Edward S. Knight, Ph.D., A National Consumer Leader, To Be Vice President at Managed Behavioral Healthcare Organization (MBHO)

Source: Mental Health Weekly, December 3, 2001


It is believed to be the first time a major MBHO has established such a high-level position occupied by a consumer.

What Ed Knight has demonstrated is that you can give people new medications and they will have fewer symptoms, but their lives won't change until you change the approach to treatment.�

Ed Knight is a consumer leader who considers capitated managed care the best vehicle for promoting recovery from serious mental illness. That's not the only aspect of Knight's life and work that some might find surprising.

After all, one of Knight's signature accomplishments in recent years involves spearheading a rural Colorado program in which seriously mentally ill patients who had spent years in restrictive day treatment and congregate living are now living independently, with many holding jobs.

As of Jan. 2, however, perhaps the most unexpected development will take place for Knight. Having worked in a consulting capacity for six years with Colorado Health Networks, the public-sector managed care partnership between managed behavioral health care organization (MBHO) ValueOptions and a group of community mental health centers, Knight will ascend to a full-time position at ValueOptions: vice president for recovery, rehabilitation and mutual support.

It is believed to be the first time a major MBHO has established such a high-level position occupied by a consumer and devoted to promoting a culture of recovery across the organization. For Knight personally, his hiring represents a major arrival point in an odyssey that began from a psychiatric hospital bed more than 20 years ago.

"My dream when I was in the hospital with mental illness was that someone would keep track records on how therapists did with their patients,"� Knight, 59, told Mental Health Weekly last week. "I wanted to help people lead meaningful lives."

He has often talked in the past about how many mental health professionals dismissed his ruminations at the time as "delusions of grandeur."� But Knight remained motivated by the words of one provider who told him, "Don't ever give up those delusions of grandeur. They're your goals."

Under the new title that he will assume next month, Knight will be in a position to duplicate the success of empowerment-focused mutual-support programs for Medicaid recipients with serious mental illness that he has coordinated in Colorado, Arizona and New Mexico. His efforts will reflect a desire among ValueOptions executives to move more forcefully toward a system that creates more possibilities and expectations for the seriously ill client.

"The company over the last several years has recognized that it is good for consumers and for the business to work more aggressively to transform the delivery system," Steve Holsenbeck, M.D., executive director and medical director at Colorado Health Networks and vice president of ValueOptions' Colorado service center in Colorado Springs, told Mental Health Weekly.

"Even the new antipsychotics haven't fully produced the hoped-for results for people living in the community," Holsenbeck said. "What Ed has demonstrated in Colorado is that you can give people new medications and they will have fewer symptoms, but their lives won't change until you change the approach to treatment."

Knight's initial efforts in Colorado in the mid-1990s launched mutual-support groups known as Double Trouble in Recovery, a national 12-step approach for people with co-occurring mental illness and substance abuse disorders. As Knight began to work more closely with consumers in the service system, he began to hear more often that program staff members' attitudes toward their clients constituted one of the biggest impediments to recovery.

The emphasis of his work thus began to shift toward the training of community-support program staff in principles fashioned after the psychiatric rehabilitation model of Boston University's Center for Psychiatric Rehabilitation (see Mental Health Weeky, Sept. 4, 2000). At the same time, Knight had begun to get involved in innovative projects in ValueOptions contract regions in New Mexico and Arizona, including a grant-funded project in Maricopa County, Ariz., that resulted in the formation of several businesses offering work opportunities for Medicaid clients with serious mental illness.

Regarding his early years working with ValueOptions, Knight credits people such as former ValueOptions executive Sandra Forquer, Ph.D. (now a vice president at Comprehensive NeuroScience Inc.) with encouraging him to translate his longtime goals into meaningful action.

"Her mantra was that the best utilization management strategy was mutual support and self-help,"� Knight said of Forquer.

But Knight stresses that he and the people he's worked with have always based their efforts in this area on data, not not mere anecdotal observation. He customarily cites half a dozen studies that document self-help strategies' value in reducing relapse to illness and hospitalization, and thus their ability to reduce system costs in the long run.

National impact
It's possible that Knight would have been content to continue initiating consumer-empowering programs at a state or regional level for some time. But work that he became involved with in rural southeastern Colorado would end up vaulting him to a position of national prominence at the country's second largest MBHO.

A group of about 120 public-sector clients with serious mental illness had been receiving five-day-a-week day treatment services at Southeastern Mental Health Services in La Junta, the only community provider agency in the remote region. As Holsenbeck describes it, Knight was discouraged about what he initially saw in the client population, which was living in congregate housing and having to visit the mental health center every weekday just to receive needed medication.

"It was a very disempowered group of folks,"� Holsenbeck said. "At first Ed said, `This is hopeless.'" But Knight and others gradually worked to create an approach built on the factors that motivate all people: the desire to live independently, to learn a skill, to help others and be helped in a supportive environment. The effort has not been easy, but today most of the region's Medicaid clients live in individual residential units; some have home health aides to help ease the transition.

In addition, 38 percent of the Medicaid clients with serious and persistent mental illness in the Southeastern Mental Health Services region are either working, volunteering or in school, Knight said.

Also, a former group home in the area has been converted into a crisis hostel where clients can walk in at any time of the day or night to chat with someone, or maybe to stay a few days.

Not only did these services improve patient satisfaction and outcomes considerably, they proved more cost-effective than the old way of doing things had been, Knight said. That potent combination of doing the right thing and saving money was not lost on ValueOptions' corporate executives.

When Elliot F. Gerson, president of ValueOptions parent company FHC Health Systems, and Don Fowls, M.D., chief medical officer at FHC, visited La Junta, they were "blown away" by what had been accomplished there, in Holsenbecks' words.

Now they will ask Knight to spearhead the introduction of such principles in other states where ValueOptions has contracts. "No one can speak as authentically as Ed can about what's possible," Holsenbeck said.

More goals
Knight hasn't stopped setting goals. One area that he would like to explore involves whether the kinds of recovery principles that have worked in the public sector could be applied to commercial managed care.

Admittedly, a recovery philosophy may be more difficult to define and track on the private-sector side because it is harder to identify a critical mass of people with serious mental illness. But Knight and others at ValueOptions believe that if a way to do it could be found, they would be in the best position to implement it.

"In the for-profit world, when you realize that something will work, you can implement it effectively and quickly,"� Holsenbeck said.

Knight is a believer, saying that ValueOptions has separated itself from its competitors by looking at recovery and mutual support as a
companywide policy. "It's the only [managed care] company I'd work for,"� he said.