Field Of Community Mental Health Research Articles

Communty mental health--an underview.

This paper has attempted a panoramic view of an immensely complex aspect of psychiatry, an aspect so tumultuous as to over-flow the bounds of psychiatry as a specialty of medicine. The panorama is described as an “underview” because it is not seen from without and above, but aspectually, by a participant, and from within. In spite of the inescapable restrictions of the author's perspective, he has tried to maintain as much objectivity as possible and to make the biases explicit where they could not be avoided. No attempt is made to predict where the emergent thrust of historical movement will carry the field of community mental health. No attempt is made to espouse any particular direction of future growth. It has seemed enough of a task to attempt to say where we are and whence we came to this place. The future comes in its own time.

Suicide in San Francisco's skid row.

THERE is an increasing appreciation of ecology as a fundamental construct in the study of human problems. In a review of relevant experimental literature, Hunt¹has concluded that the major variation in behavior is not due to "... individual differences in subjects per se, nor the variations among situations per se. It is, rather, the interactions among these which are important." From the context of the emerging field of community mental health, Kelly,²Klein,³and Kalis⁴have emphasized the relevance of ecological considerations for community psychology. This recognition of the "mutuality" between persons and their environments has slowly become explicit in research design.^5,6 Nowhere are human-community problems more acute than in the heavily populated metropolitan centers.⁷Two examples of widespread urban problems are suicide and alcoholism. The present communication represents a preliminary attempt to assess whether these two problems are interrelated and, if so, in

Aspects of mental health consultation.

THE WORDS consultant or have had in all fields and all periods of history a wide variety of meanings, the most common of which have been the meeting of two or more persons for the purpose of deliberating or conferring about some matter of mutual concern. The consultant, therefore, is one who speaks to another person or group or gives advice or counsel to someone else (consultee) about matters Pertaining to the consultant's specialized area of knowledge. Recent developments in community mental health practice have made it necessary to define the place of consultation within the increasingly complex field of community mental health and community psychiatry. Mental health consultation as it is conceived by this writer represents a variety of approaches ranging from interest and concern with helping the consultee understand more clearly the nature of his client's difficulties in psychodynamic

Community adaptation as an evaluative concept in community mental health.

THIS PAPER outlines the background to the conceptualization, and the tentative instrumentation of "community adaptation." Data from an initial study using the "Community Adaptation Schedule" is presented. Applications for the evaluation of community mental health programs are discussed. <h3>The Need for Program Evaluation</h3> The interest being stimulated in the field of community mental health compels attention to the many voices¹raised in warning about the need for research and evaluation. Properly feared is a possible digression that may cause embarrassment decades hence. The undertaking of carefully controlled studies in this field has been hampered by the lack of sound evaluation techniques. Besides the Well—known difficulties of measuring change after an intervention, the absence of an appropriate criterion relevant to the goals of community mental health makes the task that much harder. Approaches embodying crisis consultation, multilevel prevention, short-term treatment, sector analysis, and the

The “medical model,” miasma theory, and community mental health

Current practices in the field of community mental health are examined to determine the extent to which the so-called “medical model” is actually being utilized. In many respects it is shown that the time-honored miasma theory model is more appropriate in understanding these practices. Miasma theory is described and contrasted as a model with the medicobiological model as regards its pertinence for understanding present ideas of the taxonomy of emotional disorders, principles of diagnosis and treatment, and theories of primary prevention. Some implications of miasma theory as a community mental health model are suggested.

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

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-

Types of mental health consultation.

Mental health consultation is defined and differentiated from other forms of professional activity in the community mental health field. The four main types of mental health consultation are discussed and one, “consultee-centered case consultation,” is described in some detail, to illustrate the basic principles of method and technique.

BEHIND THE SCENES IN COMMUNITY MENTAL HEALTH

Comprehensive community mental health programs follow the pattern of public health philosophy which places the need for community service paramount to individual considerations. Public support and professional participation are seen as the cornerstones of such a program, but both the social and professional aspects are influenced by factors which we tend to overlook. In the community mental health field we have been all too prone to develop services without consideration to solving the vast community problems created by a wide range of disordered behavior. Proper integration and control of local services could have a preventive impact. This must become the ultimate goal, for without it, there is no solution.