A below average grade in organic chemistry prompted Dr. Susan Mandel to rethink her original plan to become a physician. Instead, she decided to pursue a Ph.D. in psychology, inspired by a psychologist who ultimately led her to the field that would remain her passion for more than 40 years.

"Little did I know, in those days, it was much harder to enter the Ph.D. program than to enter medical school," she recalls. The native-born New Yorker (and still a die-hard Giants fan), had interned across a span of mental health services: county hospitals, the Veterans Administration, and university counseling before finally finding her niche with her first job. After receiving her degree from the University of Cincinnati in 1967, she began work in an acute psychiatric unit in Alameda County Hospital in Northern California. "I realized how unprepared I was. Yet, contrary to the current practices at the time, the challenge of understanding who the patients were, how they got there, and helping them move forward became my first love and remains so today."

As a staff psychologist she took great energy and enthusiasm to her new role. After a series of promotions and increasing responsibilities, she was ultimately promoted to Chief of Inpatient Services for Alameda County Hospital in Northern California. She made many patient-centered system changes: taking nurses out of uniforms and away from nurses' stations, engaging staff in patient/group participation, and developing their skills and talents in serving patients. Her success led to her appointment as Director of Mental Health for Alameda County. This was "a gutsy move for the Board to choose the first woman and the first non-psychiatrist as Director."

Her five-year tenure in that position enabled her to institute many pace-setting changes. Realizing the demographics of a large and growing Asian-Pacific Islander population, "We were the first to reach out to, and work with, multi-ethnic communities. This encompassed work with the first, second, and third generations of families, in a cross-generational approach." She also focused on services for children and families, professional training, and the inclusion of clergy and law enforcement within the circle of mental health services. These, and other practices, planted the seeds of her vision, which would inform the rest of her career and carry forward to her next job in Southern California at Pacific Clinics.

With the advent of Proposition 13, and the subsequent cut in mental health budgets, a chance reading of a letter of recruitment for an Executive Director position at Pasadena Child Guidance captured her attention. After sharing her vision with its Board of Directors, Dr. Mandel was hired in 1980, moving her from an agency with an annual budget of $22 million and 700 employees to the Clinic's $800,000 budget with 30 employees and volunteers. "But," as she explains, "that was exactly the reason for accepting the position-- the opportunity to expand into needed areas of service that no one else was addressing."

Supported whole-heartedly by the Board, Dr. Mandel demonstrated the need for and secured funding for family and geriatric services, culturally sensitive ethnic services, and pursued a focus on client strengths-based services. Her vision expanded the capacity of Pasadena Child Guidance so that, in 1987, its name was changed to Pacific Clinics to better reflect the breadth and depth of its programs and support services for children, adolescents, adults, older adults and families.

During her 27 years as Pacific Clinics President and CEO, Dr. Mandel has developed the organization to its current status with a $97 million annual budget and a staff of 1,200 professionals at more than 77 locations in five Southern California counties. Pacific Clinics has also become nationally renowned for its demonstrated leadership in several areas that include ethnic, language, and cultural competencies and involving, educating and giving voice to consumers in shaping agency practice and policy. Other hallmarks of the agency's effectiveness are demonstrated in the training of professionals in best practices; educating families and communities on behavioral health and anti-stigma issues, and the development of culturally specific services for Latino and Armenian communities.

Dr. Mandel's concern for broader community behavioral health issues led her to organize both the California and Los Angeles Mental Health Contractors Association to represent the non-profit organizations in shaping policy. This also led to her role as the founding President of the Association of Community Mental Health Agencies (ACHSA) in 1983 and her involvement as a member of its Board of Directors until 1999. She also served as Chair of the California Mental Health Planning Council and currently leads its Human Resources Committee. A member and former chair of the Board of the Human Services Unemployment Trust (HSUT), a pooled unemployment insurance trust created by and for non-profits organizations, Dr. Mandel now serves on its Trust Advisory Council.

"In a world where workforce recruitment and retention is a burning issue for behavioral health services, I'd have to include the length of service of Pacific Clinics staff as a source of pride in our accomplishments," adds Dr. Mandel. "Many have been with us for more than 20 years, progressing to positions of greater challenges and responsibilities as Pacific Clinics grew. Many are previous consumers who, with training, transitioned to part and full-time employees, bringing a deeper understanding to our client interactions and serving as a tribute to Pacific Clinics' practice of helping people express their own hidden talents."

Yet, Dr. Mandel is deeply concerned with the aging out of executives in the field. "In California particularly, recruiting and retaining quality people continues to be an ongoing challenge." However, she feels that highly attractive opportunities exist here for those joining community-based agencies. "When I was in private practice briefly, I felt the terrible responsibility for, and limited impact on, just a few individuals. Community agencies present a wide-open gateway to set up a program that touches and changes hundreds, if not thousands, of lives." She advises with a laugh, "Become trained in a special skill, and then write your own ticket, just please hurry up and get in here!"

Reflecting on her management style, Dr. Mandel says, "My talent is in spotting talented people who take risks to get things done. I provide the environment to let them shine, and then stand back. They make me look good." She emphasizes, "The hallmark of effective leaders is having a clear vision of what is to be done and how to get there. But, they must keep in mind that after hiring the best people it is more than imperative to listen to their ideas. There is more than one way to accomplish the vision."

In looking forward, Dr. Mandel notes that during the span of her career, "In general, behavioral health services have become much more sensitive to clients' rights and the curbing of unfounded and uneducated charges against the mentally ill. Medications have improved, with fewer side effects. Yet, stigma is still strong and professionals still live in a schizophrenic world of reconciling 'medical necessity' documentation requirements versus the best practices of encouraging consumer self-understandings and progress towards achieving goals." In an ideal world, Dr. Mandel envisions a place where everyone has access to services, there is a great capacity for earlier intervention, and the public becomes better educated as to mental illness and its stigma.

An avid golfer, cook, and mystery novel fan, Dr. Mandel's greatest source of personal satisfaction is to see people thrive and to see young people, be they consumers, professionals, or staff, assume the reigns of responsibility with clarity of vision and purpose in order to influence lives in positive ways -- as her own career so ably demonstrates.