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“This kid doesn’t need meds, he just needs to smarten up.”

Joe spoke the above words in Duncan’s outpatient office about 12 years ago, as they discussed one of the wayward teenagers from the Residential Program at which Joe worked as a therapist.


At the time, it was a good illustration of each of their very different starting points: Duncan, a psychiatrist trying to get a child’s explosive temper under control with medication; Joe, an informal behaviorist, who distrusted medication and wouldn’t take Tylenol for his own fever.


The two had only recently met and their differences, at least on a superficial level, were striking. Duncan was a fourth-generation Harvard grad, third-generation psychiatrist, and a conventional-looking, conventional-sounding, pragmatic “man of science”. Joe, on the other hand, earned his degree in street-smarts growing up as an adoptee into a Sicilian family living on the wrong side of the tracks. He was idealistic and artistic, drawn to Eastern philosophy and dubious of Western Medicine.

It’s fair to say that – despite liking and respecting each other – Joe and Duncan entered their professional relationship with some mutual suspicion. Joe’s experience with psychiatrists in the past had not inspired a whole lot of faith in the field. To Duncan, Joe’s seeming fixation on a system he created – entitled (misspelled?) “Wholeistic Education” – left Duncan scratching his head and slightly concerned.

Nevertheless, the two found out they had much in common. In addition to a shared love of guitars and sports, the two both had clinical experience dealing with a wide spectrum of mental and behavioral problems. Duncan had worked for years in a variety of clinical settings, including inpatient units, outpatient clinics, and group homes. Joe for his part had worked for years in a supervisory position at Nashua Children’s Home, a local residential program for the most troubled kids with some of the most traumatic pasts imaginable.


Most importantly, Duncan and Joe shared a passion for what they did, a frustration with traditional “treatment as usual,” and the conviction that they could do better.


So, ignoring the warnings of others about the risks of opening their own mental health business, they quit their jobs and created Direction Behavioral Health Associates. Direction would offer the area’s only Intensive Outpatient Program (IOP) for adolescents struggling with mental health issues. Later, they added a Partial Hospitalization Program (PHP) to offer a slightly higher level of care as well.


And boy it was (and continues to be) an adventure for them. Despite their excellent clinical chops, neither had experience running a business. They soon found themselves consulting accountants, lawyers, IT specialists, and building contractors. Joe found himself leaning on Duncan’s inspiration and ultimate vision for the program. Duncan found himself leaning on Joe’s ability to negotiate the relationships with all the professionals involved. Over time, they realized their differences were largely superficial, and grew to trust each other. Joe became a believer in the use of medication in certain instances for clients, and Duncan found himself increasingly impressed by Joe’s strange treatment model.


The success rate for start-up businesses is low.  We are sure it is lower for non-business people trying to build a sustainable model in the mental health industry. Nevertheless, Direction has appeared to beat the odds, and is still going strong 12 years later.

 
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