10 - Community Mental Health

Abstract

This chapter focuses on community mental health and its evolution from tertiary prevention to the promotion of well-being. The confluence of two salient events in the early 1960s—efforts to deinstitutionalize the chronically mentally ill and legislation to create community mental health centers across the nation—launched the community mental health movement. With the aide of a prevention framework adapted from the field of public health, this movement has continued to evolve and grow. Initial emphases on tertiary prevention, often in the form of alternative community-based methods of treatment for the severely mentally ill, were followed by efforts aimed at early detection and intervention. In both tertiary and secondary forms of prevention, emotional and behavioral problems, or early antecedents thereof, continued to be identified at the level of the individual. Interventions were implemented within institutions in contrast to within communities. However, to reduce the incidence of disorder in the population, primary prevention programs aimed at communities, population groups, or settings were developed and implemented. These centers were mandated initially to offer inpatient care, outpatient care, emergency services, partial hospitalization, and consultation and education, and ultimately to include diagnostic services, rehabilitation services, precare and aftercare services, training, and research and evaluation. The aim was to integrate the patients into their local communities and smaller treatment settings in contrast to huge, anonymous state hospitals in remote physical locations. The use of phenothiazines made it more feasible to return patients to their communities as they were less likely to engage in the extremes of deviant behavior. At the same time, deinstitutionalization was seen as a dramatic cost-saving device by fiscally conservative legislators.