislators from the area. Although this influence can be used to help the state mental health agency pursue its goals, it can also be used to oppose state mental health policy (or the commissioner). The commissioner must therefore carefully cultivate the support and allegiance of institutional superintendents. Even when a commissioner accomplishes this, there will probably be one or two recalcitrant superintendents who believe their interests are best served by refusing to cooperate with the commissioner. They may even decline to abide by state mental health policies. Depending on the locale and the strength of the political ties of these people, the commissioner may face anything from a nuisance to a serious threat to his or her survival.
