A little more than a decade ago, Marv Southard faced a crisis that shaped his approach to leading the largest public mental health treatment system in the country.

In 2003, budget projections left the Los Angeles County Department of Mental Health approximately $21 million in the red. Would the burden of those cutbacks fall on staff members who worked directly for the county or contracted community agencies that provided equally valuable services?

“In the past, there was always a fight about what was going to be cut,” said Southard, who led the department as director from 1998 to late 2015.

To avoid an ugly battle, he worked with consultant John Ott to gather agency leaders, staff members, and clients and their family members to hash out a deal. Nothing would move forward until a unanimous agreement had been reached.

“It was an excruciating process, but we succeeded in getting through it,” he said.

When the books eventually closed months later, it turned out the department didn’t have a deficit. But the approach established a structure for community planning that helped Southard tackle some of the largest mental health issues in the county, including embracing the integration of mental health and substance abuse treatment and enhancing mental health services for children.

As a new professor of practice at the USC School of Social Work, he hopes to continue that work.

“Working here at USC gives me an opportunity to feel like I can make a contribution to every piece of what I have been passionate about for my entire career,” he said. “It brings together so many different strands of my life experience.”

Born to serve

Southard traces his interest in helping others to the values instilled by his family, whose religious commitment had held his parents together despite the misgivings of their respective elders.

His mother met Southard’s father, an Army chemical engineer involved in the Manhattan Project to develop the nation’s first nuclear weapon, while working as a secretary for the military in Los Alamos, New Mexico. The two fell in love but neither family approved.

“My dad’s mother did not want her son marrying a Mexican and my grandfather did not want his daughter marrying an Anglo,” Southard said. “The unifying factor was that both families were very Catholic.”

His religious upbringing led Southard toward the Catholic priesthood, a path he first considered taking in seventh grade during the Cuban missile crisis, a particularly terrifying period given his proximity to a strategic military base.

“As I was focusing on what I was going to do with my life, I thought I may as well focus on doing as much good as I can because it’s not going to last long,” he said.

Southard completed 10 years of training, eventually relocating to California to attend St. John’s Seminary in Camarillo. But as he approached his ordination, he felt he wasn’t quite ready to become a priest.

A new path

Instead, he took a leave of absence to pursue his master of social work degree at UC Berkeley, where he studied community organizing and social planning. The university operated on a block placement system, so after a year of courses he began searching for a paid internship.

“My parents weren’t particularly pleased with the change in my career path,” he said. “I needed to support myself, so the placement that worked out best was with the Kern County mental health department’s drug abuse division.”

At the end of his placement, a colleague encouraged him to apply for a job in the area with Catholic Social Services, which was launching a mobile substance abuse treatment program to serve five towns in the San Joaquin Valley.

Southard figured the experience of interviewing for a position would be valuable and was surprised when he received the job. He had little knowledge of substance abuse treatment and had to learn from the staff members he supervised.

“It set up a really good template for my future management in terms of being someone who was willing to listen and build teamwork,” he said.

His focus on community organizing at UC Berkeley also paid off. The mobile program consisted of driving a large recreational vehicle outfitted with a counseling room to a park and waiting for clients.

“If that was all we would have done, the program would have shut down immediately, because who would have come to such a place?” Southard said.

Working with local church and city leaders, schools, and other community groups ended up generating the opposite problem: too many clients. The treatment team had to borrow space at schools and churches. In some communities, the program was essentially the only social service organization in operation.

Holistic treatment

Although the team focused on substance abuse and diversion work, people came with a wide variety of issues, including mental health and domestic violence problems. It proved instructive, Southard said, to realize that people did not come for help in discrete categories but rather as complex individuals.

 

“If you are going to really make a difference, you have to deal with everything a person is facing and not just the thing you happen to be funded to do,” he said.

After several years managing the mobile program, he decided to further his knowledge, this time earning a doctorate in social work at UCLA. While looking for a summer job, Southard reached out to a high school friend working for El Centro Human Services in East Los Angeles and landed a gig as a forensic specialist.

The assignment became permanent after Southard finished his degree, and he spent the better half of a decade at the organization as vice president of mental health programs and director of clinical services.

“It was one of the main formative experiences for me as an administrator,” he said.

In addition to tackling the emerging issue of HIV and AIDS and gaining knowledge of Latino specialty mental health, he began to recognize the importance of community support for people with mental illness, including assistance with employment to ensure individuals live rich lives rather than simply managing their symptoms.

A personal connection again drew Southard to a new position. He had reconnected with a colleague who worked on the mobile substance treatment team in Kern County, and when the two began dating, fell in love, and got married, he took a job as program chief in charge of county mental health programs.

Integrating care

After a year, the director of the department retired and Southard was promoted. He promptly set about attempting to integrate mental health and substance abuse treatment, particularly after one client came to him for help. The man lamented that he had sought mental health treatment but had been turned away because he needed to be clean and sober for 30 days. When he attempted to enter a substance abuse program, he was told he had to be stable on his mental health medication.

Believing the issue to be an easy fix, Southard had the substance abuse and mental health treatment divisions trade a few clinicians.

“The immune systems of both organizations rallied to expel the outsiders, in one case even to the point of slashed tires,” he said. “The transplant was rejected.”

Careful planning would be needed to integrate the two systems, he realized, a lesson he carried into his subsequent role as director of the Los Angeles County Department of Mental Health. He had initially planned to interview for the job only as a favor to his predecessor, who wanted a solid candidate pool, but reconsidered when offered the position.

“It was an opportunity to use my talents, but also to have a bigger policy impact from a place like Los Angeles than I could in Kern County,” Southard said.

In addition to tackling the issue of integrated care, he continued efforts to embrace the recovery model, which focuses on client preference and needs, and sought to expand children’s mental health services. Another major initiative involved working alongside Los Angeles police officers to provide mental health training and respond to crises involving individuals with mental health problems.

In his later years with the county, Southard began shaping the concept of health neighborhoods, a coalition of mental health, substance abuse, and primary care providers that would work with community stakeholders to address a particular social issue that affects health conditions in a certain area of Los Angeles, such as Watts or Boyle Heights.

Building a community

“That issue they work on presumably gets better and the very fact of working together creates the social capital that builds stronger connections and improves other health outcomes,” he said.

In addition to attracting interest from health care providers and other institutions such as UCLA and RAND Corporation, Southard said he hopes to build on USC’s community engagement efforts to advance the health neighborhood approach.

In the immediate future, he will be leading the creation of a clinic for military veterans at USC and preparing to launch a doctorate of social work program via the school’s virtual education platform later this year.

Southard’s longer-term plans also include potential research evaluations of health neighborhoods and Medicaid substance abuse benefits, which are being revamped in California. He is also interested in exploring the integration of faith and spirituality into mental health treatment, noting that Los Angeles was the first to develop clinical parameters for such work.

“I hope I can add value from some of the policy and practice experiences I’ve had to move some of these initiatives forward with students and the brain trust that is this school,” he said.