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Susan Neth, newly-appointed Executive Director.

Susan Neth, who joined MHS in 1988 as a case manager and is the longest-tenured MHS staff member, was selected to be the MHS Executive Director by a unanimous Board of Trustees during their meeting of 18 December 2008. Ms Neth was one of several candidates interviewed by Board members following Dr. Steven M. Friedman's announcement in September that he was leaving MHS after nearly 16 years as Executive Director. She had been serving as Interim Executive Director after Dr. Friedman's departure in October.

Staff members responded enthusiastically to the news. Ms Neth long ago earned her identify as one of the most trustworthy, talented, and credible leaders of MHS, because of her devoted service of more than 20 years, and also because of the many roles she has competently served in the agency's development.

With a newly-awarded license as Social Worker, Ms Neth came to MHS in 1988 as a Case Manager, providing community-based rehabilitative and supportive services for homeless, severely mentally-disabled adults. Before joining MHS, Ms Neth had earned a Bachelor of Arts degree in Psychology and a Bachelor of Science degree in Social Work from Cleveland State University. In 1989, she became a Clinical Record Specialist for MHS, earning the agency's certification from the Ohio Department of Mental Health, and negotiating contracts by which MHS would receive reimbursement for Medicaid-eligible services. During the last fiscal year, MHS earned nearly $1.9 million in Medicaid reimbursement for the performance of case management, counseling, crisis intervention, and psychiatric services.

Ms Neth was promoted to Systems Director in 1991, managing the agency's administrative, fiscal, billing, and information-systems functions, as well as serving as the MHS Client Rights Officer. She crafted and implemented a comprehensive quality improvement plan that later became a critically important foundation for the agency's successful expansion into residential, shelter, and crisis intervention services. She also wrote and directed the implementation of a comprehensive set of agency operational policies and procedures.

In 1993, Ms Neth earned her Master of Science degree in Organizational Development and Analysis from Case Western Reserve University. The following year, she was named Director of Community Support, and directed the creation of many of the assertive outreach, shelter, and permanent supportive housing programs that now comprise the 17 coordinated homeless assistance programs operated by MHS. She was also instrumental in the difficult task of integrating a child crisis service team from another agency into the newly-created MHS Mobile Crisis Team.

As community support became just one of many services helping MHS homeless and disabled clients to achieve housing, recovery, and independence, Ms Neth became Director of Homeless Services in 1999. In this role, she created, developed, and monitored a broad range of outreach, shelter, community support, and housing programs, and ensured that their services were well coordinated and readily accessible to clients. In 2002, Ms Neth was named Director of Community Development. In this role, she led the agency's development of the Community Women's Shelter, and a major initiative that resulted in MHS' accreditation by the Commission on Accreditation of Rehabilitation Facilities. She also supervised the Director of Quality Improvement and the Director of Development.

Appointed the agency's first Chief Operating Officer in 2006, she continued her work to cultivate and nurture constructive relationships with other community service providers, and led the agency's planning and renovation of the 36,000 square foot physical facility that now serves as the MHS administrative and service headquarters. She also worked closely with agency leaders in an initiative to improve service efficiency, productivity, and outcomes.

With this impressive scope of achievements, the trust and enthusiasm of MHS staff members, and the strong relationships she has developed with many of the service providers, government officials, and advocacy groups in the greater Cleveland area, Ms Neth is well prepared to lead MHS in the fulfillment of its important mission during a time of significant cultural, political, and economic turmoil.

Twelve 8th-grade students (left) from Hawken School, accompanied by three of their teachers, came to MHS to learn about its programs.

Later, they travelled to an MHS Safe Haven program, sharing lunch and conversation with its clients.

With the goal of "making a difference" in their community, the students came to learn about MHS programs and the clients they serve. Students will meet later to discuss what they've learned, and to decide where to direct charitable donations they help raise. Earlier this year, with information from a visit to MHS last year, they made the decision to make a substantial donation of $4,000 to the North Point Transitional Housing Center that MHS operates with the City of Cleveland, the Board of Cuyahoga County Commissioners, and other partner agencies. That generous donation was used to purchase kitchen equipment, so that the 160 men who stay at North Point can now prepare hot meals. The clients and staff members of North Point want the students, teachers, and donors of Hawken School to know that their kindness and generosity are making a big difference, every day of the week. Thank you!

At MHS, the students met with Acting Executive Director Susan Neth, and North Point Program Manager Jeffrey Bricker. Safe Haven Program Manager Daniel Wutsch coordinated the various events of the visit. All were impressed with the authentic curiosity of the students, and with the thoughtfulness and sophistication of their questions. We later learned from an eMail sent by Dorothy Moulthrop, their 8th Grade Humanities Teacher, that students were moved by their visit. Ms Moulthrop wrote: "I found myself thinking about your work and the clients we met all weekend long. My students did too because they came in this morning with more questions and thoughts about our day. Thank you!"

MHS wishes to thank the students and teachers of Hawken School for their interest in the mission of MHS, and their kindness to the clients they visited. People with long histories of homelessness and mental illness are accustomed to being treated with disdain. For these MHS clients, it makes a huge difference just to experience the genuine respect and interest of gifted, young people who will soon become the leaders of our community. Thank you!

( Read Dr. Friedman's letter to MHS staff members about his departure. )

Steven M. Friedman, Ph.D., Executive Director of MHS since January 1993, announced to stunned and saddened staff members his decision to leave MHS in October to become the Executive Director of the Cleveland Sight Center. "I never thought I'd be saying this to you," said Dr. Friedman, who explained that he was unexpectedly contacted by the Sight Center to secure its future in the 21st century.

During his nearly 16 years as Executive Director of MHS, Dr. Friedman became one of Cuyahoga County's most thoughtful and effective advocates for quality healthcare and supportive services for vulnerable children and adults. For homeless adults with mental disabilities, he created the most comprehensive and coordinated scope of services of any agency in Ohio. With the creation of the Mobile Crisis Team in 1995, he brought mobile, 24/7, community-based services to those in crisis, and worked with others to conduct and publish pioneering, scientific studies demonstrating the effectiveness of those services.

Susan Neth, MHS Chief Operating Officer since 2006, was appointed by a unanimous vote of the Board of Trustees to be Interim Executive Director. She has served MHS since 1988, the longest tenure of any MHS staff member. She had been Director of Homeless Services for many years, and later served as Director of Community Development. With a Master’s degree in Organizational Development, she has been one of the most influential leaders of the development of MHS' homeless assistance programs. She has also been a forceful advocate for the rights and interests of homeless persons. To better meet their needs, she has conceived, developed, and secured funding for unique and effective programs, and also played a key role in the agency initiative to earn CARF accreditation.

It was in late 1992 that Dr. Friedman had been asked to lead MHS by the Board of Trustees and Dr. Ishiama, then the Chief Executive Officer of the Cuyahoga County Community Mental Health Board (CCCMHB). At that time, the CCCMHB had assumed operational control of MHS after numerous stories of clinical, financial, and administrative problems had been published in The Plain Dealer.

Because MHS services under Dr. Friedman's leadership consistently and effectively met critical community needs, MHS quickly grew from an agency of 15 staff members and an annual budget of $600,000 in 1993 to an agency of more than 200 staff members and a budget of more than $14 million this year. Annual audits have repeatedly concluded that financial resources are used for the sole purpose of supporting program services and activities. There have been no HUD findings or audit findings for any of our programs, and auditors have always characterized their compliance opinions as "unqualified." Despite recent funding reductions, and the unanticipated costs accompanying the recent launch of major new programs, MHS is financially sound, and its fiscal governance is strong.

Also under his leadership, MHS consistently received excellent results in audits conducted by the Ohio Department of Mental Health, and earned certification by the Ohio Department of Alcohol and Drug Addiction Services.  Through his leadership of strategic initiatives, MHS earned accreditation by the Commission on Accreditation of Rehabilitation Facilities, and The American Association of Suicidology.

When CARF awarded MHS its highest level of accreditation - 3 years - in September, 2006, the CARF survey team noted strengths in 15 areas, including the dedication of the Trustees, Executive Director, and staff members, "genuine caring for persons served," "respect for persons served," the high level of satisfaction expressed by persons served, "excellent management documents," and "a strong commitment to obtaining input from the persons served and other stakeholders." MHS was also "commended for it vision, strategic plan, and program and resource planning that led to the development of the [Prison Pilot Program] and the program for Children Who Witness Violence (CWWV). Both programs involved significant collaboration with other groups and organizations, and they make major contributions in addressing critical needs of the persons served."

Dr. Friedman also created the agency's computerized database applications for the collection, analysis, and reporting of clinical, service, billing, and other operational data. Outcome data demonstrate that MHS programs help clients achieve housing, sustained recovery, and self-determination.

In addition to his creation of homeless assistance and crisis intervention programs, one of Dr. Friedman's most significant accomplishments was his work with the Board of Cuyahoga County Commissioners to create the Children Who Witness Violence program in 1999. It has since earned recognition as a national model for its coordination of clinical services with the work of police departments to better serve children who have experienced domestic violence. This work helps to keep families intact and self-sufficient. This program was one of only 26 provider agencies in the country first chosen to join the National Child Traumatic Stress Network that was established by a Congressional initiative.

Dr. Friedman has earned the respect of local, state, and national leaders of healthcare and supportive services for vulnerable populations. Through his careful conception and competent stewardship of innovative programs addressing the urgent and unmet needs of those whose only secure possession has been the scorn of others, he has been a caring and potent agent of change in the lives of thousands. He has helped clients of MHS achieve health, housing, and recovery, and create lives of purpose and dignity. He has given his staff members the opportunities, resources, and support they needed to explore and develop their talents, craft rewarding careers, and achieve personal and professional growth. The Trustees and staff members of MHS -- as thankful and now wistful beneficiaries of his gifted mind, compassionate values, and devoted service -- wish him well in the challenges he will confront in his leadership of the Cleveland Sight Center.

The Suicide Prevention Education Alliance (SPEA) holds its fifth annual Into the Light Walk at 6:00 p.m. on Sunday, 28 September 2008, at the Cleveland Metroparks Zoo. SPEA is a Cleveland-based nonprofit organization founded in 1992 to "prevent suicide and promote recognition of adolescent depression through education and alliances with community partners."

The purposes of the Walk are to: "shine the light on depression and suicide prevention; ... provide an opportunity for survivors of suicide to experience healing in a safe, anonymous way; [and] ... raise funds to support SPEA's prevention education program, Recognizing Adolescent Depression and Suicide Prevention." SPEA has provided this program to 30,000 students in 52 schools since December 2000. The program teaches students how to identify at-risk friends, what to do, and how to get help.

MHS supports SPEA's mission, and encourages you to participate in the SPEA "Into the Light" Walk. Click here to learn more, and register for the Walk.

Robert E. Drake, M.D., Ph.D., Professor of Psychiatry and of Community and Family Medicine, and Deborah R. Becker, M.Ed., Research Assistant Professor of Community and Family Medicine and of the Psychiatric Research Center of the Dartmouth Medical School visited MHS to speak with staff members about Supportive Employment and other evidence-based practices (EBPs) on 14 & 15 August 2008.

Dr. Drake is a pioneer in the development and evaluation of innovative and evidence-based community interventions for persons with severe mental disorders. He is Director of the Dartmouth Dual Diagnosis Center, and created the Integrated Dual Disorder Treatment model MHS uses for its clients who have severe mental disorders, and co-occurring substance-use disorders. Dr. Drake has published eight books and is an author of more than 300 scholarly articles about mental health recovery, and the quality of life among persons with severe mental disorders and those in their support systems.

Ms Becker is the nationally-known Director of the Dartmouth Supported Employment Center. MHS is beginning to implement the evidence-based Supported Employment intervention model at its permanent housing sites. Click here for a list of recent publications about EBPs from the Dartmouth Psychiatric Research Center.

Dr. Drake introduced the topic of EBPs by noting that the U.S.A. spends more on healthcare, per capital, than any other nation on earth, yet research shows that few people who have a serious mental illness get evidence-based care. In a recent 12-month period, of all people in the U.S.A. with a serious mental illness, only 5% participated in care based on EBPs; 15% got minimally-effective care; 20% got ineffective care; and 60% didn't participate in any care.

He explained that the Robert Wood Johnson Foundation developed a keen interest in EBPs in the 1990's, and identified several EBPs, including Systematic Medication Management; Assertive Community Treatment teams; Integrated Dual Diagnosis Treatment; Supported Employment; Family PsychoEducation; and Illness Management and Recovery. ( Read about the EBPs being implemented at MHS. )

As EBPs were developed, tested, and refined, it became clear that they shared some common features. (1) First, EBPs emphasized the client's self-management of his or her illness, in contrast to the more authoritarian and paternalistic practices that were common. (2) EBPs of all kinds also pay careful attention to the patient's goals. Dr. Drake said that it was a common belief years ago that employment was "destabilizing" for people with serious and persistent mental illnesses, and that people who had these illnesses were discouraged from seeking employment, despite their wishes to work. He noted there is no evidence that employment is destabilizing, and that the Supported Employment model shows that employment is a significant contributor to the recovery efforts of those with mental disorders. (3) EBPs also pay attention to clients' choices, and emphasize the shared responsibility of client and clinician to make difficult choices that involve complex trade-offs of potential benefits and adverse events. (4) EBPs tend to focus on clients' independence and education, so that clients are better prepared to manage their lives. (5) Finally, EBPs tend to focus on the enhancement of client skills, and the offering of support when requested or when it is apparent that it is needed.

Focuing on Supported Employment, Dr. Drake noted that, "in rough figures," 25% of clients in mental health settings have no interest in employment; 25% want to work, but are not successful in finding and keeping employment; 25% want to work, and have limited success; and 25% want to work and become good workers, usually in part-time jobs. However, once an organization develops a Supported Employment program, many clients who at first had no interest in work become interested in working.

Dr. Drake noted that what most hurts a client's job performance is not the overtly psychotic symptoms, but the cognitive deficits, such as problems with attention, memory, and problem solving. The assessment of cognition is becoming a standard feature of initial and ongoing assessments of people who are participating in treatment for schizophrenic disorders, he said. For example, the Brief Assessment of Cognition in Schizophrenia (BACS) test battery is becoming more widely used, and a brief version of it has become available. He said that trials of computer-based, compensatory memory training have been shown to be of significant help to clients whose performance is impaired by cognitive deficits. Dr. Drake later spoke of the impact that information technology is likely to have on mental health services during the next five to ten years. He believes that the use of IT will become an integral part of EBPs, and help clients to take control of their healthcare.

Preliminary results of a ten-year, longitudinal study of Supported Employment showed that most clients participating in this EBP tend to get better over time, even though they participate in fewer mental health interventions. "People continue on this trajectory of doing better," said Dr. Drake. The number of hours they work increases dramatically during the first year, improves at a lower rate during the next five years, and then seems to reach an asymptote after that. At the same time, mental healthcare utilization drops dramatically during the first five years, and remains low for the next five years.

MHS thanks Dr. Drake and Ms Becker for the valuable consultation and enthusiastic training they provided during their visit.  Our staff members were eager to hear from these two nationally-known leaders in EBPs, and we look forward to our continued work in the implementation of Supported Employment and other EBPs.

Construction progress is evident in this series of photographs of South Pointe Commons, a permanent, supportive housing program now being built by Emerald Development and Economic Network, Inc., a nonprofit housing development agency devoted to increasing the number of quality, affordable housing units for low-income individuals with disabilities. This photograph was taken 28 March 2008.

Construction status as of
28 April 2008...

... 16 May 2008 ...

... and
29 June 2008.

Opening in autumn 2008, this program will provide permanent housing and supportive services for 82 chronically homeless individuals who have a severe mental disability, or other disabling condition. The program site is on West 25th Street, near the campus of the MetroHealth Medical Center, on Cleveland's near west side.

MHS will provide on-site supportive services for 41 program participants who have severe mental illnesses, many with co-occurring substance-use disorders. The AIDS Taskforce of Greater Cleveland will serve 25 individuals with HIV-related disabilities, and the Louis Stokes Cleveland VA Medical Center will provide specialized supportive services for 16 veterans with disabling conditions.

The opening of South Pointe Commons will bring to 288 the number of formerly homeless individuals who will be in permanent housing sites operated by MHS. MHS also serves 192 formerly homeless individuals who now live in three MHS-operated transitional housing programs (Safe Haven II, the Young Adult Program, and North Point Transitional Housing Center).

See the artist's depiction of the completed structure.

Sherri Brandon, MSSA, who began her career as an MHS Community Support Worker for homeless persons, has been chosen as the new Executive Director of Transitional Housing, Inc. (THI). She is to be welcomed into her new role at a THI Open House Reception on Wednesday, 2 April 2008, from 3-6 p.m., at THI's offices at 1545 West 25th Street, in Cleveland.

In addition to her work with MHS homeless clients, Ms Brandon later worked with the MHS Mobile Crisis Team, and served as the MHS Liaison to Northcoast Behavioral Healthcare Services, providing inpatient psychiatric services for uninsured residents of Cuyahoga and other Ohio counties. She was well known for her diligent and productive work, keen intelligence, and commitment to helping her clients achieve enduring housing and recovery.

THI is a leading provider of transitonal housing services in Cleveland, working with the Cleveland and Cuyahoga County Office of Homeless Services. The mission of THI is "Providing homeless women with a safe environment, programs and services to promote self-sufficiency and independence to end the cycle of homelessness."

MHS is proud of Ms Brandon's achievements at MHS and at other supportive service providers in Cuyahoga County, and congratulates her in her important new leadership position within the Cuyahoga County Continuum of Care.

MHS and Emerald Development and Economic Network, Inc. (EDEN), one of Cleveland's leading nonprofit housing development corporations, welcomed the first clients to Liberty Commons at Saint Clair.

This HUD-funded program will provide permanent housing with on-site supportive services for 72 persistently homeless men and women. The program also includes eight apartments at different sites throughout Cuyahoga County, for families with children. MHS will provide on-site supportive services for 42 program participants who have severe mental illnesses, many with co-occurring substance-use disorders. The Louis Stokes Cleveland VA Medical Center will provide healthcare and supportive services for an additional 30 program participants.

As of 24 March 2008, the program housed 64 residents, and Program Manager Sonya Thompkins (photo below) reports that the program will be at its capacity of 72 by month's end. She also reports that one of the eight apartments for families is now occupied by a mother and her one child.

Oher MHS staff members include Community Support Workers Melissa Keith, Kenneth Lipka, and Tim Smith. The V.A. staff members are Community Support worker Devon Booth and Life-Skills Worker Shirley Henderson.

Sonya Thompkins

Kenneth Lipka

Tim Smith

MHS supports Issue 15, the Cuyahoga County Health and Human Services levy, on the 4 March 2008 ballot. Issue 15 would replace and reduce the current 4.9 mill levy with a 4.8 mill levy beginning in January 2009. Cuyahoga County uses funds from the levy to support programs and services essential to communities throughout Cuyahoga County, and to build the foundation for economic development.

The monthly cost per $100,000 home valuation would be just $2. Cuyahoga County’s Health & Human Services levy funds vital care and protection for more than 200,000 people every year in every community of Cuyahoga County. Passage of the issue would generate $18.6 million annually to help ensure the continuation of critically important services, including emergency services at MetroHealth Medical Center, Life Flight, the Severe Burn Treatment Center, and Northeast Ohio’s only Level 1 Trauma Center.

Funds from Issue 15 would provide protection and counseling for abused or neglected children, foster care and adoption services, and services to make sure young children get proper health care and are prepared for school. A portion of funds generated by the levy go to the Cuyahoga County Community Mental Health Board to fund the suicide prevention and crisis response services of the MHS Mobile Crisis Team, and other essential mental health services. The issue also provides home health care and home-delivered meals to seniors, allowing them to continue to live at home. Families and individuals need strong Health & Human Services because of job losses, reduced health care, and lost pensions. Voters overwhelmingly approved a separate and smaller levy in November 2006.

MHS supports the passage of Issue 15 because funds from the levy would help people who need emergency care and cannot afford to go anywhere else. Although election day is Tuesday, 4 March 2008, any eligible voter may vote early by submitting an Early Voting Application to the Cuyahoga County Board of Elections.

Addendum of 5 March 2008
Thank you, voters!   Issue 15 passed by a margin of more than 100,000 votes. With results from all 1,436 precincts, votes for the levy totaled 234,023 (64%); votes against, 131,096 (36%).

Cleveland Mayor Frank G. Jackson (at right), and Cleveland Ward 13 City Councilman Joe Cimperman, at the opening of North Point.

MHS, joined by City and County officials, welcomed the first clients of the new North Point Transitional Housing Center in downtown Cleveland, where 160 homeless men will find housing and a broad range of on-site supportive services. MHS will operate the program, and provide case management and supportive services. Lutheran Metropolitan Ministries, Towards Employment, and the Louis Stokes Cleveland V.A. Medical Center are partners with MHS in service provision.

The program will serve homeless men who had been using the Men's Shelter on Lakeside Avenue in Cleveland, or the overflow shelter at Aviation High School.

Cleveland Mayor Frank G. Jackson and Cleveland Ward 13 City Councilman Joe Cimperman (in the photo at left) welcomed the first homeless men to move into North Point on 17 January 2008. The City of Cleveland and the Board of Cuyahoga County Commissioners (Peter Lawson Jones, Timothy F. Hagan, and Jimmy Dimora) invested nearly $4 million to purchase and renovate the three-story building on Superior Avenue, and to fund the first year's operations. Residents moving into the Center will live in semi-private rooms, and have on-site access to social and employment services. In his press release, Mayor Jackson said that North Point "will help address the problems that lead to homelessness, like lack of job trainining. By taking steps like this, we will be able to help reduce homelessness and improve the quality of life for all Clevelanders."

A television news reporter interviews one the first residents to move into North Point on 17 January 2008.

Most men who will be the Center's first residents have experienced multiple episodes of homelessness, and nearly half have been homeless for more than a year. Half are working, but earn an average of only $7.88 per hour - an insufficient amount to allow them to achieve stable housing. Most (57%) of the new residents are between 31 and 50 years of age, and 26% are older than 50 years.

North Point is Cuyahoga County's largest and most ambitious transitional housing program, bringing to its clients the expertise and resources of an on-site team of premier social service providers. Services will address the individualized needs of participants, with the goal of helping them achieve competitive employment paying a living wage, and permanent housing within six months of program entry. Each participant will have a case manager, and the service team will help create the supportive environment participants need to achieve success.

Edward Gemerchek, MHS North Point Program Manager (left), and Eric Morse, MHS Director of Homeless Services.

Eric Morse, MHS Director of Homeless Services, and Stephen M. Friedman, Ph.D., MHS Executive Director, worked for many months with City and County officials to develop plans for the project. Mr. Morse said "It has been thrilling to be a part of this collaborative effort of City and County governments, and local nonprofit and federal service providers. This project embodies a shared vision of services for vulnerable men who have endured many challenges in their attempts to find employment, housing, and self-sufficiency."

In addition to the City and County officials mentioned earlier, Dennis Madden and Rick Warner of Cuyahoga County, and Ruth Gillett, Manager of the Cleveland and Cuyahoga County Office of Homeless Services, were instrumental in making North Point a reality.

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