Principles of community mental health in a rural setting: The Halifax County program

A temporary solution to the manpower problem inherent in trying to meet the mental health needs of people in rural areas is the development of consultation programs. Based upon a history of organization and operation of such a program in rural North Carolina, zo principles, focusing on community sanction, consultation techniques, clinical services and other aspects of community mental health programming are proposed. These are presented as hypotheses to be subject to empirical examination.The late Dr. Young was Director of the Halifax County Health Department.The authors wish to thank the many individuals whose participation made this program particularly stimulating, Irving Alexander (IA) and the trainees who shared many of these experiences with us, the people of Halifax County, and their officials for their continued cooperation and support.     

A study of the process and the outcome of mental health consultation

This study begins to explore the effectiveness of the mental health consultation process in relation to an experimental, interdisciplinary continuing education program. The program was designed for regional mental health professionals who were interested in learning more about the theory and practice of mental health consultation. Each participant selected an agency in his own community to offer a consultation service as part of the learning experience. To assess the quality of these services, a series of evaluation instruments were administered by the faculty. Findings from three instruments revealed the consultant's impact and showed a high level of agreement between consultant-consultee pairs on specific items. These results could reflect the nature of the working relationship developed between the consultant and consultee.The data for this study derive from a regional continuing education project conducted at Tulane University. The project is supported by the National Institute of Mental Health, Continuing Education Branch, Division of Manpower and Training Program Grant (MH-1170601-02).     

A conceptual model for a program of community psychiatry for a deaf population

A conceptual model for the development of a comprehensive program of community psychiatry for a deaf population is presented, with illustrations from a program currently underway at the Langley Porter Neuropsychiatric Institute in San Francisco. The model has worked well with this special population, bound together by a common communicative mode, common educational experiences, similar problems of living. The model stresses primary prevention of mental disorders, in addition to providing secondary and tertiary prevention and treatment. Eight ingredients of the comprehensive program include: clinical or therapeutic services for individuals and families; collaboration with other agencies; mental health consultation; research; community organization; public education; administration; staff development. The deaf patient, the deaf community, and the response of the hearing community to deafness all present problems for the mental health practitioner which are in some ways unique. The model presented here is one approach for dealing with the unusual and interesting aspects of these problems.Work described in this paper was supported by a grant from the Social and Rehabilitation Service (RD-2835-S) to the State of California, Department of Mental Hygiene, and by an endowment from the San Francisco Foundation to the University of California.     

State government at the grass roots: A community relations approach to mental health program development

Integrating consultation and education and community organization techniques within a community relations framework has proven effective in catalyzing a productive partnership between grass-roots, community leaders and a state mental health program. The programmatic accomplishments-enhanced mental health services for the most vulnerable populations, including the aged, the chronically mentally ill, and high-risk youth, and enhanced community and political support for mental health services, all achieved without increase in state mental health expenditures-validate a methodology which is applicable in a wide variety of mental health settings.     

The making of a consultation program: Administrative issues and strategies

Although one of the original five mandated services, consultation programs are not faring well in community mental health centers (CMHCs). This paper looks at the organizational and administrative aspects of creating and maintaining a viable consultation program within the CMHC. Included are types of organizational structures for consultation programs, with an analysis of which types are best suited for different types of CMHCs; building staff support for a new consultation program; and protecting the consultation program so that it survives and flourishes.Laurie Laitin Bergner, Ph.D., is affiliated with the Human Service Center, Peoria, Illinois. Reprint requests may be addressed to her at 20 LaTeer Drive, Normal, Illinois 61761.     

Neighborhood psychiatry: New community approach

Neighborhood health and multiservice centers are increasingly becoming a means of delivering medical care to communities. This paper describes the function of a “neighborhood psychiatric team,” using a “family life center” as a base of operations for a comprehensive preventive and treatment program in one neighborhood of Boston. This program consists of direct treatment services to neighborhood residents, consultation with health and social service professionals and paraprofessionals in the Family Life Center itself, and consultation with other community agencies. The advantages of working in a neighborhood-early intervention in crisis with individuals and agencies, accessibility to the entire family, integration with general health services, easy follow-up and aftercare of recently discharged psychiatric patients-are described with case examples.     

Clergy consultation as a community mental health program

The authors describe the planning, development, implementation, and results of a consultation program to the clergy as part of an agency's community mental health service. The paper focuses on the four main program goals of (1) revitalizing a local association for the clergy, (2) developing the clergy's pastoral skills, (3) increasing community supports for mental health, and (4) developing a counseling service sponsored by the local clergy for community residents.     

Psychiatric disorders and the need for mental health services among a sample of orthopedic inpatients.

This report concerns psychiatric disorders and the need for mental health services among patients admitted to a general orthopedic surgery service. The planning of mental health services for medical and surgical inpatients in terms of current community mental health concepts is discussed.It has been observed that patients being treated for medical or surgical conditions have a higher than expected incidence of psychiatric disorders.^1–6 Previous studies of inpatients with orthopedic or other surgical conditions report a wide range (19%–86%) of psychiatric disorders depending upon the diagnostic criteria employed. In spite of the documented need for mental health services among such patients, primary physicians are often reluctant to request psychiatric consultation, and the psychiatrist is usually consulted only when a patient presents a difficult management or diagnostic problem.^3,7,8 Thus, many other medical or surgical patients could benefit from mental health consultation if their needs could be identified.In recent years, psychiatrists have become more involved in the functioning of general medical services, with consideration being given to the application of the principles of community mental health to the consultation services.^2,4,9–12 Psychiatrists have participated in indirect consultation through the medical and nursing staff in addition to providing direct consultation within medical and surgical settings. In planning this type of consultation service, more information is needed about the kinds of mental health problems experienced by medical and surgical patients.     

Some problems and parameters of mental health consultation

This paper is an attempt to look at mental health consultation from a variety of different points of view; to distinguish it from clinical consultation and direct services to patients; to relate it to mental health and mental illness, social handicap, and social functioning; to program goals and caretaker populations; and, finally, to discuss evaluation both in terms of current studies and future needs.The authors are indebted to Mrs. Irene Marquez for her assistance in the writing and preparation of this paper.     

Mental Health Center and School District Partnership for Emotionally Disturbed Children

The award winning partnership between a school district and mental health facility to operate a special day program for severely emotionally disturbed children is described. The Northside Independent School District in San Antonio, Texas has contracted with the Southwest Mental Health Center for 15 years to provide clinical program management, counseling, and consultation plus the behavior management services by mental health workers. Over fifty elementary age children participate daily in the Northside Children's Center therapeutic program. The District assigns special education teachers and necessary support staff for this program plus the school facility. Parent satisfaction has been positive and school attendance is congruent with both District and State averages for regular students.     

Expectations for the comprehensive mental health center: The community

The process of developing community support for a comprehensive mental health center in a rural and an urban setting is described. The more limited the community in existing services, manpower and economic potential, the more radical the realignment of such resources must be before a center can emerge. In his efforts to obtain community commitment, the mental health professional must be aware that idiosyncratic expectancies of what the center will accomplish are held by the sponsoring agencies. Shaping such diverse aspirations into a realistic program of services is a hazard and a strength of the community mental health movement.     

Patterns of community mental health development in major American cities

Community mental health developments in major American cities are reviewed and compared through 1968. An open-ended questionnaire covering nine areas basic to urban community mental health services was forwarded to appropriate authorities in 25 American cities. Data collected from the 15 respondents indicated extreme diversity in terms of type of administration, funding patterns, scope of program, community participation, and so forth. The data also indicate rapid developments in community mental health services in major American cities. The findings are consistent with the general conclusion that community mental health services in urban settings are in an early developmental stage.     

Considerations in community mental health programming for youth

The particular challenges of providing mental health programs which engage youth and offer effective and acceptable services are discussed. The paper identifies and discusses the guiding principles for development of a comprehensive and integrated multiservice centre for the varied needs of youth. The program focuses on problems occurring as part of the normal developmental process as well as on the needs of emotionally disturbed or mentally ill youth. The place of such a program within the context of the community is identified with the responsibility for indirect consultation and effective community liaison being stressed. An established program based on this model is described.     

Anticipated and actual barriers to developing community mental health programs for the elderly

Teams of state and local agency professionals responsible for mental health and aging services participated in a model project utilizing education and consultation to facilitate community mental health programming for the elderly. Participants identified both anticipated and actual barriers to programming. Competing program priorities and lack of staff knowledge about mental health and aging were anticipated and confirmed as major barriers. Agency-organizational barriers were unanticipated, yet there were severe problems in cooperative interagency programming.     

Mental health needs assessment of Tucson's urban Native American population

This report presents the design, implementation, and results of a 1992 mental health needs assessment of Tucson's urban American Indians. The study was conducted under the auspices of the Traditional Indian Alliance (TIA) of Greater Tucson, Inc. TIA is a community-based, non-profit corporation committed to addressing the health and social welfare issues of Tucson's American Indians. As a result of having provided health and social services since 1974, TIA recognized that there were many unmet needs for culturally sensitive American Indian mental health programs. The organization established a goal of assessing the mental health needs of Tucson's urban American Indians in order to obtain the information needed to enhance program development and the provision of services. This survey was conducted in order for Traditional Indian Alliance to enhance its mental health program development and improve the provision of mental health services to Tucson's urban American Indians. The specific objectives of this study on Tucson's urban American Indian population included documentation of (a) the nature of socioeconomic problems that might have a psychological effect, (b) the existence of psychological distress, and (c) the types of available support systems and their utilization.     

The organization and management of community mental health services

Development of Community Mental Health Centers has revealed the need for more effective administrative mechanisms for planning, developing, and controlling mental health services and for involving effectively the local community in this process. The public health model of primary, secondary, and tertiary prevention was used as a basis for planning and developing mental health services in two settings. The resulting organizations proved effective in providing qualitative mental health services and in developing effective work groups throughout the organization to take responsibility for program. Experience with this model supports specialization of state hospitals into rehabilitation facilities and their close integration with programs in the communities they serve. It is proposed that this will require state hospital programs becoming the responsibility of local communities.     

An indigenous mental health program in remote Northwestern Ontario: development and training

This paper describes a shift in the focus of mental health services to remote Indian villages in Northwestern Ontario. Traditional indigenous counsellors are assuming control of this service, previously offered by non-Indian outsiders. The resources of the Federal Sioux Lookout Zone Hospital and psychiatrists from the University of Toronto are used in the ongoing training of the counsellors. Challenges encountered by outside non-Indian professionals providing relevant training and consultation to the area's natural helpers are described. This unique program has enjoyed enthusiastic acceptance by local people in helping positions.     

The Eye of the Beholder: Youths and Parents Differ on What Matters in Mental Health Services

The goal of this study was to examine the degree to which youths and caregivers attend to different factors in evaluating their experiences with mental health programs. Youth (n = 251) receiving mental health services at community agencies and their caregivers (n = 275) were asked open-ended questions regarding the positive and negative aspects of the services. Qualitative analyses revealed some agreement but also divergence between youth and caregivers regarding the criteria by which services were evaluated and aspects of services that were valued most highly. Youths’ positive comments primarily focused on treatment outcomes while caregivers focused more on characteristics of the program and provider. Youths’ negative comments reflected dissatisfaction with the program, provider, and types of services offered while caregivers expressed dissatisfaction mainly with program characteristics. Results support the importance of assessing both youth and caregivers in attempts to understand the factors used by consumers to evaluate youth mental health services.