Leadership Competencies: A Global Perspective ACHMA, June 16, 2009

1. Leadership Competencies: A Global PerspectiveACHMA, June 16, 2009 Richard H. Beinecke DPA, ACSW Departments of Public Management and Health Administration Suffolk University, Boston

2. Mental Health Is a Global Problem 500 million people with some form of a mental illness Mental illness will increase from 12 to15% of world population by 2020 Psychiatric and neurological conditions- 28% of years lived with disability 4 of top 10 leading causes of disability (DALYs – Disability-adjusted life years) are unipolar depression (1), alcohol use disorders (3), schizophrenia (5), bipolar disorders (7)

3. The Urgent Need to Train and Pass on Knowledge to the Next Generation of Leaders • 40% of US workforce over age 50 • 31% of Federal employees now eligible for retirement • Up to 40% of senior public managers will retire within the next five years • Line and mid-level workers including clinicians are not trained in management and leadership • Funding for leadership training is very limited

4. The Project • Collaboration with the International Initiative for Mental Health Leadership (IIMHL) (Australia, Canada, Ireland, Northern Ireland, New Zealand, Scotland, UK, US) • Review of leadership literature • Identification and descriptions of mental health, substance use, health, public administration, and some business leadership training programs in the countries • Analysis of leadership program competencies and development of new competency model

5. IIMHL “Virtual” agency that seeks to improve mental health services by supporting innovative leadership processes. Annual leadership exchange and conference (2009-Australia/New Zealand; 2010-Ireland) Membership of 1750, free, anyone can join Web site (www.iimhl.com) has reports and much other info. The Brisbane Group (sub-group of IIMHL) focuses on leadership training. IIMHL and Brisbane Social Networking site: www.community.networkofcare.org/groups/iimhl

6. Methodology • Extensive literature review and internet search • Networking and report review with over 35 mental health leaders in the eight countries • Most extensive listing of these programs and competencies ever done • Content analysis and comparison of 25 mental health leadership training programs where good information was available • Report at www.iimhl.com

7. What is leadership? • “Complex, difficult to capture, open to numerous definitions and interpretations... An intangible illusive notion, no more stable than quicksand.” (Middlehurst, 1993) • “...the process of persuasion or example by which an individual (or leadership team) induces a group to pursue objectives held by the leader or shared by the leader and his or her followers.” (Gardner, 1990)

8. Leadership is Leading and managing complex adaptive systems that operate as a series of networks with multiple stakeholder interests A dynamic process that emphasizes the need for quality, flexibility, adaptability, speed, and experimentation Critical needs: shared values, responsible and empowered members, effective communication and information sharing

9. Leadership Capabilities for Policy Change (Crosby and Bryson, 2005) Leadership in context Personal leadership Team leadership Organizational leadership Visionary leadership Political leadership Ethical leadership Policy entrepreneurship (coordinating leadership tasks)

10. Three Types of Problems (Heifitz, 1994) Type 1: Technical Problems – Problem is definable and can be solved with technical knowledge and abilities Type 2: Problem is clear, but the solution is not. Type 3: Adaptive Problems – No obvious definition of the problem or solution. Type 3 are complex, multi-framed, cross-boundary, and hard to solve.

11. Wicked Problems Wicked Problems: “when organizations have to face constant change or unprecedented challenges..It is the social complexity of wicked problems as much as their technical difficulties that make them tough to manage.” (Camillus, 2008) “Working in a swamp, compared to hard ground.” (Parks, 2005) No definite formulation of the problem. Each problem is essentially unique, often has not been faced before, is entwined with other problems. The search for solutions never stops. Solutions are not good or bad but are judgment calls and are often difficult to measure.

12. Transactional and Transformative Leadership (Burns, 1978 and others) • Transactional: Manage and maintain the current system: efficiency, planning, and goal setting • Transformative: Visioning, proactive change, entrepreneurship, teamwork, relationships, creativity, communication, engagement and renewing • Leader as technician or conductor (Cohen and Bradford, 1991) • Both transactional and transformative leadership are needed: catalytic leadership (Luke, 1998), adaptive work (Heifitz, 1995), change masters (Kanter, 1985)

13. Are they separate functions or is management an essential function of leadership? Is Leadership the Same As Management?

14. Problems and Competencies Technical (Type 1) problems are more management and require more transactional skills. Type 2 & Adaptive (Type 3) problems are higher level leadership challenges and require more use of transformative competencies.

15. Can Leadership Be Learned? • “Many dismiss the subject (development of leaders) with the confident assertion that ‘leaders are born not made.’ Nonsense. Most of what leaders have that enables them to lead is learned. Leadership is not a mysterious activity. It is possible to describe the tasks that leaders perform.” (Gardner, 1990) • “Leadership can be developed...leaders can improve their own effectiveness across a wide range of situations, from those requiring change and innovation to those with diverse populations and different cultures to those in crisis.” (Conger and Riggio, 2007)

16. What Are Leadership Competencies? • “The complete competency set or model for an individual role identifies all the knowledge, skills, experiences, and attributes a person should display in their behaviour when they are doing the job well.” (Mackay, 1997) • “The combination of attributes, skills, and knowledge that contribute to a person’s ability to perform a job to an appropriate standard. Includes personal attributes, knowledge, and skills (Health Research Council of New Zealand, July 2005)

17. Competency Models: Developing Leadership & Performance Improvement in Health Care (New Zealand)

18. Leadership Competency Architecture (New Zealand)

19. NHS Leadership Qualities Framework (UK)

20. SAMHSA Transformation Leadership Competencies Wheel (US)

22. The Leadership and Management Skill Set (Beinecke and Spencer, 2007) • Based on review of mental health, substance use, public administration, and business leadership literature and programs from eight countries • Full listing of competencies from theory and programs • Identification of specific competencies found in reviewed leadership training programs (numbers on slides) • Leadership self-assessment tool

23. The Model

24. PERSONAL SKILLS AND KNOWLEDGE

25. INTERPERSONAL (PEOPLE) SKILLS

26. TRANSACTIONAL (EXECUTION, MANAGEMENT) SKILLS

27. TRANSACTIONAL (EXECUTION, MANAGEMENT) SKILLS

28. TRANSFORMATIONAL SKILLS

29. POLICY AND PROGRAM KNOWLEDGE: UNDERSTANDING

30. Characteristics of Effective Leaders in Behavioral Health While core competencies are similar for all leaders, behavioral health leaders need to be particularly skilled in: Personal and interpersonal skills including verbal communication. Need better business acumen (transactional skills) Given behavioral health’s stigma and low position on the health priority, need creativity, evaluation, marketing, mobilizing support, &inspiring.

31. Changing Knowledge in 5-10 Years Continued battle for recognition and resources, e.g. universal health care, any attention and services in developing countries – transformation skills CQI, evidence based practice implementation, outcomes measurement Information technologies Knowledge of medical and primary care as well as genetics Training of consumers as well as professionals

32. Developing Needed Knowledge More comprehensive leadership and management training in behavioral health professional schools and association sponsored continuing education programs at all levels and for professionals, consumers, and families. Web based directories of training programs including those in health, public administration, and business. Case studies of behavioral health leadership development, and change in action – lessons learned. What can ACMHA do?

33. Current Brisbane Group Projects Articlecomparing three types of effective leadership training projects in three countries. 2010 conference on global behavioral health leadership training. Book of case studies of effective global mental health interventions and leadership competencies, strategies, and lessons learned from them.

34. References and Other IIMHL Related Readings Annapolis Coalition (2007). An Action Plan for Behavioral Health Workforce Development: A Framework for Discussion: Executive Summary. www.annapoliscoalition.org McDaid, D., Raja, S., Knapp, M. (2008). Barriers in the Mind: Promoting an Economic Case for Mental Health in Low- and Middle-Income Countries. World Psychiatry 7, 79-86 Patel, V., Garrison, P., de Jesus Mari, J., Minas, H., Prince, M., Saxena, S. (2008). The Lancet’s Series on Global Mental Health: 1 Year on. The Lancet 372, 1354-1357 Sachs, JD (2008). Common Wealth: Economics for a Crowded Planet. New York: Penguin

35. References cont. Sherer, R. (2002). Mental Health Care in Developing World. Psychiatric Times 19(1), 1-5 Beinecke, R.H., Daniels, A., Peters, J., Pitts-Brown, S., Chehil, S., Van Zwanenberg Z. (2008). Attributes of a Successful Professional Exchange: The 2007 International Initiative for Mental Health Leadership (IIMHL) Cincinnati Group. International Journal of Leadership in Public Services 4(1), 59-66 Beinecke, R.H. and Spencer, J. (2007). International Leadership Competencies and Issues. International Journal of Leadership in Public Services 3(3), 3-14

36. References continued… Sherer, R. (2002). Mental Health Care in Developing World. Psychiatric Times 19(1), 1-5 Beinecke, R.H., Daniels, A., Peters, J., Pitts-Brown, S., Chehil, S., Van Zwanenberg Z. (2008). Attributes of a Successful Professional Exchange: The 2007 International Initiative for Mental Health Leadership (IIMHL) Cincinnati Group. International Journal of Leadership in Public Services 4(1), 59-66 Beinecke, R.H. and Spencer, J. (2007). International Leadership Competencies and Issues. International Journal of Leadership in Public Services 3(3), 3-14

37. References continued… Beinecke, R.H. and Spencer, J. “Examination of Mental Health Leadership Competencies across IIMHL Countries” in Raffel, J.A., Leisink, P., Middlebrooks, A.E., (Eds), Public Sector Leadership: International Challenges and Perspectives, Cheltenham, UK: Edward Elgar. To be published in May 2009.   Beinecke, R.H. (Ed.). Special issue of The Innovation Journal: The Public Sector Innovation Journal (www.innovation.cc) on Leadership including articles by Beinecke and Pitts-Brown/Peters

38. References continued… Beinecke, R.H., Daniels, A.S., Peters, J., Silvestri, F. (2009). Introduction to the Special Issue: The International Initiative for Mental Health Leadership: A Model for Global Knowledge Exchange. International Journal of Mental Health 38(1), 3-13. We edited this issue. Daniels, A.S., Adams, N., Carroll, C., Beinecke, R.H. (2009). A conceptual model for behavioral health and primary care integration: emerging challenges and strategies for improving international mental health services. International Journal of Mental Health 38(1), 101-113

39. References continued… Shah, A.A. and Beinecke, R.H. (2009). Global mental health needs, services, barriers, and challenges. International Journal of Mental Health 38(1), 14-29