Analysis of Agency Policy Contexts

Analysis of Agency Policy Contexts

The Case of Dr. Breeze and the San Marcos Community Mental Health Center.

By Samuel H. Taylor, D.S.W.

Exactly one year ago, Dr. Breeze came to San Marcos, a metropolitan suburb of Los Angeles with a population of 60,000 people, to direct the recently established Sam Marcos Community Mental Health Center. Dr. Breeze had previously worked in Philadelphia, where he had acquired a reputation as the innovative, inspiring, and flexible director of Manford University’s Outreach Mental health services Department.

When Dr. Breeze initially interviewed for his position, several board members expressed some reservations about how he would fit in, since he did not wear a tie and seemed almost overconfident. Dr. Sedgwick, the retiring director, calmed the board by saying that, as a young psychoanalyst, he too had been fairly unconventional. The board had to keep in mind that this was no longer the San Marcos Clinic, it was a new mental health center, and it needed new ideas and the dedication of youth. “He will work out,” Dr. Sedgwick reassured them.

Shortly after George Breeze arrived at the San Marcos Community Mental Health Center, he made it clear to the staff that waiting lists, long-term therapy, and supervision were outdated. In the following months, he:
1. urged short-term, crisis-oriented management of cases
2. requested and received permission to establish an advisory board of citizens from the catchment area and another board composed of consumers
3. abolished the supervision system and established a flexible peer-consultation system
4. asked staff members to work evening in order to see families
5. got into an argument with the Chief of Police about how officers were handling youngsters and emotionally ill persons
6. hired paraprofessionals from a human services program of a community college to serve as community aides
7. told the staff that he wanted to know personally about the service and disposition of each case that involved a racial or ethnic minority client because he suspected that staff members were allowing biases to influence case management.

Within six months, the staff in the agency had become deeply divided. Three major groups
had formed and developed leadership. First, some of the original clinic staff members (who had helped Dr. Sedgwick prepare the mental health center application) resented Dr. Breeze’s nontraditional was and felt that they had had no chance to introduce their ideas. They rallied behind Dr. Jones, met privately, and decided they must take their case to other agencies in San Marcos and to local civic leaders and then must present their complaints to the agency board with the support of these other groups and leaders.

The staff hired by Dr. Breeze (young activist professionals and community aides) learned of the strategy and immediately alerted Asian, black, and Chicano groups in San Marcos and rallied behind Dr. Smith, who contacted both the NIMH (the prime federal funder for the center) and the Citizen and Consumer Advisory Boards. They were ready to ask for termination of federal and state funds if Dr. Breeze were fired.

Finally, a number of agency supervisors formed a group behind Dr. Virtue that advocated “responsible.” They were not opposed to all the changes instituted by Dr. Breeze but particularly opposed to those that deprived “professionals” of their rightful positions of authority and prestige within the agency. They wanted restoration of the supervisory system and curtailment of hiring of new careerists.

The issue reached crisis proportions when a patient being cared for by a community aide committed suicide in a most sensational manner. A reporter from the newspaper interviewed a member of the original staff and was told that “this would never have happened if Dr. Sedgwick had been there. Dr. Breeze’s ideas just don’t work.

The board decided to hold a meeting to settle the issue, and they agreed to allow representatives to all sides to present their evidence. They felt that Dr. Breeze had introduced some good programs but also felt that he was unconventional. At this meeting, they hoped to reach a final decision as to whether Dr. Breeze should be fired, retained (but only after placing limits on the reforms he had issued), or given a vote of complete confidence.

“Traditionalists,” then, rallied behind Dr. Jones and wanted to restore the traditional mission of the agency-long-term therapy with white and middle-class clients. ‘Insurgents” supported Dr. Breeze and his various reforms with no qualifications. “Advocates of responsible change” wanted some innovations, but not at the expense of the traditional prerogatives of professionals. The board wished to bring unity to the agency as soon as possible to avoid further adverse publicity as well as possible loss of funds.


Length: At least 4 pages, double spaced, not including the Cover Page or the Reference Page. Please number your pages. Provide a minimum of three (3) scholarly references using APA format.
References must be provided in a separate page. Lack of references will result in lost points.


After reading the Dr. Breeze case:
1. Identify the five stakeholder groups and their positions in regard to the change that Dr. Breeze is initiating in San Marcos Community Mental Health Center*
2. Using a policy lens, provide the historical and policy rationale as to why Dr. Breeze was hired.
3. In your view, which group or groups want Dr. Breeze to be fired, retained, or voted with complete confidence? What is their rationale?
4. What kind of changes did he initiate?
5. What are the reactions of each stakeholder group? Do you think they acted appropriately and why?
6. What side do you take with these groups and why you are taking that position?
7. Identify the main responsibility of each stakeholder group.
8. What do you like about Dr. Breeze and what don’t you like about him? Explain your reasons.
9. Given the changes Dr. Breeze initiated at San Marcos Community Mental Health Center, what would you do if you were Dr. Breeze? Assume that you are strongly taking a position siding with one of these stakeholder groups. Describe your actions.
*In the event you have identified stakeholder group/s that are different from what was decided in class, you will need to provide a rationale for doing so.