Feature

David Shern, PhD, was born with cataracts so bad he was functionally blind as a child, so he knows what it's like to live with a disability and feel the cruel sting of rejection from others.

His parents had to put drops in his eyes every morning, dilating his pupils so he could see enough to move around. Reading was almost impossible, though he figured out a way to cup his hands around one of his eyes and peer down at the print, face pressed close to the page to gradually make out the words. But forget about kicking a soccer ball, throwing a baseball or being a welcome member of any athletic team.

"You'd always be the last kid picked for any team, and the other team that got you was always disappointed, and they were not subtle about expressing that," says Shern, 55.

Two surgeries during his teen years enabled him to see the leaves on the trees for the first time--an "explosion of color and detail" that he says was almost disorienting. "You don't know what you don't see until you see it," he says.

Shern attributes his interest in social psychology--why people behave toward one another the way they do--and his empathy for people struggling with the stigma of mental illness to what he endured growing up. And now, as president and CEO of the National Mental Health Association (NMHA), Shern is using that empathy to help people with mental illnesses move toward the same sort of life-changing transformation that he experienced--for them in the form of recovery from their illness.

His path to the post started last year, when Cynthia Wainscott, NMHA's acting CEO, asked him to suggest candidates for it.

Shern, then dean of the University of South Florida's Louis de la Parte Florida Mental Health Institute, suggested some names, then realized he was interested too.

So he applied, interviewed and got the post. He took over full time in September. The first psychologist to lead NMHA, Shern says his experience will help NMHA focus on the translation of scientific research into therapeutic practice. His passion is seeking the effective delivery of publicly funded mental health services to people with severe mental illness.

Through a reinvigorated public education effort called the Mental Health America campaign, he aims to strengthen NMHA's role as the nation's premier voice for affordable, everyday access to mental health care for everyone. Tentatively scheduled to kick off this month, the campaign's catchphrase will be "Bringing Wellness Home."

"What we're trying to do is to really nail the integration of health and mental health--that they're not separate things, but that in fact as goes mental health, so ultimately will go your health," he says.

And given that the NMHA is a community-based organization, with 340 chapters in counties and cities nationwide, Shern wants to help local chapters work in their own communities for better mental health care, and to make people with mental illness and their families the driving force in helping decide how mental health care is delivered.

Making that care more available won't necessarily cost more money, says Shern. Noting that the United States already leads the world in per capita health-care spending, but doesn't get the best results, he insists that more efficient use of the money already being spent--through prevention and early detection and treatment--can engender better overall results.

For her part, Wainscott says it was Shern's passion to see big changes in mental health services delivery that got him the job.

"The most important thing we were looking for was somebody with fire in the belly--an understanding of what needs to happen to change policies so that there's an aggressive mental health component to our health system," she says.

Speaking up for treatment

Besides re-energizing the public campaign, Shern lists three other goals for the NMHA, including:

  • Dealing with "pushback." The mental health community needs to fight efforts in Congress and state legislatures blocking mental health screening for teens.

  • Legislating mental health parity. Health insurers need to make behavioral health services available at the same cost as other health services.

  • Fighting stigma. Besides talking about why treatment works, the mental health community needs to use its research base to make the case against the arguments of groups that claim mental illnesses do not exist, such as the statements made by the actor Tom Cruise against psychotropic medications.

For all those efforts, the priority is making recovery from mental illnesses possible for more people, he says. Scientifically validated research helps make the case that such recovery is possible with the proper support and resources, Shern says.

Someone with a mental illness ought to have a chance to live as normally as possible, he says.

"What [people with serious mental illness] should expect is a normal life in the community: a decent place to live, a worthwhile job and a date on Saturday night. That's the goal," he says.

Seeing the big picture

Shern says his career in public policy and mental health began almost by accident.

While a doctoral student in social psychology at the University of Colorado at Boulder in 1976, a classmate called with a tip about an opening for a job studying the treatment of offenders with severe psychiatric problems for Denver General Hospital.

The idea was to figure out what combination of treatments led to the best outcomes for the offenders and the criminal justice system, in terms of less recidivism, says Shern. That job started a progression of positions in Colorado and New York evaluating how public mental health systems deliver treatment to people with severe mental illnesses.

After several years with a lead role evaluating programs at New York State's Office of Mental Health, Shern took the job at the Florida Mental Health Institute in 1995. There, he continued the institute's commitment to field-based services research conducted with consumer, clinician and policy partners. During his time as dean, it quadrupled in size, encompassing the full range of behavioral health and human service settings.

When Shern arrived, the APA clinical internship program focused on clinical treatment of serious mental illnesses, says Rick Weinberg, PhD, an associate professor and internship director at the institute.

Shern helped the training program shift its focus to the study of how mental health services are delivered, Weinberg says.

Now, psychology interns work at different mental health treatment centers in the community, and also spend about 20 percent of their time studying mental health policy, he says.

Weinberg says he originally was concerned by Shern's push for a different training model, but now sees the value of having clinicians study service-delivery policy.

"He helped me think through a different kind of training model, and it's forced us to move out into the broader community...with time spent on mental health policy, [the interns] understand the 'macro' factors in mental health services. And the better-informed the clinicians are, the better policy we create," he says.

While focusing on policy, Shern doesn't lose sight of the reason the policy exists, which is helping people, says Roger Boothroyd, PhD, an associate professor and associate chair of the institute's Department of Mental Health Law and Policy.

"One thing he never forgets is why we do the work we do," Boothroyd says. "I don't think David has ever forgotten the person who walks through the front door. I think you're going to hear a lot from NMHA in the future. He'll make an impact."

Shern's interest in policy previously brought him into a public role in 1999, when he chaired the Florida Commission on Mental Health and Substance Abuse, a gubernatorial commission that examined the delivery of mental health and substance abuse treatment in Florida. In a 2000 report to Florida's legislature, the commission spotlighted the pervasiveness of "de facto" mental health treatment of people in jails, the juvenile justice system, schools and the child welfare system.

Shern also spearheaded a multistate report--submitted to President Bush's New Freedom Commission on Mental Health--on the need for an overhaul in mental health services to emphasize prevention and recovery.

"It's been said, and I think it's true, that no disease was ever eliminated through treatment. The only way you eliminate a disease is through prevention," Shern says.