Funded Community Mental Health Centers Research Articles

Reducing posttraumatic stress disorder symptom severity among depressed women with childhood sexual abuse histories in interpersonal psychotherapy-trauma: The role of improved social functioning.

Childhood sexual abuse (CSA) increases risk for posttraumatic stress disorder (PTSD), and both CSA and PTSD are strongly associated with impaired social functioning. Interpersonal psychotherapy (IPT) has demonstrated promise for adults with PTSD and has been shown to be effective for women with PTSD and histories of CSA, but the mechanisms by which IPT might improve PTSD are unknown. The current secondary analysis tested whether the ameliorative effect of IPT-trauma (IPT-T) on PTSD, demonstrated in a randomized effectiveness trial, was mediated by improved social function. The randomized effectiveness trial compared IPT-T to clinic psychotherapy in a publicly funded community mental health center. Women with CSA histories and major depression (n = 162; Mage = 36.3; 54% White, 38% Black, 8% other race) were randomly assigned to IPT-T or CP, and 16 free sessions of IPT-T or CP were offered within a 32-week treatment period. Eighty-eight percent of the sample met diagnostic criteria for PTSD. Mediation models confirmed hypotheses, showing that the effect of IPT-T on improved PTSD symptoms at Week 32 (end of treatment) was partially mediated by better social functioning at Week 16 (middle of treatment period; path c¹: B = 12.25, p = .04, 95% confidence interval [.44, 24.05]). Findings support that a non-exposure-based therapy can reduce PTSD symptoms via improved social functioning. Given extensive literature showing the importance of social functioning in mental health generally and PTSD specifically, integrating a focus on social functioning (e.g., building social skills, expanding support networks) into treatments, including exposure-based treatments, may enhance outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Utilizing a CBPR approach to assess the impact of COVID-19 on individuals who receive publicly funded behavioral health services.

The coronavirus disease pandemic has highlighted significant gaps in community mental health services, placing vulnerable individuals at greater risk for mental health and substance use difficulties via disrupting their wellness journey. Guided by a wellness framework, a needs assessment was conducted among adult consumers of behavioral health services to understand their needs during the pandemic and to help develop and strengthen service delivery strategies. A team of three university researchers and four Consumer Researchers, who receive services at a publicly funded community mental health center, engaged in a community‐based participatory project in which 13 focus groups were conducted with 51 consumers. Several themes emerged from a thematic analysis of transcripts regarding consumer well‐being and healthcare needs, coping strategies employed, and the accessibility, benefits, and perception of clinical and support services during the pandemic. Results highlighted strengths in service delivery and areas in need of enhancement. Findings may inform similar community services that seek to enhance delivery of care among vulnerable populations.

First federally funded community MH center celebrates 50 years

The first federally funded community mental health center in the nation is celebrating its 50th anniversary this summer, The Daily Oklahoman reported Aug. 8. The Central Oklahoma Community Mental Health Center opened in 1969 in Norman as part of the movement to take people out of institutions and provide them outpatient care in the communities where they lived. Vocal leaders in Congress pushed for Oklahoma to get funding for the first center after President John F. Kennedy signed the Community Mental Health Act in October 1963, said Cathy Billings, the center's director. Dr. Hayden Donahue — who served as the first director of Oklahoma's mental health department and superintendent at Central State Hospital (now Griffin Memorial Hospital) in Norman — was a big part of that movement, said Jeff Dismukes, spokesman for the Oklahoma Department of Mental Health and Substance Abuse Services. “He was a huge national figure who did some cutting‐edge things in mental health,” Dismukes said. The Central Oklahoma Community Mental Health Center has served thousands of Oklahomans from Norman and surrounding communities. It has been a leader in the delivery of innovative treatment for mental health and substance use, said Terri White, state commissioner of mental health. “We were the first in the country to begin bringing services to people at the community level, expanding access to care and finding ways to address community needs,” White said.

Rebranding "community mental health".

What do we mean by ‘‘Community Mental Health’’; what does it mean to be a ‘‘Community Psychiatrist’’? One assumes these are easy questions to answer, but the responses are not as simple as they may seem. Let’s start with some simple history: Community mental health as a term originated over 50 years ago. Related to the work of seminal pioneers like Erich Lindemann, the term originally referred to addressing the mental health needs of an entire community, rather than just individual patients, and to engaging in community consultation that would leverage natural caregivers to respond to crises and promote community health. This concept was transformed by the Community Mental Health Center Act (1963), which led to the first wave of federally funded community mental health centers in the mid to late sixties and early seventies. Although many of these centers initially aspired to broad community missions, their development was heavily influenced by the de-institutionalization movement of the same time period, and the concept of community mental health evolved to include and focus on service in the community (as opposed to in the hospital or in the institution) for adults with chronic and severe mental illness and children with severe emotional served in the public sector. Finally, because the generativity of community mental health arose from several broad social movements (community focus and community organizing; publicly funded and organized mental health service delivery in catchment areas across the nation; the de-institutionalization and ‘‘liberation’’ of individuals who had been trapped in institutions for decades), community mental health and community psychiatry have long been associated with a ‘‘cutting edge’’ movement in response to the challenge of providing innovative services for those most in need and least able to pay. So what is community mental health; what does it mean to be a community psychiatrist? And perhaps the key issue: does this all mean the same thing now as it did 50 years ago? Some questions might help us determine a response:

The challenges for primary caregivers of adolescents with disruptive behavior disorders.

Adolescents with disruptive behavior disorders (DBD), including oppositional defiant disorder and conduct disorder, present unique challenges for their families. Although, most empirically supported treatments for DBD are family-based, the emphasis is typically on the behavior of the child rather than on the life challenges and resultant distress experienced by the family members. Fifteen families of adolescents with DBD were recruited from a large publicly funded Community Mental Health Center. For this report, data from in-depth interviews with the adolescents' primary caregivers were analyzed by standard content analytic procedures to describe the challenges they experienced living with and caring for the adolescents. The primary caregivers reported that the challenges were overwhelming, demanding, and unrelenting. The two most salient challenges were (a) managing the adolescents' aggressive, defiant, and deceitful behaviors, and (b) interacting frequently with a number of child-serving agencies. A number of clinical implications are drawn from these findings.

Patients' Perception of Possible Child Custody or Visitation Loss for Nonadherence to Psychiatric Treatment

This study explored whether parents treated in public mental health settings perceived that they might lose child custody or visitation if they were not adherent to treatment. Interview data were gathered from 1,011 adult outpatients from five community mental health centers located in five states in different U.S. regions. Among parents with children younger than 16 (N=187), 19% perceived in the past six months that they might lose child custody or visitation if they were not adherent to treatment. Two-thirds of the identified sources of this perception were family, themselves, or individuals outside the treatment, welfare, or legal systems. These preliminary data indicate that the perception of possible loss of child custody or visitation for nonadherence to treatment is not uncommon among patients treated in these public mental health settings and that "informal" sources are often the perceived source. Further study regarding the effects of this perception on patient and family outcomes is needed.

Using telephone prompts to improve initial attendance at a community mental health center.

Contacting patients by telephone before their appointment has been shown to increase clinic attendance in various settings. However, no such studies have been conducted in New Zealand, which has a unique mix of publicly funded secondary care and largely privately funded primary care. A controlled prospective study of telephone prompting was carried out in a New Zealand publicly funded community mental health center. One group of 190 patients was phoned the day before their initial appointment, and their attendance rate was compared with that of 496 patients not phoned. Ninety-six percent of the patients who were successfully contacted kept their appointment, compared with 76 percent of those not contacted.

Research on Mental Health Services for Hispanics: Targets of Convergence.

In reaching to serve the mental health needs of new catchment neighborhoods, the 1963 federally funded Community Mental Health Center (CMHC) program stimulated culturally oriented research on the effectiveness of mental health services for Hispanics. The research, at first scattered and diffuse, has converged on a number of targets. This article examines four of the targets of research and how they can be brought into a unified perspective if they are viewed in temporal order as sequenced disadvantages Hispanics confront in using mental health services. The targets can be arrayed longitudinally: reasons for Hispanics' underutilization of professional mental health services, difficulties in retaining Hispanics in such services, errors in evaluating their mental health, and the problems of adapting treatment modalities to their needs.

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.

Federally funded CMHCs: the effects of period of initial funding and hospital affiliation.

Previous research on federally funded community mental health centers has largely failed to recognize fundamental differences among different types of centers. Here we show that such basic factors as the arrangement for providing inpatient services and the period of initial federal funding have large effects on the development and organization of a center. Although the centers joining the federal program from 1965-1970 are the largest, those facilities funded between 1971-1975 are generally smaller than those funded later. The arrangement for providing inpatient services has an important effect on staffing. This work suggests the national norms may not be the most useful data for evaluating past performance or planning the future of a specific center.

Insurance coverage and other factors affecting utilization of inpatient psychiatric services

The effect health insurance has on the length of stay in an inpatient psychiatric service was studied for an area that is used in much marketing research. A sample of 1416 admissions from three general hospitals, a proprietary psychiatric hospital, and a state funded community mental health center was used. It was found that length of stay in a psychiatric setting is the product of a constellation of factors.

Training of interns and practicum students at community mental health centers.

This study assessed training experiences offered to interns and graduate students at 464 federally funded community mental health centers. Doctoral level internship programs existed at 128 centers, and practicum training was offered at 240 settings. Questionnaires filled out by directors reveal that although the majority of training programs are not as yet APA-approved, they have become an important component in the training network in terms of the number of students being trained. Training and exceptional areas of training are still in traditional clinical areas. However, there has been an evolution of training in community mental health/community psychology areas which is still gaining momentum. Data are presented on consultation settings, orientations to consultation, and the availability of training in consultation. The need for directing effort at obtaining financial support for training is indicated.

Manager and evaluator views of program evaluation.

This article presents the results of a 1979 national survey of federally funded community mental health centers (CMHCs). The directors and chief program evaluators of 323 CMHCs returned questionnaires which allow comparisons of the opinions of the center managers and their evaluators regarding accountability and evaluation and the level and knowledge of center evaluation staff. The CMHC directors and evaluators are also compared to a random sample of community psychologists and four other criterion groups of professionals regarding their responses to three items of the service provider accountability subscale of the Human Service Ideology scale.

Principles of mental health care for elderly inpatients.

Although the elderly's need for psychiatric treatment has long been recognized, publicly funded community mental health centers generally have been unsuccessful in establishing geriatric programs. If properly used, state mental hospitals remain a potential resource, but the more appropriate community-based placement of mentally impaired elderly persons is in special psychiatric units of general hospitals or in geropsychiatric units of private psychiatric hospitals. Principles for establishing such units in either setting include organizing a treatment team that empathizes with older patients and that has been trained to deal with the complex problems of the elderly. Formulation of comprehensive diagnoses and prognoses may require consultation and facilities outside the hospital; treatment planning should involve the patient's family from the beginning. Follow-up and supervision of referral after the patient's discharge are essential to the program's success.

Patterns of Program Evaluation in Community Mental Health Centers

In an exploratory study of the program evaluation efforts of federally funded community mental health centers prtor to the enactment of mandatory program evaluation, survey data were submitted to factor- and cluster-analyses. Results yielded: (1) a typology of evaluation activities performed by community mental health centers (2) a meaning ful patterning of (organizational) approaches to program evaluation suggesting developmental stages of an increasing range of types of activities; and (3) the tentative conclusion that, at a low level of evaluation effort, client-change evaluations are less related to impact on program development than are evaluations using descriptive statistics about chents.

Correlates of community mental health center underservice to non-whites.

The relationships between relatively low utilization rates for non-whites and catchment area demography and center service characteristics were examined for 142 federally funded community mental health centers. Center characteristics were less strongly related to relative utilization by non-whites than were area demographic characteristics. Several characteristics of the black population were among those most highly associated with relative non-white utilization rates.

Staffing patterns in community mental health centers.

Staffing patterns of federally funded community mental health centers were examined in a survey of 512 centers conducted in 1977. A total of 275 usable responses were received. The findings showed that rural centers had significantly fewer trainees in three of the major mental health disciplines (psychiatry, psychology, and soical work) and fewer affiliations with training institutions, factors that contribute to the maldistribution of mental health professionals in rural areas. The survey also showed that center directors tended to hire more staff of their own professional background.

GENERAL HOSPITALS TAKING GREATER ROLE IN PROVIDING SERVICES FOR CHRONIC PATIENTS

SMaurice H. Greenhill’s excellent review article on general hospital psychiatry in the March issue of Hospital & Community Psychiatry is both informative and timely (1). Dr. Greenhill asserts that the psychiatric inpatient unit in the general hospital is the “core service to succeed the state hospital.” The central role of general hospitals in deinstitutionalization is frequently overlooked. While community mental health centers have defined for thefl iseIves a broad role in which services to chronic patients play only a part of total services i#{241} some specific cases, a minor part-the role of general hospital psychiatry has been increasingly determined; as Dr. Greenhill points out, by state hospital population shifts. The phenomenal growth of outpatient psychiatric care in the United States has sometimes clouded the fact that inpatient care, too, has been increasing, albeit at a slower rate. Thus statistics from the National Institute of Mental Health reveal that between 1971 and 1975 additions (admissions and readmissions plus returns from extended leave) to inpatient psychiatric services increased by 19 per cent, and those to outpatient services by 73 per cent. It is altogether possible that general hospitals are providing the bulk of community-based psychiatric inpatient care for state hospital dischargees and for other chronically ill individuals who are effectively barred from state hospital admission by deinstitutionalization policies. Dr. Greerihill’s thought-provoking article does not take into account some of the major differences between general hospital psychiatric inpatient units operated under public and nonpublic auspices. I should like to provide an addendum by citing some recent statistics from the NIMH Division of Biometry and Epidemiology. In 1976 there were 791 psychiatric inpatient units in general hospitals (excluding 167 units in hospitals affihiated with federally funded community mental health centers and 89 units located in Veteraiis Administration general hospitals). They consisted of 157 facilities operated under public auspices and 634 under private auspices. Together they accounted for 35 per cent of all inpatient psychiatric settings, in contrast to federally funded community mental health centers, which constituted only 23 per cent. Additions to the psychiatric inpatient units of general hospitals totaled 543,731 in 1975. This figure represented 36 per cent of additions to all psychiatric in-

Developing a Community Board for a Mental Health Center

Federally funded community mental health centers are required to have governing boards made up of community residents to ensure that services are meeting the community's needs. Sound View-Throgs Neck Community Mental Health Center in Bronx, New York, met that requirement by developing three local advisory boards, one for each subcatchment area served by an outpatient clinic. Later a central community board with 12 members, four from each of the local advisory boards, was formed. The central board has several standing committees that parallel the organization of the center, including community, hospital, and rehabilitation services; research and development; and administration. Board members and center staff meet regularly. They have found that they must act as partners and learn to share power, privileges, and knowledge.

Will community mental health survive in the 1980s?

There are now 675 funded community mental health centers (CMHCs), covering almost half the country. Many of these programs were funded in the social optimism of the 1960s and now face a crisis of purpose and funding. Additional requirements imposed by the 1975 amendments to the CMHC act are not matched by additional fiscal resources. Programs are graduating from the federal grant to find that other sources of funds, especially third-party insurance funds, are not replacing the lost federal dollars. There is evidence that CMHCs are changing from clinical/medical programs to social programs; the numbers of persons seeking care who have diagnosable mental illness and of psychiatrists and nurses relative to other staff are decreasing. The issue is whether CMHCs as a national program are headed for extinction or whether there will be new vitality for this program into the 1980s.