Feature

The path that led psychologist Terry Cline, PhD, to his new job overseeing the nation's mental health and substance abuse services programs started 20 years ago, on the streets of Cambridge, Mass.

As a young clinical psychologist, Cline delivered home-based therapy to families living in a low-income housing project.

Walking to his appointments, he would think about all the people who he passed by and didn't have time to help. He offered therapy one family at a time, but practically every family in the community needed help.

There had to be a more comprehensive approach to making mental health and substance abuse services available to more people, he thought.

"You go and visit one family, and you walk by 15 families on your way there who all need help, who all need services, who are struggling with the same issues that this one family is struggling with," he says.

He'll get a chance to make a difference in a lot of people's lives in his new post as administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the Department of Health and Human Services. With a budget topping $3.3 billion, SAMHSA oversees and funds state-administered mental health and substance abuse treatment and prevention programs.

The first psychologist to serve as administrator of SAMHSA, Cline was nominated to the post late last year by President Bush, and confirmed by the Senate in December. He started on Jan. 8.

Cline comes to the job after serving as Secretary of health for Oklahoma since May 2004 and commissioner of the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) since January 2001.

Observers credit Cline with fostering deep changes in Oklahoma's delivery of mental health and substance abuse services; now, he'll have a chance to push for changes on a national scale.

Cline's new job isn't his first position at SAMHSA. Before becoming Oklahoma's commissioner, he spent a year as a health policy fellow at SAMHSA, a fellowship co-sponsored by APA. During his fellowship year, Cline studied the organization and financing of mental health services with the Center for Mental Health Services.

Transformation

Cline endorses the conclusions of President Bush's New Freedom Commission on Mental Health report, which describes a fragmented system of mental health care.

"It needs a radical transformation. Not a restructuring, not a tweaking, not an expansion, not a realignment, but a complete and total transformation," he says.

A transformed mental health system should focus on building people's resiliency and promoting their recovery-with the overall goal of "a life in the community" for everyone with substance abuse and mental health issues, Cline says.

On the state level, locally based treatment capacity needs to expand, he explains, with attention paid by SAMHSA to measurements of how effectively that treatment is being delivered, and with accountability to each state and SAMHSA for overall results

To make that transformation happen, Cline says a key part of his job involves building relationships with stakeholders in the system, traveling for face-to-face meetings nationwide.

Just two weeks into the job, Cline traveled cross-country and met representatives from 15 different mental health and substance abuse treatment and advocacy groups.

"I'm not walking in with a preset agenda that I think is most important to the nation," he says. "There are many, many people who have much to contribute to that vision."

An Oklahoma native, Cline earned his doctorate from Oklahoma State University. He worked with children and families from urban neighborhoods struggling with dysfunction and delinquency issues during his internship at Children's Hospital in Boston in 1984-85. APA Past-president Gerald Koocher, PhD, first got to know Cline during that year. Describing him as an intelligent and compassionate intern, Koocher says Cline showed a talent for blending the skills of a budding practitioner with a willingness to grapple with questions of how to make services available to more people.

Cline's career serves as a good example to young psychologists who want to influence public policy, Koocher says.

And Koocher also likes the fact that although he's now a top administrator, Cline is someone who's dealt with "desperate" clients during his time as a practitioner.

"Aside from his sincerity and his focus on public mental health, he's a clinician," he says.

Leading change in Oklahoma

Back in Oklahoma, people who worked with Cline describe him as a nonpartisan consensus builder who brought a fundamental shift to the goal of the state's mental health care and substance abuse treatment system-from maintenance to recovery.

"He's really changed the mindset, such that the consumer should not just be the recipient of services, but the driver of services," says Steve Buck, executive director of the family and consumer advocacy group National Alliance of Mental Illness Oklahoma.

Cline also helped to significantly expand the state's number of drug courts-county-based diversion programs that place people charged with nonviolent drug offenses in substance treatment programs rather than jail-says psychologist Larry McCauley, EdD, who serves on the governing board of ODMHSAS. In fact, the program grew from funding 1,000 people annually in 2001 to more than 4,000 in 2006.

Cline also helped establish the state's first mental health court in Oklahoma County in 2002, and a sixth mental health court is set to begin operations this year.

The courts offer an alternative to incarceration for people with a diagnosed mental illness who have been charged with a non-violent crime.

During his time as commissioner, Cline's meetings with consumers brought changes that eased people's access to treatment, McCauley says.

Treatment-seekers had told Cline horror stories about being put on a never-ending paperwork shuffle, such that they'd rather give up than be told to come back with yet another form one more time.

Responding to the complaints, Cline pushed through changes requiring staffers to adopt a "one-stop shop" approach for completing treatment applications.

"We take the time to help them fill it out, so they can get access right then and there," McCauley says.

As an advocate for services, Cline worked effectively with state legislators, securing more funding and building awareness of mental health and substance abuse issues, McCauley says. State appropriations for mental health and substance abuse services grew 50 percent during Cline's tenure.

McCauley still remembers the time Cline drove him out to a piece of farmland in Woodward, Okla., that been donated for a construction site for a community mental health center. Walking the property, Cline excitedly pointed out where the different sections of the center would be located, on what was then an empty stretch of ground.

"He's still got that passion for his work, and to see that excitement tends to be infectious," McCauley says.