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Introducing AMHCA's New Executive Director & CEO
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A Q&A With Joel E. Miller


The Advocate: You have devoted a lot of your professional life to mental health and healthcare-related issues. What draws you to these issues?

Joel Miller: I became keenly aware early in my graduate studies that our nation treated people with mental illness incredibly poorly, and with a pervasive lack of compassion. 

The population with mental illness includes many

Joel E. Miller,AMHCA’s new executive director & CEO, comes to AMHCA from the National Association of State Mental Health Program Directors (NASMHPD), where he was the senior director for policy, government affairs, and healthcare reform.

Prior to that position, Miller was senior vice president for operations at the National Coalition on Health Care, and he has served as director of state policy for the National Alliance on Mental Illness (NAMI). He has extensive knowledge of federal and state mental health and healthcare policy, financing and delivery issues, and public and private health insurance programs.

Miller has lived in the DC area for 25 years. He met his wife Shelley when they were both at the University of Illinois in Champaign–Urbana, where he earned a bachelor’s degree in liberal arts and sciences. Shelley is a professional
wedding and portrait photographer, and their son, Greg, is the associate athletic director and head baseball coach at Herndon High School in Northern Virginia.

He steps into the position held for the past 15 years by W. Mark Hamilton, PhD, who retires this month. (See Hamilton’s last column.)

of the most vulnerable members of our society, yet mental illness and its treatment are in many ways still invisible. 

These neglected members of our society are perpetually cycled from our emergency departments, correctional systems, mental health facilities, homeless shelters, and back and forth all over again. Many cannot afford basic healthcare, mental health services, or their medications—or may not have the ability to understand the need for continuous or consistent care. 

Many of these individuals lack person-centered care or compassion, and in the public arena they may not have a voice or a vote. Not that long ago, cancer patients were once treated as outcasts and faced discrimination, too.
Our society’s poor treatment of people with mental illness motivates me to help address their needs through macro-policy and program solutions.

The Advocate: Do you think the recent shootings involving individuals with mental illness have changed the way politicians and the public perceive people with mental illnesses?

Joel Miller: The typical initial response by policymakers has been demands for more help for people with mental illness and verbal commitments to provide more services and funding. But then interest wanes and we end up back at square one. 

Think about this: A member of Congress—Arizona’s Rep. Gabrielle Giffords—was seriously injured by a person with severe mental illness, and 20 innocent schoolchildren and teachers were murdered in Newtown, Conn., by an individual with a history of mental illness. Yet Congress is still loath to fix our fragmented and underfunded mental health system.  

Although I applaud President Obama for initiating a new program to fund increased screening and detection of mental illness, especially for younger Americans, the proposed budget does not meet the need.

The Advocate: Haven’t we made progress toward reducing stigma and helping people with mental illness get care?

Joel Miller: We certainly have had pockets of success, but unfortunately, significant stigma and discrimination remain and serve as a reminder of the scope and impact of mental health and substance use problems in our country. And many people with mental illness have co-morbid healthcare issues such as hypertension and diabetes that complicate the provision of care. 

Even with the tragic incidents in Aurora, Colo., Newtown, and Tucson still fresh in our collective souls, individuals with mental health conditions seem to live on an island—literally cast away—surrounded by an ocean of indifference. As a society, we need to be able to see individuals with a mental health condition as people first—as fathers, mothers, students, musicians, business owners—who live with an illness and contribute to our society like anyone else. 

Mental health disorders continue to substantially impede the overall well-being of our nation because of their prevalence, their pervasive impact on multiple areas of one’s life, and the lack of treatment for many who need it.

Despite the progress we have made and major advances in the field, mental health disorders are the leading cause of disability in the United States, and needlessly cost our nation billions of dollars in productivity. There are ways we can address these problems, but we have not had the collective will as a nation to close the gaps. 

The Advocate: How will your background in legislative affairs and your work at NASMHPD help you work for the advancement of the clinical mental health counseling profession?

Joel Miller: I have been able to straddle the healthcare and mental healthcare sectors in my legislative advocacy efforts over the last 20 years. On behalf of AMHCA’s board and members, I believe I can provide strategic policy guidance by connecting the dots in both fields among policy details, political dynamics, and business realities on legislative and regulatory issues.

One persistent obstacle to overcome is that policymakers at all levels are uninformed or mis-informed on policy issues related to the prevalence and treatment of mental illness. This is not to criticize individual policymakers; it’s simply a fact that policy-makers are bombarded with con-flicting healthcare and mental healthcare data from hundreds of stakeholders fighting for a piece of the government financing pie. 

That is why it is critical for the profession to speak with one voice, and to provide timely and credible data to members of Congress and state legislators showing that treatment works for the vast majority of people with a mental illness. 

A key challenge is for us to pro-vide reliable “return on investment” data on preventing mental illness and the cost-effectiveness of treatments. We need to present this data in user-friendly materials, and we need to prepare it now, since when the next New-town or Aurora—unfortunately—occurs, policymakers will want instant input on problem-solving policy strategies. The mental health community is sorely lacking in compiling the data required in this new fiscal environment to demonstrate how it is possible to expand services and protect budgets simultaneously.

The Advocate: What do you see as the greatest challenge ahead for AMHCA?

Joel Miller: In this brave new world, achieving policy goals will require intensive cooperation among diverse contributors and stakeholders. On my part, that challenge will mean generating shared visions, identifying pockets of value and niches, developing new messaging platforms, forming unique alliances, and managing complex strategic policy and program relationships. 

This will also entail constantly moving in new directions by shaping emerging networks of contributors and using those contributors’ skills and attributes to address the needs of AMHCA members—and as a byproduct—those of our partners. I envision an AMHCA team process where we constantly arrange new inter-actions with movers and shakers to solve problems and contribute to each other’s success.  

The ultimate goal is to trigger a chain reaction of win-wins for organizations throughout the mental health ecosystem and other enterprises.

In a world of constant change, I believe AMHCA’s success will require having an awareness of the big picture while finding ways to play a major role in the dynamic mental health ecosystem and related environments.

Ancient Greek philosopher Heraclitus has been quoted as saying, “You can never step in the same river twice, as new waters are ever flowing upon you.” AMHCA will do its best to make sure that mental health counselors, as they wade into those waters, have the tools to navigate those rapidly changing currents and stay on course.

The Advocate: Let’s follow up on this area. What does the new payment and care delivery environment mean for clinical mental health counselors?

Joel Miller: I believe that mental health counselors will need to move well beyond the confines of the mental health ecosystem. To solve problems, those in our field must connect with many other sectors—such as educational institutions, primary-care settings for children and all ages of adults, the courts, juvenile justice and correctional systems, corporate wellness systems, the military, and wherever counselors’ clients’ paths cross. 

Many observers of the behavioral health field—including purchasers and those who work in various settings—are beginning to recognize that mental health counselors and other caregivers work with many of the same people, but at different moments in their lives—and that if we work together, we will surely do better than we are now. Due to their credentials and meeting high standards and the perception of them by various stakeholders as collaborators and integrators, mental health counselors will be valued partners in new alliances that deliver cost-effective, quality services and contribute to developing new solutions.

The implementation of the Affordable Care Act, whether one likes the law or not, will also dramatically alter the mental health landscape, as has been demonstrated by providers’ interest in developing new care delivery approaches such as Accountable Care Organizations (ACOs) and Health Homes. 

The Advocate: What made you interested in running the day-to-day operations of AMHCA?

Joel Miller: During my career, I have had the good fortune and opportunity to manage departments, lead multidisciplinary teams under dynamic circumstances, and organize broad-based coalitions. The ED–CEO position at AMHCA enables me to bring all of those skills and experience together to benefit an organization for which I have great respect. 

I look forward to leveraging all of AMHCA’s assets to address the needs of members and promote their interests in a comprehensive and integrated fashion. I will work closely with AMHCA’s board and staff, with state leaders and our partners, to determine the approaches, organizational structures, and functions we need to embrace to provide quality, timely member services. 

The Advocate: What do you like to do in your spare time?

Joel Miller: I have recently taken up golf—not very well, I might add. It’s quite a challenging game, but I really enjoy the camaraderie with friends and playing a sport, since I played a lot of baseball and basketball growing up in Chicago. 

I also enjoy reading biographies. The most recent one I’ve read is, “Jack Kennedy: Elusive Hero,” by Chris Matthews. Matthews credits President Kennedy’s team during the 1960 election with putting together the first modern-day presidential campaign.

The Advocate: What would you most like members to know about you and your approach to heading AMHCA’s staff?

Joel Miller: I like to think that in every position in my career, I have brought a strategic focus to my work that has resulted in developing and disseminating problem-solving information to staff members, association members, and the board. To thrive in this new business environment, we will need to move the ball forward rapidly on a team-based, project-by project basis and identify the necessary tools to measure definable outcomes. We will be a results-oriented operation.

I know that I will wake up every day thinking how to make AMHCA a great organization and how we can make a distinctive impact. I will be constantly striving to make the organization’s contribution to the members and communities it touches so noteworthy that no other institution on the planet could match it.

I am excited about leading AMHCA during these dynamic times, and I look forward to work-ing closely with AMHCA President Judie Bertenthal–Smith, LPC, ALPS, the AMHCA board, state chapter leaders, and the AMHCA staff and team to implement key projects that address the needs of the members.