(Within hours after posting this blog, I received an email from Community Services Board Executive Director Tisha Deeghan who explained that the CSB board had a member with lived mental health experience serving on it up until April 27th when that appointee retired. She reminded me that it is the Fairfax Board of Supervisors’ responsibility to appoint board members, not the board’s. I also received an email from Board of Supervisor Chair Sharon Bulova’s office assuring me that the board was aware that the CSB currently does not have a self-acknowledged peer serving on its board. I was told that it is actively searching for an appropriate candidate.)
(6-9-16) The Fairfax – Falls Church Community Services Board, which is responsible for delivering mental health services where I live in Northern Virginia, does not have anyone on its 16 member board who is a peer. The board also recently decided to not hire a new Director of Consumer and Family Affairs, a job specifically created to be held by a peer. This means there is no peer in a top leadership position in my county.
In 1968, Virginia decided that mental health services should be administered locally. The state created 39 Community Services or Behavioral Health Boards, commonly called CSBs. While the legislature allowed local jurisdictions to pick board members, it codified the importance of peers and family members. According to Virginia law:
One-third of the appointments to the board shall be individuals who are receiving or who have received services or family members of individuals who are receiving or who have received services, at least one of whom shall be an individual receiving services.
Not having a peer on our local board may or may not violate that statute – I am not a lawyer. But I know that not having a person with lived experience on the board puts it at a disadvantage when it comes to fully understanding how its decisions will be viewed by the Virginia residents most impacted by them.
The CSB also recently decided not to fill the Director of Consumer and Family Affairs position. That post was held by David Mangano, who retired last year.
Mangano was recruited in 2009, three years after the Fairfax County Board of Supervisors appointed a blue ribbon panel known as the Josiah H. Beeman Commission to “recommend a vision and blueprint for transforming the local mental health delivery system for Fairfax County, Fairfax City and the City of Falls Church.” Among its top recommendations was:
Establish an Office of Consumer and Family Affairs with well defined responsibilities and a leader who reports directly to the CSB Executive Director. Forward-looking states and localities across the country have been establishing Offices of Consumer Affairs since the early 1990s. As of January 2007, thirty-seven states had established these offices, several of which subsequently changed their name to Office of Consumer and Family Affairs.
Because we believe that persons with psychiatric disorders and their families should be involved in all aspects of CSB services, we support efforts already under way to establish an Office of Consumer and Family Affairs. This office will be a resource to individuals, families, and staff in system transformation, service quality assurance, and the leadership and engagement of individuals receiving mental health services. The leader of this office should be a person with lived experience of mental illness, as is the case in many states and localities.
We agree with the National Association of State Mental Health Program Directors that a core element of a successful Office of Consumer Affairs is that its “establishment, planning, and hiring must be supported by and involve consumers.” We envision that this office would seek and encourage a healthy advocacy process.
As the county’s first and highest ranking peer manager, Mangano helped implement a variety of peer services. These included the development of Wellness Recovery Action Plans, the use of advanced directives, Whole-Health and Wellness management (WHAM) training and the operation of four peer run recovery centers.
Just as importantly, Mangano helped change attitudes in Fairfax. His position as a director showed that persons with lived mental health experiences can and should hold management positions. He served as an advocate for family members and consumers who were unhappy with the services that they were receiving but were afraid to speak out against their doctors or other mental health workers for fear of retaliation. Part of his task was to emphasize self-determination and to insure that the voice of persons most directly impacted by CSB decisions were heard and fairly considered.
When Mangano announced that he was retiring last year, the CSB began advertising for a replacement. It offered a salary that ranged between $76,347 and $127,244 annually, along with benefits, that were commensurate with what other top managers received. During the budget planning process, the CSB board decided it could save money by keeping Mangano’s position vacant and parceling out his responsibilities to other managers. None of these managers has lived mental health experience. None is a peer.
At this point, I need to disclose that my son, Kevin, works as a peer specialist in Fairfax County. His superiors urged him to apply for Mangano’s job. That is when I first learned that Mangano was retiring. That creates an obvious conflict of interest for me. I am writing this completely independent of him, without consulting him, or asking for his permission. I must trust in the integrity of the CSB leadership to separate my opinions from my son’s and not hold him responsible for my opinions.
My feelings about the importance of listening to peers are deep rooted. In April 2007, I penned an Op Ed in The Washington Post calling for a peer to be appointed to a state panel investigating the Virginia Tech shooting. If the state truly wanted to know why no one intervened before that tragedy, it needed to include a peer in the investigation who could explain why someone with a mental illness might feel disenfranchised or hostile on a college campus. Whenever anyone hires me to give a speech, I send them a contract that states that I want a peer included on any panel that I am asked to moderate or participate in. I also have urged Congress several times to include peers when seeking testimony and whenever I agree to serve on a commission, I raise the issue of having a peer as a fellow participant.
This doesn’t mean that I always have agreed with what peers say. In fact, I have served on panels where peers have assumed that because they have an illness they are the only voices that should be heard. That is ridiculous. It also is ridiculous to not listen to persons who actually have recovered from a mental illness. We would not send soldiers off to war without listening to someone who actually had combat experience.
In an email exchange, I asked Tisha Deeghan, the CSB Executive Director, why the board had chosen not to fill Mangano’s job. She explained that budget cuts had resulted in more than 108 CSB jobs not being funded. She wrote that the board felt it could successfully continue to run the peer programs that Mangano helped establish without employing a separate director. The board’s priorities were detailed, she noted, in a presentation made to the Board of Supervisors on February 23rd that is available at http://www.fairfaxcounty.gov/dmb/lob/2016/40040-ppt.pdf. Some of those priorities, she said, were mandated and therefore had to be funded, leaving less money for other services, including Mangano’s post. She concluded:
Close collaboration with peer run organizations and advocacy will continue, and is a personal agenda of mine. Daryl Washington, Lyn Tomlinson, and Jean Hartman (if not myself) will be covering those duties to ensure there continues to be executive leadership presence and support. Managing the contracts for peer run organizations will be handled by Allen Berenson (a senior service director) in collaboration with our contract management staff. Finally, the Human Rights duties that were handled by the Director of Consumer and Family Affairs will now be handled by the CSB’s office of Compliance and Risk Management. This is a customary fit in a typical community mental health agency. I hope this helps explain this very difficult decision.
All of us can sympathize with Director Deeghan’s plight in trying to provide as many services as possible on limited funds. I should add that I have much admired her performance since she was hired two years ago.
However, I would urge the board to reconsider its decision.
When my son first became ill, I sought advice from dozens of experts. Many were helpful, but I found myself paying extra attention to two men: Fred Frese and Jonathan Stanley. Why was their advice so poignant? Because they had accomplished what I desperately wanted my son to achieve. They were living successfully with a serious mental illness. Fred has schizophrenia. When he retired in 1995, he had been Director of Psychology at Western Reserve Psychiatric Hospital for fifteen years. He is a husband, a father, and an inspirational speaker. Jonathan has bipolar disorder. He is a lawyer, a high school teacher, a founder of the Treatment Advocacy Center, and is married.
If they succeeded, I thought it was possible for my son to get better. Offering others hope is an off-shoot of listening to peers. Now there is a third person who helps me better understand mental illness. My son.
The county needs a peer in CSB management who can go directly to the CSB Executive Director with concerns and insights. That was the conclusion of the blue-ribbon Beeman panel when it issued its report and that finding is still true today. (It is interesting to note that Mangano was hired even though we were in the midst of a national recession in 2008 when mental health budgets were being stripped bare.)
The CSB also needs to recruit a person with lived mental health experience to serve on its board. It will not be an additional expense. It will offer the board a much needed point of view.
About the author:
