Community Mental Health Movement Research Articles

Deinstitutionalization—The Sacramento story

Sacramento County's approach to deinstitutionalization was to devise a system of care for those persons in need of ongoing support so as to enable them to develop their own resources and achieve their potential. Community based treatment programs enhance the person's independence because they permit the development of supportive relationships with family and friends. Provision of a continuum of services and a variety of residential options creates a maximum flexibility toward meeting the needs a person may have at any given time. The success of our programs has been directly related to our ability to apply the principles of good community mental health planning. It is important, however, to remember that changes in human services are not accomplished simply by scientific fact. They also depend upon the economy and the political scene. New and innovative human service programs are easier to adopt in times of inflation and easy money when liberal politics hold sway. They suffer during periods of economic depression and conservative politics. An example of this is the early 20th century health center movement. It grew out of the effort of those who operated settlement houses and was based on the principles of: (1) district location or accessibility, (2) preventive goals rather than direct care, (3) community participation, and (4) bureaucratic organization rather than solo practice. It was surprisingly similar to the Community Mental Health movement. It held promise and was achieving support, but came to an early demise with the shift to conservative politics and economic depression that followed World War I. Those of us committed to community-based treatment of the mentally ill need to be able to demonstrate that we have more than optimism and hope to offer and that deinstitutionalization of the chronically mentally ill can be accomplished.

Culture Conflict in a Community Mental Health Center

The ordinary ambiguity of clients' membership in service organizations is heightened when lay members of an organization's service community or catchment area are made members of its service staff. It is further heightened when the methods of training, supervising, and governing staff resemble the methods of serving or treating clients. The ethos or culture of the early community mental health movement promoted an extreme form of this ambiguity: an expressive openness between and equality of clients and staff, and a structural openness which allowed easy movement from the client role to the staff role and vice versa. A service organization of this kind would conflict with a more traditionally bureaucratic and professional organization, but an organization containing both community and traditional mental health ideologies contains a destructive form of culture conflict within itself. In such a self‐contradictory organization the structural ambiguity of the client role cannot be adequately understood without first examining the nature of this culture conflict; this is the purpose of our ethnographic analysis of a community mental health center.

The psychologist in the community mental health center: an analysis of activities and training needs.

Professional activities and expressed needs for additional training were examined in the case of 211 psychologists employed in 51 community mental health centers in western United States. Two-thirds of the work week is taken up directly or indirectly with traditional clinical services, 19% with community mental health activities; and the balance in program development, administration, research, and program evaluation. In contrast to the common assertion linking psychologists and research activity, the current results indicate that psychologists in community mental health centers devote very little time to research or program evaluation. Expressed training needs parallel reported activity patterns - highest for clinical functions and moderately high for community mental health functions. The significant impact of the community mental health movement is seen in both the distribution of professional activities and in expressed needs for additional competence.

The role of a regional treatment center in a model mental health delivery system.

The author discusses the changes that have occurred at the Mendota Mental Health Institute in Madison, Wisconsin, in response to the growth of the community movement. He traces Mendota's evolution from a traditional state hospital to a regional center that offers specialized treatment services for those who cannot be cared for in community programs, and that places strong emphasis on education and consultation services and on research into treatment methods. He believes a major problem with the community mental health movement has been the expectation that community services should be able to meet all the needs of the people in their areas, an expectation that he considers impossible to fulfill. He proposes a mental health delivery system with primary, secondary, and tertiary levels of care (at the third level would be regional centers similar to Mendota), and a fourth level that would provide protective care.

Organization development: A new modality for community mental health

Organization development (OD) is discussed as being a valid tool for advancing mental health and for promoting the present goals of community mental health centers, as well as for accomplishing organization development's traditional objectives of increasing organizational effectiveness in business, industry, and government agencies. A comparison is made between the main objectives of the community mental health movement in the United States and the major thrusts of current OD practice, showing how the foci of the two fields are essentially similar. The psychological aspects of OD are presented in their relation to mental health. Organization development is demonstrated to be both a legitimate and an effective modality for the community mental health practitioner to use in reaching large numbers of people in promoting positive mental health, primary prevention, improved interpersonal relations, and personal growth activities in the community.

AN ASSESSMENT OF THE COMMUNITY MENTAL HEALTH MOVEMENT—edited by Walter E. Barton, M.D., and Charlotte J. Sanborn, B.A., A.R.T.; Heath, Lexington, Massachusetts, 1977, 191 pages, $18.50

Back to table of contents Previous article Next article ArticleNo AccessAN ASSESSMENT OF THE COMMUNITY MENTAL HEALTH MOVEMENT—edited by Walter E. Barton, M.D., and Charlotte J. Sanborn, B.A., A.R.T.; Heath, Lexington, Massachusetts, 1977, 191 pages, $18.50Israel ZwerlingIsrael ZwerlingSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.29.3.198AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "AN ASSESSMENT OF THE COMMUNITY MENTAL HEALTH MOVEMENT—edited by Walter E. Barton, M.D., and Charlotte J. Sanborn, B.A., A.R.T.; Heath, Lexington, Massachusetts, 1977, 191 pages, $18.50." Psychiatric Services, 29(3), pp. 198–199 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 29Issue 3 March 1978Pages 198-199 Metrics PDF download History Published online 1 April 2006 Published in print 1 March 1978

Crisis intervention and the prevention of institutionalization: An interrupted time series analysis

In the context of the community mental health movement in Illinois, the evolution and development of a crisis intervention program aimed at avoiding state hospitalization and bringing more appropriate and efficacious resources to bear on the difficulties of the individual and/or family is described. This intervention program is characterized by a more active-seeking style of delivering mental health services. With the novel application of interrupted time series analysis to both the targeted and matched nonequivalent control communities the efficacy of this more active intervention in reducing the number of state hospital administrations diagnosed as "mentally ill" is highlighted. The cost/benefit to the taxpayer is also discussed.

Problem kids and preventive medicine: the making of an odd couple.

This paper maintains that the preventive medical model is inappropriate for dealing with childhood developmental disorders. The history of preventive medicine is traced briefly, and its adoption by the mental hygiene, child guidance, and community mental health movements is discussed. It is concluded that a program of screening, diagnosis, and treatment for poor children will have negative consequences for those it is meant to serve.

An Assessment of the Community Mental Health Movement

Back to table of contents Previous article Next article ArticleNo AccessAn Assessment of the Community Mental Health MovementALLAN BEIGELALLAN BEIGELSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.134.12.1455AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "An Assessment of the Community Mental Health Movement." American Journal of Psychiatry, 134(12), p. 1455 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited ByNone Volume 134Issue 12 December 1977Pages 1455-1455 Metrics PDF download History Published online 1 April 2006 Published in print 1 December 1977

Overcoming the Mistakes of the Past

#{149}If politics is a game, then we in the community mentat health field have played very poorly. The score is now against us, and I fear the game will soon be over. Our game plan has been defensive in nature with constant bickering among our own players. The result has been loss of funding for training, for research, and for clinical services, a decline in consumer support, and a gradual return to a system of diminished services. A decade ago we were buoyed by a great surge of enthusiasm for the community mental health movement. We spoke in glowing terms of treating clients in the community, care for those not treated previously, primary prevention, consumer involvement, continuity of care, comprehensiveness of services, use of shortterm intensive care, and the use of new professionals on the therapeutic team. We talked of forging a grand coalition of consumers as a political force in the service of mental health. We spoke of cooperative efforts between private and public psychiatric institutions and the new community agencies in the areas of training, research, and clinical services. There was the vision of cooperation between all the professionals and the new professionals. There was the anticipation that federal support would continue indefinitely for training and operations. We thought that such a worthwhile movement would continue to receive escalated support from state and local sources. It was anticipated that private foundations would open their coffers for training, research, and clinical innovation. General revenue and special revenue sources were to be a financial bonanza. What went wrong, and why, and what are the keys to survival? The first great political failure was the inability to mobilize the consumers and potential consumers of service and the large mass of concerned citizens into a major political force. Possibly the reason for the failure was that we were novices at political persuasion. The psychiatrist, the psychologist, the psychiatric nurse, and the social worker were in an unknown wilderness, the normal habitat of the professional politician, the lawyer, the urban and the social planner. In addition, those in the mental health movement were too involved in other areas of program planning for this new adventure in mental health services. In the early years there was constant bickering between the providers and consumers of services over such issues as the role of community boards, staffing

Being Black Is Detrimental to One's Mental Health: Myth or Reality?

Introduction The community mental health movement of the past few decades came about largely as a result of the realization that enormous disparities existed between psychiatric treatment provided to white Americans and that provided to the poor, the deprived, and the black. The charge of this paper is to look at the mental health of black Americans. Through an analysis of available data we shall try to determine if there has been a closing of the gaps in mental health status between blacks and whites, as we attempt to answer the question Is being black detrimental to one's mental health? Unfortunately, we encounter many difficulties in our :attempts to address this issue. Mental health data have not been routinely collected in a systematic way by race. Additionally, data which are available by race prior to quite recently are dichotomized by white-nonwhite. Even though we recognize that the various groups which comprise the nonwhite population are quite divergent, we have found it necessary to use these categories through much of this paper. There are problems in defining mental health. We shall be looking at differential patterns in the utilization of various types of mental health facilities by whites and blacks, along with results from community surveys measuring psychological problems, and patterns of physician utilization for emotional disorders all which could be construed more as measures of mental illness rather than of mental health.

General Systems Theory and Community Mental Health: A View from the Boiler Room

The complex of concepts that are now widely known and accepted as part of general systems theory (GST) were first presented by Von Bertalanffy (1940). In the 36 years since his article appeared, GST has become an important approach to an enormous number of different problems and a subject of abstract endeavor in and of itself, as the lead article in this issue of the International Journal of Mental Health (Pp. 5-31) most aptly demonstrates. The purposes of my contribution are to review the basic concepts of GST, to provide an overview of some of its applications, as described in the literature, to discuss briefly the major structural elements and possible levels of analysis in the community mental health movement, and, finally, to analyze the current application of the principles of GST by the management and staff of an average community mental health center. GST: A Review of the Concepts

Behavior therapy techniques as a fulfillment of community mental health ideology.

Due to value orientations, lack of knowledge, or exposure, the behavioral approach has been avoided by many professionals in the community mental health field. This is unfortunate, because many concepts of behavior analysis are identical to some of the guiding principles of the community mental health movement. Furthermore, the methods derived from a behavioral framework can help implement the community mental health idiology. This paper identifies possible linkages in the areas of treatment, client population, and evaluation.

The emerging role of sociological consultation in the field of community mental health

One of the most innovative features of the community mental health movement is its expansion to include other than the traditional mental health personnel. It seems most appropriate now that the sociologist be among the new manpower resources put to use by the various agencies concerned with the community mental health movement. In this regard, it is necessary that both professionals and lay people working in mental health be made aware of what the sociologist can contribute to the mental health movement. Sociological services relative to the comprehensive community mental health centers, to other mental health agencies, and to lay and professional persons concerned with mental health are described. The emergence of this role will not be without problems, several of which are described here.

Ethnicity and Mental Health: An Empirical Obstacle Course

Ethnicity and mental - certainly a scholarly sounding and somewhat weighty subject. Yet when reduced to its basics, the topic is people; and the goal is an exchange of information that may help mental health professionals appreciate the psychological implications of the divergent backgrounds and life-styles of people in order to respond better to their needs. Despite all its contributions, the community mental health movement remains surprisingly distant from the people it aims to serve. Each of the papers in this issue seeks to reduce that distance a bit by pointing out the need to recognize ethnic influences on adaptation and on the acceptance and impact of therapeutic interventions. My paper will consider some of the methodological difficulties associated with empirically taking up the challenge of adapting mental health services to different ethnic groups. I hope it will stimulate further, systematic research on the issues it raises.

The impact of the community mental health movement on psychiatric practice and training.

The three basic concepts of community mental health will have profound impact on many aspects of traditional psychiatric theory and practice, the author believes, and must be taken into account in psychiatric residency programs. The catchment-area concept means that psychiatrists are obligated to provide help for far larger numbers of people, including those who have problems and attitudes psychiatrists are not accustomed to dealing with. Psychiatrists must also work in partnership with communities that demand a voice in defining and labeling problems and specifying treatment modalities. The concept of promoting health as well as treating illness means that psychiatry becomes involved with broader concerns about improving the quality of life. The third concept, that behavior has family, community, social-class, and other sociocultural determinants, has already affected psychiatric practice and education, but it continues to generate friction.

Family coping with the mentally ill: an unanticipated problem of deinstitutionalization.

The author studied 125 families to determine the effect of the current movement toward returning mental patients to their homes. From interviews with and attitudinal tests of those families, he reports that they will generally care for the former patient in their home, often with little shame or embarrassment, and usually without rehospitalizing him. But the former patient's presence, especially when severe psychotic symptoms persist, often puts heavy emotional and social strains on the families. He warns that although families accept the physical presence of the patients, the accompanying social rejection could have serious consequences for the community mental health movement.

Parents as therapeutic agents: the usefulness of filial therapy in a community mental health center.

Filial Therapy, a program training parents as play therapists for their own children, has been found an effective part of the functioning of a child unit in a community mental health center. The basic philosophy and principles of Filial Therapy are identified. The use of parents as therapists is viewed as consistent with the growth of the community mental health movement and the concept of treating the context in which the child resides. The structure and flexibility of this model are delineated to provide the reader with a basis to introduce Filial Therapy in his/her own setting.

Editorial: The sometimes science of suicidology.

During the halcyon years of the community mental-health movement in the early 1960's, "suicidology" was launched as the study of "thanatopic impulses."1 "Suicide Prevention Centers" were created across the country, using resources such as 24-hour "hot-lines," accompanied by an active program of intervention for suicidal persons. All were well publicized in the mass media. It was hoped that such efforts would move mental-health professionals out of the consultation room and hospital ward — away from the preoccupation there with survivors of suicide attempts — and toward interventions earlier in the course of self-destructiveness in persons. More recently there has been . . .

The Psychiatrist as Physician

THIS IS a time for reappraisal and reconceptualization for psychiatrists. Critics deny the concept of mental illness, question the special expertise of psychiatrists for treating emotional disorders, protest against the practices of involuntary commitment and behavior modification, cite the failures of the community mental health movement, argue against the expanded role of psychiatrists in social and forensic issues, accuse the profession of not being responsive enough to problems of poverty, minority groups, and social inequities, and even doubt the legitimacy of psychiatry as a medical specialty, indicating that its scope encompasses only mental disorders of unknown cause. These attacks cannot be simply dismissed as unreasonable, irrational, and prejudicial attitudes of critics; they are symptomatic of the particular vulnerability of modern-day psychiatry to such charges. It is not my purpose to engage in polemics with this cadre of critics who, as Socratic gadflies, often force constructive appraisal or to indict psychiatry