PROFESSIONAL COMMUNITIES AND THE EVALUATION OF DEMONSTRATION PROJECTS IN COMMUNITY MENTAL HEALTH.

Abstract

IT iS still undoubtedly true, as Kotinsky and Witmer had occasion to remark in 1955,1 that the field of community mental health lacks a high degree of and organization. A notable lack of clarity and often sharply conflicting views exist about such fundamental matters as the meaning of mental illness; the appropriate conditions for practicing different methods of treatment and care of patients; and, not least of all, what the community itself can offer and how it can be used successfully in programs directed toward these ends. It may be naive to expect a unified viewpoint at this time when the field is being pushed forward with an intense sense of urgency that involves reshaping many traditional ideas about preventing and caring for emotional disorders. Nevertheless, the clear guidelines that are essential if we are to sort out and pick our way through the heterogeneous perspectives that exist on these and similar matters have hardly even begun to emerge. While it is neither a particularly fresh nor enlightening notion, it seems nonetheless true that this lack of coherence is the result of difficulties experienced in mounting and implementing a vigorous research program. Although the problems requiring solution in the community mental health field place the burden of research on projects, efforts to evaluate the accomplishments of these are, as MacMahon, Pugh, and Hutchison have recently pointed out, conspicuous by their absence.2 A demonstration project, defined in ideal terms by Elizabeth Herzog, is one which . . tests out a hunch or conviction based on experience or practice and systematically builds up evidence designed to show whether the hunch or conviction stands up to the test. The demonstration project combines the world of research and the world of practice.3 The question we ask, as the basis for this paper, is why the diverse hunches and convictions that have been and are currently being carried into practice in the field of community mental health, whether bearing the arbitrary label of demonstra-