Strategic Thinking Where It Matters Most: Designing Behavioral Health Systems That Actually Hold

A Harvard Business Review article on demonstrating strategic thinking skills made me think about how my agency’s role, while state grant funded and imbedded in the county system, is working to support local agencies to provide better, more timely, services. 

In local government, strategic thinking is often framed through plans, priorities, and performance metrics. In behavioral health, it shows up in something far more concrete: whether an uninsured family finds help in a crisis, whether a nonprofit agency survives another budget cycle, and whether county systems bend under pressure, or break.

Across the country, crisis response and community mental health services have become the default safety net for problems far beyond their original design. Housing instability, untreated trauma, substance use, and family stress now flow directly into behavioral health systems. Counties didn’t choose this role. History assigned it. Strategic leadership begins when leaders stop treating this reality as temporary and start building for it as permanent infrastructure.

The challenge isn’t commitment. It’s the collision between rising demand and finite resources. Leaders are expected to expand access while holding budgets steady. Agencies are asked to innovate while surviving on unstable funding. These tensions don’t resolve through goodwill. They require strategic design.

That’s where strategic thinking becomes real. In behavioral health, it isn’t proven by vision statements or task forces. It’s demonstrated by the systems leaders build to sustain care when conditions are hardest.

Strategic counties shift from program-first to people-first thinking. Instead of asking which agencies to fund, they ask which populations are falling through the cracks such as uninsured families, rural residents, justice-involved individuals, or children navigating schools without mental health support. This reframing changes everything. Funding decisions focus on impact across the care continuum, not the survival of isolated programs.

They also move from measuring capacity to managing flow. Success isn’t just how many services are delivered, but where people end up. A mobile crisis team that diverts ER visits. A school-based counselor who prevents a court referral. A coordinated intake system that shortens waitlists. Strategy here isn’t about doing more with less. It’s about designing systems that reduce friction before human suffering compounds.

Just as important, strategic counties redefine their relationship with providers. Underfunded nonprofits now carry a major share of public responsibility. Treating them as interchangeable vendors is no longer realistic or strategic. Forward-looking leaders stabilize their networks through multi-year funding, shared infrastructure, and data support. This isn’t generosity. It’s risk management. When an agency collapses, the cost doesn’t disappear. It shifts to emergency rooms, law enforcement, child welfare, and courts. Counties that avoid strategic investment still pay just in quieter, more chaotic, and far more costly ways.

This work also takes political courage. Supporting services for uninsured and underinsured families rarely delivers visible wins. Success often looks like a crisis that never happened, a hospitalization that never occurred, a family that never entered the system. These are quiet victories. They don’t make headlines but they define the health of a community.

For municipal leaders, the question is not whether they value compassion. Most do. The real question is whether they are willing to design systems that make compassion sustainable. That means aligning budgets with long-term outcomes, not just annual cycles. It means rewarding collaboration instead of competition among providers. It means using data not as a compliance exercise, but as a guide for where limited dollars have the greatest stabilizing effect.

Making this system work isn’t easy but it’s no longer optional. The needs are here, and they aren’t waiting for perfect conditions. Real progress doesn’t require a five-year plan. It requires leverage.

There are a few focused changes that can move the needle more efficiently.

First, stabilize the provider network before it collapses.
If agencies are bleeding staff and cash, nothing else matters. Shifting from fragile, one-year contracts to bridge funding and multi-year agreements for core crisis and safety-net providers creates immediate impact. Even modest predictability lowers turnover, preserves institutional knowledge, and keeps access points open. Stability isn’t boring bureaucracy—it’s emergency infrastructure.

Second, fix access, not just availability.
Counties often fund services that people still can’t reach. Centralized intake and real-time visibility into beds and appointments change that fast. One door, not ten. One phone number, not a scavenger hunt. This alone reduces drop-off, no-shows, and inappropriate ER use within months.

Third, put crisis response where the crisis actually happens.
If police and emergency rooms remain the default response to behavioral health emergencies, systems overspend and under-serve. Mobile crisis and co-response models divert people before situations escalate, producing results quickly by interrupting the costliest pathways.

Fourth, stop funding outputs and start funding outcomes.
You don’t need a full performance overhaul to change incentives. Pick three outcomes that matter this year, such as, reduced ER stays, faster crisis response times, and fewer repeat involuntary holds, then tie a portion of funding to progress. Behavior follows money faster than mission statements.

Fifth, remove administrative friction for frontline care.
Counties can create instant capacity by cutting paperwork. Simplify authorization. Align documentation across funders. Reduce redundant reporting. Every hour a clinician spends clicking boxes is an hour a family doesn’t get care. Few reforms improve morale and access at the same time, this one does.

Immediate change in behavioral health doesn’t come from new programs. It comes from stabilizing what already exists, clearing the path to it, and aligning incentives so the system stops working against itself.

In the end, counties demonstrate strategic leadership in behavioral health not by how elegantly they describe their goals, but by what happens when a family in crisis meets the system. If care is accessible, coordinated, and humane even when budgets are strained, strategy stops being theoretical. It becomes operational, doing exactly what local government exists to do: turning collective responsibility into collective resilience.

Reference
Harvard Business Review. (2019, September 5). How to demonstrate your strategic-thinking skills. Harvard Business Review. https://hbr.org/2019/09/how-to-demonstrate-your-strategic-thinking-skills