The Role of the Medical Director in Public Mental Health Organizations

Abstract

For 26 years the Public Psychiatry Fellowship (PPF) of New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons has been training young psychiatrists who wish to exert leadership roles in public psychiatry. In the early years of the fellowship it was assumed that alumni would naturally fill executive roles in mental health services. Over the ensuing 25 years, however, such leadership roles have increasingly been filled by other mental health professionals and, more recently, by people with business training with or without mental health experience. This trend is especially true in community-based organizations and also in hospital-based organizations to a lesser extent. For medical-legal reasons, however, almost all mental health organizations have medical directors who fulfill clinical and medical leadership roles with line authority over medical but not necessarily clinical staff. The role of such a medical director is complex. Many psychiatrists who fill such roles without specialized training end up doing little more than signing prescriptions and treatment plans. Over the years PPF has developed a strategy to prepare fellows for facing the challenges of public sector leadership and to support alumni in this endeavor throughout their careers. PPF encourages fellows and alumni to focus on specific problems their organizations are encountering and to develop appropriate strategies to exert leadership in helping their organizations deal with these issues. The series of articles in this section are examples of this approach. In each case the author describes choosing and carrying out a particular strategy designed to deal with a pressing challenge he is facing in his management position.