Comprehensive Community Mental Health Center Research Articles

Ah, To Be a Psychiatrist

Back to table of contents Previous article Why I Aspired to Be a PsychiatristFull AccessAh, To Be a PsychiatristRobert McAllister,M.D., Ph.D.Robert McAllister,Search for more papers by this authorM.D., Ph.D.Published Online:18 Sep 2018https://doi.org/10.1176/appi.pn.2018.9b7AbstractRobert McAllister, M.D., Ph.D., is a retired private practitioner and author. His latest book is Predator Priest.My desire to help others came early in life. It was an uncertain path with no fixed goal. Growing up on a cattle ranch in Montana during the years of the Great Depression, I was aware of the marked poverty in the area. I was inspired by my mother and father who never let a stranger or a neighbor go hungry and who characteristically helped the “needy” out of their own sparsity. Their goal became my goal. Through the years “needy” was variously defined. In the 30s, it was poverty. I studied to be a priest (to respond to spiritual need?) but left the seminary, for want of a life companion (my own neediness). After basic training, I was a combat infantryman in Austria. (Peace was the need.) It was a world of destruction and decay, disorder and death, concentration camps, POW camps, DP camps. After the war I earned a Ph.D. in psychology from Catholic University. Dr. Robert Odenwald, a psychiatrist teaching there, encouraged me to study medicine and become a psychiatrist. I had depleted my G.I. bill, but various jobs made Georgetown possible. I got my M.D. in 1956 at the age of 37. Four more years: internship one, residency three. I began the practice of psychiatry on September 1, 1960. It’s difficult to explain how it felt. It was clearly the goal I’d been looking for. I can’t say I was inspired to become a psychiatrist; it’s more like I stumbled into it, thanks to Bob Odenwald. The truth is that psychiatry has been an inspiration to me. I’ve learned the depth of sorrow, the breadth of goodness, the delicacy of childhood, the harshness of prejudice, the wickedness of abuse, the bitterness of vengeance, on and on. With compassionate psychotherapy and whatever medicines were appropriate, I’ve tried to mend damaged lives, lift shattered spirits, and bring peace to broken hearts (all DSM-4 labeled). The world opened quickly for me. In 1966 I became superintendent of the Nevada State Hospital in Reno. We got the hospital accredited. We obtained a grant for the first comprehensive community mental health center in our region. We obtained a federal grant to educate staff. Howard Rome, Frank Braceland, Dana Farnsworth, George Valiant, Chet Pierce, and other notables honored us with their lectures. I met these stalwarts of the psychiatric world as fellow summer faculty at the Pastoral Mental Health Institute at St. John’s University in Collegeville, Minn. I published Conflict in Community (St. John’s University Press, 1969) and Living the Vows (Harper & Row, 1986). Both were well received by Catholic religious. As a result, much of my work related to the treatment of Catholic religious, consulting with and lecturing to their communities throughout the United States. I taught at Catholic University, Gonzaga University in Spokane, Loyola University in Baltimore. I closed my psychiatric practice on December 31, 2005. My life’s love had Alzheimer’s (Jane’s need was my need). Then it all ended—almost.After my wife’s death, I began “supervising” a social worker whom I knew from Taylor Manor Hospital. After she retired, I “supervised” her psychologist friend for several months. Then she retired. The three of us still get together every two weeks to discuss old cases, people who could be cases, and sundry aligned matters. Once you’re a therapist, the fire never goes out. It smolders. At the age of 100, I attempt to communicate peace and calm and a sense of personal worth to those with whom I live in an adult care community. It’s what I was inspired to do and have done since I began life as a psychiatrist in 1960. ■ ISSUES NewArchived

Commentaries on health services research

Commentaries on health services research

Misdiagnosis of African-Americans with Psychiatric Issues – Part I

This article highlights issues of misdiagnosis in an African-American, adult clinical population by doing point prevalence, record review study within a comprehensive community mental health center. Psychiatric evaluations of 330 patients were reviewed and clinically identifiable variables of: a) childhood Intellectual Disability (ID), special education, Attention Deficit Hyperactive Disorder (ADHD), or Autism/Pervasive Developmental Disorder (PDD); b) head injury causing Organic Brain Syndrome (OBS) or Temporal Lobe Epilepsy (TLE); c) a history of chronic substance abuse prior to the development of psychiatric symptoms; or d) childhood trauma causing Anxiety, Depression, and Panic Disorders were tabulated. Two hundred and twenty patients, who were free of the four variables, had a single psychiatric diagnosis and 18 had multiple co-morbid diagnoses. More than 25% (92/330) of the patients had the four variables in their histories. Four of the 92 patients had more than one variable in their history. Of the remaining 88 cases, 42 had psychiatric issues beginning in childhood (28 had history of ID, 4 had history of learning disabilities, 3 had history of ADHD, 7 had histories of Autism/PDD); 9 had histories of OBS or TLE; 20 had histories of substance abuse; and 18 had histories of extensive childhood trauma). Careful attention to common issues in African-Americans can inform the psychiatric diagnostic process pointing to prevention or treatment considerations that would benefit the African-American community at large.

Integrating Complementary Therapies into Community Mental Health Practice: An Exploration

To (1) describe the integration of massage and energy-based therapies with psychotherapy in a community mental health center, (2) to present qualitative feedback on the service, and (3) to present pilot data from a sample of long-term clients with persistent mental health concerns. A noncontrolled pilot study was conducted using interview data before and self-report instruments after completing a brief program of complementary therapy accompanying ongoing psychotherapy. The program took place at a comprehensive community mental health center in southern Maine and in the private offices of massage therapists and energy healing practitioners who contracted with the program. Subjects were 20 women and 5 men, with mean age of 42 years and a mean history of 7.4 years of mental health treatment. All had histories that included trauma, 10 of which involved sexual abuse. The Diagnostic and Statistical Manual of Mental Disorders IV Axis I diagnoses were PTSD (10), major depression (nine), anxiety disorder (three), and dual diagnosis (three). Clients receiving ongoing psychotherapy were assigned to one modality of complementary therapy based on clinical judgment, availability of practitioners, and client interest. Modalities used were massage, acupuncture, Reiki, and Healing Touch. The mean number of sessions was five. Clients completed an investigator-generated instrument with Likert-scaled ratings of satisfaction and perceived changes in four dimensions of trauma recovery: perceived interpersonal safety, interpersonal boundary setting, bodily sensation, and bodily shame. Clients reported high levels of satisfaction with the service and significant levels of perceived (self-rated) change on each outcome measure. Qualitative results included enhanced psychotherapeutic outcomes reported by mental health clinicians. The integration of complementary therapies into community mental health practice may hold promise of enhancing mental health outcomes and improving quality of life for long-term users of mental health services.

Creating Hope Through Employment for People Who are Homeless or in Transitional Housing

Persons with significant disabilities, especially those with problems relating to mental illness and/or substance abuse, face numerous challenges in securing employment. The program described in this article, Hope, Vocations, Progress (HVP) of Columbia River Mental Health Services (CRMHS) in Vancouver, WA, represents an aggressive strategy to facilitate the entry into work for persons with significant disabilities of mental illness and/or substance abuse, who also are in need of shelter, transitional housing, and other life supports. HVP was funded under a Rehabilitation Services Administration (RSA) demonstration grant and includes as its key partners a comprehensive community mental health center, a transitional housing program for women who are exoffenders, and a homeless shelter system. The program design is examined and program results through 39 months of a 60-month cycle are provided. The author examines the impact of the program to date, its strengths and weaknesses in relation to evidence-based p...

Community Violence and Children on Chicago’s Southside

This report summarizes a program of study on African-American children and violence conducted by a comprehensive community mental health center on the southside of Chicago. The research, which looked at exposure to violence, self-reports of aggression, and possible interventions, grew out of: (1) an awareness of the enormous amount of familial and extrafamilial violence in the black community; (2) clinical experiences that indicated that victimization and covictimization (i.e., victimization of close others) were often significant factors in the lives of the mentally ill; (3) a growing uneasiness, and indeed curiosity, over the extent to which children were witnessing these events and the impact of this witnessing, particularly on their own levels of aggression; and (4) a belief that the integrity of the black community was being threatened by the violence and that solutions must be sought.

Reliability of Self-Reports of Alcohol Use by Community Clients

Eighty-five of 116 randomly selected clients receiving case management services at a comprehensive community mental health center responded anonymously to a survey questionnaire that included two measures of self-reported alcohol use: questions about frequency and quantity and a retrospective diary for reporting the number of drinks consumed daily in the preceding week. Forty-two patients reported using alcohol; consumption was higher among younger patients. A significant correlation was found between responses to the frequency-quantity questions and the information provided in the retrospective diary, indicating that self-reports of alcohol consumption are reasonably reliable for the clients studied. Future research is needed to establish the reliability and validity of self-reported alcohol and drug use in typical treatment settings.

Twenty Years of Primary Prevention

Summary Throughout the two decades of the agency's existence, Consultation, Education and Prevention programming at the Washtenaw County Community Mental Health Center has developed, adapted, and survived during a number of major changes in agency mission, priorities, structures, and resources. Examples of services and products, a discussion of management issues, a look at the programs' relationship to theory, research, and practice, and a brief overview of the barriers and opportunities to such programming will provide an understanding of the many vicissitudes which C,E&P programs have faced since the original Federal staffing grants mandated these services as essentials among the offerings of comprehensive Community Mental Health centers.

A model project for families of the chronically mentally ill.

As a result of deinstitutionalization, families are frequently the primary caretakers of chronically mentally ill relatives. These families report a variety of stresses. La Frontera Center, Inc., a comprehensive community mental health center in Tucson, Arizona, is currently addressing the needs of these families through the Family Support Project. Families in this project have learned how to enhance the lifestyles of their ill family members as well as their own lifestyles by working in groups and focusing on distinct goals.

An empirical typology of the chronically mentally ill.

This paper describes the demographic, clinical, and psychosocial characteristics of a sample of chronically mentally ill clients at a large comprehensive community mental health center. Utilizing cluster analytic procedures, five basic types of chronically mentally ill clients are empirically identified. The differential pattern of psychosocial characteristics associated with each type is explored and the distinctive profile of each type is delineated. Finally, the implications of this typology for the design of community support treatment programs and allocation of increasingly scarce resources are presented.

Rape-related services in federally funded community mental health centers.

Amendments to the Community Mental Health Centers Act (Public Law 94-63) required community mental health centers (CMHCs) to provide such rape-related services as rape prevention and control, and to assure service availability to rape victims and their families. A questionnaire designed to assess how rape-related services are delivered was mailed to directors of 107 federally funded comprehensive CMHCs in a seven-state region. Fifty-five responses were received, indicating that rape-related services were offered by approximately two-thirds of the centers, 65% of which considered their rape-related services to be less comprehensive than other services. The budget for rape services was less than $10,000 in 80% of responding centers, representing less than 0.5% of the average CMHC budget. Services provided, primarily clinical, involved crisis intervention, counseling, and psychotherapy with rape victims and their families. Prevention and educational activities accounted for less than 25% of all rape-related services at most CMHCs. The results of the study question the impact of federal mandates on local mental health services.

Caseload Management: Choosing Suitable Clients in a Community Health Clinic Agency

Discretion in decision-making is a well-known but poorly understood phenomenon. This paper examines the contextual features influencing the exercise of discretion in screening and assigning clients in a community mental health agency. I develop a caseload management model to analyze the interplay between organizational circumstances, determinations of client suitability, and decision-making outcomes. This study finds: (1) Decisions are based on judgments of client suitability. (2) These assessments use stereotyped characterizations to typify clients as suitable. (3) The typifications serve as a means of limiting the allocations of scarce treatment resources. I describe the related common-sense reasoning and decision-making practices which I observed. The community mental health care system has experienced a rapid expansion in the United States since the 1950s. Federal legislation in the 1960s provided a major impetus for this growth through subsidies for the construction and staffing of comprehensive community mental health centers. Through 1975, over 600 of these agencies had received federal funds and been designated to provide services to community residents in local catchment areas. There was also a parallel proliferation of community care agencies funded privately and by local government. Although clientele varies from agency to agency, the community mental health system as a whole must deal with two distinct client populations, each with its own needs and demands: (1) Chronic mental patients have been discharged in large numbers from state mental hospitals. Although the philosophy of community care as more humane and effective (Bellak, 1963) provided an ideological justification for deinstitutionalization, Scull (1977) argues that fiscal considerations were most important. Bassuk and Gerson (1978) note that patients released from state-funded mental hospitals can be shifted onto federally-funded support programs. (2) A new class of clients has been created through net widening (Van Dusen, 1981), expanding the definition of those in need of mental health care. These clients are generally less seriously disturbed, seeking relief from self-perceived personal problems or referred by official agents of the criminal justice and social welfare systems. The major problem currently facing the U.S. community mental health system is its failure to care for the gravely disabled, whose release from mental hospitals was predicated on continuing community care (Chu and Trotter, 1974; Kirk and Thierren, 1975). The cost of treatment has been subsidized by public funds to lower barriers to utilization, but this has not alleviated underutilization by the chronically ill population (Buck and Hirschman, 1980). Increased utilization by the less disabled population has absorbed the available supply of services without satiating the demand. The consequence is that the two client populations must compete for a limited supply of services; not all who seek treatment are able to obtain it. When the demand for an agency's services exceeds its resources, several responses are possible. It can make clients wait, or try to reduce demand, for example by negotiating with referral sources (Lang, 1981) or discouraging self-referrals (Gereboff, 1981). Alternatively, the agency

Changing models of community mental health services.

The various comprehensive community mental health centers developed at the same time as the free clinics intended to provide an alternative form of service. The origins and contributions of each of these directions of service are compared on such matters as funding, political orientation, relation to local government, the composition and functions of their boards, and their models of service delivery. The case is made that the two forms have shown a degree of convergence that shapes the present reality of what is or is not a legitimate part of mental health services.

Reaction of a frustrated citizen.

Participation on a board of a Comprehensive Community Mental Health Center is a frustrating, saddening, but occasionally positive experience. The positives can continue to outweigh the negatives only if the partnership between staff and citizen can be strengthened. Continued manipulation by either side of the partnership will in the end only destroy the goals we have worked for. With the reduction of federal commitment and the expiration of grants for most of the centers in the country we must band together to find new and creative ways to stay alive. Community Health Centers have made a real difference in the lives of ordinary citizens and in the lives of those who have served on their boards. Hopefully a renewed effect to bring staff and citizen/consumers together will bring about the new partnership without which there may be no Community in Mental Health Centers.

The forgotten staff: Who cares for the care givers?

The importance of being responsive to the personal needs of the mental health worker is discussed. It is hypothesized that for mental health workers to function at optimal levels of effectiveness, their own needs for recognition, support, and enjoyment must be attended to. The view of the comprehensive community mental health center (CCMHC) as an interdependent system where clientele, service staff, and administration are continually affecting and being affected by one another is presented. Social system, family interaction, and individual personality theory are briefly discussed so as to provide a framework and rationale for this view. Our experiences at two mental health agencies that are illustrative of “good and bad” mental health practices with regard to staff crystallize relevant issues. Specific proposals to provide for the needs of mental health staff and the improvement of agency functioning are presented.

Administrative relationships between community mental health centers and academic psychiatry departments.

The authors reviewed the administrative relationships between academic departments of psychiatry and community mental health centers (CMHCs). By telephone, they surveyed the chairpersons of 110 departments of psychiatry with approved psychiatric residency programs and found that 87 (79%) had some type of administrative relationship with a comprehensive CMHC. Almost two-thirds of the chairpersons of these departments considered the CMHC to be of major importance to their educational programs. Only 8 (7%) of the 110 departments had discontinued their relationship with a CMHC. Most of the chairpersons whose departments were involved with a center were optimistic about the future of their programs in CMHCs.

Community training in an urban university

A year-long field training project comprised of university faculty and graduate students as participant-conceptualizers in developing proposals for two comprehensive community mental health centers is described. Students experienced an urban setting of high psychosocial vulnerability and a complex network of social-political agencies. Their participation in all phases of the project is discussed, from gathering demographic data to negotiating contractual arrangements for services.

A method of evaluating the impact of services at a comprehensive community mental health center.

Efforts of one community mental health center to develop a system of program evaluation designed to meet criteria mandated by recent Federal legislation are described. This approach represents a comprehensive evaluation system with the capability of objectively assessing: (a) patterns of utilization of services, (b) satisfaction with services as well as the availability, accessibility, and acceptability of services, and (c) the quality of direct mental health services as measured by attainment of individualized treatment goals. A rationale for the development of this system as well as a description of the modifications and automatization of the procedure are included. Initial results are presented which pertain to 2,900 goals written for 1,250 clients receiving treatment within five of the Center's direct service elements.

Community Mental Health Consultation With Agencies

The Personnel and Guidance JournalVolume 56, Issue 6 p. 364-368 Community Mental Health Consultation With Agencies John L. Werner, John L. Werner John L. Werner: is the coordinator of Consultation and Education Service of the South Central Community Mental Health Center in Bloomington, Indiana. In addition to counseling and helping in the development of a comprehensive community mental health center, he has been consulting to community agencies. The primary focus of his work has been in program and administrative consultation and on the psychological training of existing community care-givers and indigenous para-professionals.Search for more papers by this author John L. Werner, John L. Werner John L. Werner: is the coordinator of Consultation and Education Service of the South Central Community Mental Health Center in Bloomington, Indiana. In addition to counseling and helping in the development of a comprehensive community mental health center, he has been consulting to community agencies. The primary focus of his work has been in program and administrative consultation and on the psychological training of existing community care-givers and indigenous para-professionals.Search for more papers by this author First published: February 1978 https://doi.org/10.1002/j.2164-4918.1978.tb04651.xCitations: 5 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume56, Issue6February 1978Pages 364-368 RelatedInformation

Categorization of comprehensive community mental health center services.

Categorization of comprehensive community mental health center services. J E Holman, and E HamburgerCopyRight https://doi.org/10.2105/AJPH.68.2.174-b Published Online: November 15, 2011