A commentary: ?Overview of the Community Mental Health Centers Program from an evaluation perspective?

Abstract

Ciarlo and Dowell indicate that " I t may not be too extreme to consider the shift in the primary locus of public mental health care to C M H C s as a 'revolutionary' change that has occurred in the last decade and a half." We agree that they have given us a thoughtful and systematic summary which should stimulate the mental health field toward further study of this "revolut ionary" e ighteen-year Federal experiment with community mental health. The authors use nine goals to organize information about community mental health centers (CMHCs) . The goals are reasonable and generally related to the comprehensiveness, availability , accessibility, efficiency and effectiveness of C M H C services. They are similar to the goals which have been articulated by Federal evaluators, such as Windle, Stockdill and Sharfstein, during the history of the Federal evaluation of the program. In relation to the success of the C M H C program as measured by achievement of the goals, the authors find that the program has been most successful in ~'increasing the range and quality of public mental health services" and has achieved significant success in "making services equally available and accessible to all." They find only partial success in "providing services in relation to existing community needs." The greatest weaknesses cited in the C M H C program relate to a failure in general to meet the needs of severely and chronically disabled clients and a failure of "most C M H C s to mount significant and credible prevention programs." The authors also point out the need in mental health for better needs assessment tools and for better measures of clinical outcomes. While we agree in general with the findings of the authors, we take issue with some findings and want to emphasize others with which we agree strongly. We do this to stimulate further study to encourage improvement in the future delivery of community mental health services.