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LINDA'S LEGACY: As Linda Rosenberg concludes her tenure as National Council CEO in 2019, colleagues laud her vision, influence and advocacy.

Earlier this year, Linda Rosenberg, president and CEO of the National Council for Behavioral Health, announced that she will be leaving her position in August 2019, just as the organization marks its 50th anniversary. The board of directors has begun the search for another chief executive.

Rosenberg leaves behind a legacy of vision, influence and advocacy, according to those who have worked closely with her. Under her leadership since 2003, the organization has accomplished a number of strategic milestones, such as sustained membership growth and advocacy efforts that have fundamentally reshaped the national dialogue surrounding mental health and addiction treatment.

"I never think we've done enough," Rosenberg tells Behavioral Healthcare Executive. "It's probably my strength and my weakness. I'm always thinking about what's still left to do."


Members and colleagues say that Rosenberg has been instrumental in identifying critical industry issues during the past 15 years, such as stigma, parity and provider sustainability. She's also been able to rally the membership base around policy initiatives through the council's ongoing advocacy efforts.

"Linda [Rosenberg] is a game-changer who is never satisfied with the status quo," says Mark Ishaug, CEO of Thresholds, a National Council member. Ishaug also says that Rosenberg has "led innovation in practice and policy that improves access to care and ensures fair payment for that care."

Chuck Ingoglia, the National Council's senior vice president for public policy, who has worked with Rosenberg for more than a dozen years, says one of the biggest changes he's observed during Rosenberg's time is the transformation in how stakeholders perceive the behavioral health provider community. The attitudes have decidedly changed for the better.

"Providers were considered the enemy and part of the problem," Ingoglia says. "Linda [Rosenberg] and the National Council have done a really good job of challenging that assumption."

And the improved perception has led to practical advances.

For example, providers are increasingly welcomed in policy discussions as resources of information on what's happening at the grassroots level. More importantly, they are recognized as mission-driven organizations that work within communities to ensure everyone has an opportunity for recovery, Ingoglia says.

Their role is reflected more broadly in legislation and funding that supports recovery. Ingoglia says National Council has been successful in emphasizing the need to include treatment as part of any initiative aimed at addressing behavioral health. Recent national policies, such as the Comprehensive Addiction and Recovery Act indeed have included a necessary focus on treatment.

But Rosenberg and the National Council have never been reluctant to call out weak policies, such as the Senate's recent Opioid Crisis Response Act, which she notes fails to invest in a full continuum of services or provide a comprehensive solution.


Rosenberg says National Council has given her the privilege of a lifetime in leading such a harmonious group. Large and small providers have joined the organization because they recognize that practice and policy go together, she says. She has watched the rolls grow naturally from about 700 member companies when she first came onboard to nearly 3,000 today--without any membership drives, she adds.

"It's a testament to the people who work at National Council but also to the member organizations," Rosenberg says. "Their work is focused on local communities, but what goes on in Washington, D.C., can set the stage."

Today, the provider members employ approximately 500,000 administrators and clinical professionals, who serve some 10 million Americans with mental health and addiction disorders. They're mostly--but not exclusively--not-for-profit settings. For many, solvency remains the top issue that keeps them up at night, and they expect the National Council's collective voice to advocate for rational payment from public and commercial payers.

Although it's been 10 years since the initial parity law was enacted, equitable coverage and adequate payment remains a never-ending fight. Rosenberg says she views it as discriminatory that behavioral health organizations aren't paid the same way that medical and surgical specialties are paid. No one seeking heart surgery, for example, has to find a hospital that has earned a grant, she says.

"We've made tremendous progress with the Mental Health Parity and Addiction Equity Act and the Affordable Care Act--which is still hanging on--as well as the Excellence in Mental Health and Addiction Treatment Act, and most recently the opioid package," she says. "But we're still dealing mostly with grants, and that has to change."

SAMHSA was budgeted to hand out nearly $3 billion in grants in 2018, but Rosenberg would much rather see sustainable funding.

"We'll know we made it when the care for people with mental illness and addiction is automatically covered by insurance plans--including all science-based interventions," she says.


Rosenberg highlights the accomplishments of the new Certified Community Behavioral Health Clinics (CCBHCs)--a model launched in 2016 under a federal demonstration program. Currently limited to eight states, CCBHCs aim to create a cost-based payment model that provides enhanced reimbursement for comprehensive care. In early results, the vast majority of the clinics report being able to hire new staff and expand treatment capacity.

National Council has been advocating for the expansion of CCBHCs into more states through bipartisan legislation, with the hope that the model ultimately will be adopted nationwide. Ingoglia says the organization will continue to advance CCBHCs after Rosenberg's departure.

"We were able to make a down payment on CCBHCs, but we need to expand that footprint so CCBHCs are available in every community and that behavioral health organizations are adequately reimbursed to provide evidence-based care and care coordination," Ingoglia says.


Another far-reaching effort that has gained traction is the Mental Health First Aid training program, National Council's first foray into public education. In less than three years, educators have trained more than 1 million people, supported by millions of dollars in grants.

"Our introduction of Mental Health First Aid into the U.S. was timed well," Rosenberg says. "The public had seen lots of anti-stigma campaigns, but they wanted to know what they could actually do."

Those participating in the classes include everyone from first responders and government leaders to professional athletes and major employers. For example, in the wake of the suicide death of fashion designer Kate Spade in June, the fashion enterprise called on the National Council to train its human resources staff and 150 corporate employees in Mental Health First Aid.


While National Council certainly aims to make its voice heard on Capitol Hill, Rosenberg has additionally nurtured discussions on controversial industry debates. It's easy enough to talk about issues of consensus, but it's uncomfortable to challenge thought leaders to take a stand on issues that might result in pushback.

For example, early in Rosenberg's tenure, statistics on gun violence were examined in the context of suicide-prevention efforts. The council found that states with greater availability of guns recorded more incidents of gun violence, yet pointing out the finding made some bristle.

"The numbers are the numbers," Rosenberg says. "We're not saying take away the right to own a gun, but it does mean if we talk about suicide prevention, we have to include safety around guns in that discussion."

Encouraging the use of medication-assisted treatment for substance use disorders was another controversial topic the organization discussed several years ago. Rosenberg says the National Council took the position that medication and fellowship groups such as AA are both important in recovery, not mutually exclusive. It's a position nearly all agree with today.


A mother and a grandmother, Rosenberg says she's been an activist her entire life and plans to find new avenues for advocacy after she passes the baton for National Council. In fact, a hospital stay last year inspired her to never forget the important role relationships have for patients--both the therapeutic relationship with caregivers and the supportive relationships with loved ones.

"That really was a defining moment," says Rosenberg. "It renewed my passion for this work and for making sure every family who has someone with mental illness or addiction gets the support of their community. They should get flowers and books and casseroles just like I did."

She says her previous career as a social worker had a profound impact on her passionate advocacy, and she wants to find more solutions for improving the care of individuals with behavioral health conditions. Working with patients and families is an experience that will stay with her indefinitely, she says.

No doubt the next leader of National Council will need a similar vibe of energy and diplomacy, however, Rosenberg believes the new CEO might even be someone quite different than herself. Internal and external candidates are being considered.

"I have tremendous faith in the search committee," she says. "They'll obviously pick somebody very smart and relational who knows the field, who is passionate and will keep the patient and their family in mind at all times."


Julie Miller is a freelance writer based in Ohio.
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Author:Miller, Julie
Publication:Behavioral Healthcare Executive
Article Type:Cover story
Geographic Code:1USA
Date:Sep 22, 2018
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