Contents

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Acknowledgements

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p. ix

It took me over ten years to write this book, which started out as a series of articles after I stepped down as Virginia’s ninth mental health commissioner. There are many among my friends, family, students, and colleagues whose support and encouragement kept me going, and I apologize that I cannot list everyone here. Nonetheless I am deeply grateful...

List of Abbreviations

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p. xi

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1. Men in Diapers: A System in Shambles

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pp. 1-33

Mental illness can be frightening both for those who experience it and for their family and friends, who may try in vain to somehow just make it all go away. It strikes young and old, rich and poor, Democrat and Republican alike. Some of our greatest leaders have experienced it, such as President Lincoln, who struggled with depression. Some of the...

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2. That Which Is Measured Improves

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pp. 35-64

It was the summer of 1994, and I was just settling in as the newly appointed commissioner for Virginia’s Department of Mental Health, Mental Retardation, and Substance Abuse Services. Monday morning at nine was our scheduled weekly staff meeting, when the commissioner and central office managers discuss strategic concerns and plan for the coming...

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3. Monopolies Don’t Work

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pp. 65-89

One of the least exciting jobs of a mental health commissioner is to review and sign off on major contracts between various suppliers and the state. The contract could be for anything—food supplies or repairs for the hospitals, psychiatric medications, new computers for the central office— you name it. Every day a stack of such documents would appear on my...

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4. Fair Is Fair: Parity for Mental Health Coverage

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pp. 91-113

Ted and Joan thought they had prepared well to meet any and all needs for their family of four. They both had stable, good-paying professional jobs in the Washington, D.C., area, and they owned a nice three-bedroom home in a quiet neighborhood. They had dutifully taken care of their wills, making sure that trusts were in...

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5. Let the People Speak

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pp. 115-113

At the core of the American democratic concept is the principle that everyone affected by a policy or decision should have a voice at the table. This principle is based on the belief that people can be trusted to make good decisions on their own behalf. In America there is no place for autocracy, whether in government or in health care. Yet currently, a great...

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6. Transforming America’s Mental Health System

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pp. 139-164

We have come a long way since the opening statements of this book. We have defined serious mental illness and documented some of the failures of the current mental health system. We have pointed to the need for evidence-based practices and outcome-oriented care, as well as innovative community-based services. We have shown why monopolies don’t work...

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Postscript—Information on Mental Illness

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p. 165

There are two sources of information for people with mental illness and their families that, in my opinion, outshine the rest. Both are Web sites. Whether one is looking for basic understanding about a particular mental disorder, the latest in treatment options, how to connect with others with similar needs, or books and articles on mental illness, these...

Notes

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pp. 167-172

References

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pp. 173-179

Index

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pp. 181-192

About the Author

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p. 193