Administrative problems in establishing a community mental health program.

Abstract

N 1952, the Division of Mental Hygiene, of the Massachusetts Depart ment of Mental Health, shifted its program from one of traveling child guidance clinics and traveling school clinics which met in various cities and towns on a part-time basis to a program of locally cosponsored community mental health centers (1). These centers were to be located in the communi ties which they served and generally were to have a population coverage of about 150,000 persons. The office space, secretarial help, and basic supplies were to be provided by a local mental health association made up of inter ested lay and professional participants, while the basic professional team was to be supplied and paid by the Division. The Division of Mental Hygiene de veloped a community organization section which was to help communities interested in such programs to develop associations or other supporting agencies. The philosophy of the Division was that this change in approach was basically aimed toward a partnership between local communities and the State, with both playing an equal role in the development and fu nction ing of the centers and with flexibility to meet the individual needs of local areas.The concept of "community psychiatry" or "preventive psychiatry" was the foundation upon which the Massachusetts Division of Mental Hygiene built its area mental health center program. One of the key features of this concept was crystallized in a new role-that of a mental health consultant who was to work at the community level rather than within the center (2). This individual was to work closely with community groups and caretaking agents who were involved directly with children and their families in health, educational and other settings. The consultation fu nction was seen as lying in the area between that of the traditional clinical fu nction and that of the mental health educator. This was to be a fourth member of the psychiatric team, in addition to the psychiatrist, clinical psychologist and psychiatric social worker ( 3).The change in program philosophy, with the mental health consultant in a key role, was based on various fa ctors, not the least of which was the obser vation that the previous traveling school clinics had not been fu lly effective • Portions of this paper were originally presented as a case study at the 1959 Annual Meeting, and were incorporated into this more general discussion which was presented at the 1959 Annual Meeting of the American Public Health Association. t Chief Mental Health Coordinator. t Supervisor of Community Mental Retardation Centers.

The organization and development of a community mental health program for children: A case study.

“…Some programs have been total-purpose in their em phasis, including both children and adults, as well as developing closer relationships with state hospitals and their aftercare programs (11,12). Others have emphasized the preventive and promotional aspects of mental health, and focused their attention upon children and their families (3,9,15). Massachusetts has had a long history of traveling school clinics and child guid ance clinics under the auspices of the Division of Mental Hygiene (17).…”

“…Massachusetts has had a long history of traveling school clinics and child guid ance clinics under the auspices of the Division of Mental Hygiene (17). How ever, in 1952, it shifted its program to a more public-health-oriented basis, and began to develop a community mental health program for children in partner-ship with local mental health associa tions (3,9,15). Previous articles have described the method of community or ganization (9), the techniques of the mental health consultant in his new role in prevention and case-finding (1,7,8), and some of the administrative problems in developing such a large scale program and relating it to other programs for the retarded and the psychotic (2,3,4,5).…”

“…In many states, there are laws regulating special class education for the mentally re tarded, as well as the certification and standardization of school psychologists and school social workers. There have been a number of papers describing these new developments and the general problems which may ensue from the interaction of school-based programs and separate community-based pro grams (3,5,16).…”