At the intersection of lay and professional social networks: how community ties shape perceptions of mental health treatment providers (original) (raw)
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Expand the Community Care System: Deinstitutionalization Can Work
Psychiatric Services, 1985
The author argues that most of the mentally ill should be treated in the community, where they can develop the skills necessary to f unction in society. The state hospitals should be used only to treat the most unmanageable patients. The author blames the presently inadequate community care system on insufficient funding and on the tendency ofstates to divide newly available funds between community services andstate hospitals so that neither system is adequate. But whereas community care's problems can be resolved through greater commitment of f unds and other measures, the author contends, the shortcomings of the state system are built-in and intractable. He examines and refutes the arguments sup porting a return to the state hospital system. Should states expand the system of community-based care or attempt to rebuild the state hospital system? Historically both systems have been inadequately funded.
The meaning of community in community mental health
Journal of Community Psychology, 1986
Lake Forest College This article critically reviews the development of community mental health in both theory and practice and explores new directions and dilemmas for future policy and programs. First, we trace the dialectical development of the ideology of community mental health and the rediscovery of community. Second, we outline the two key transitions: (a) from professionals to natural helpers and (b) from catchment areas to natural networks. Third, we offer alternative conceptions of community from the sociological literature and suggest ways that these can benefit new program planning. We conclude with a series of policy questions that legitimate the expansion of community mental health beyond the parochial confines of the local community. Community mental health has emerged in the past two decades as an important perspective in both theory and practice in the provision of mental health services. The current approaches and programs in community mental health are already being reassessed. The purpose of this article is to aid this reassessment by focusing on the meaning of the concept of community as it has developed in theory and as it has been used to guide this practice. Specifically, we address four issues: (a) the search for a mental health ideology that led to the rediscovery of community; (b) the transition to community mental health that involved a movement from catchment areas to natural networks and from professionals to natural helpers; (c) the consideration of alternative conceptions of community, primarily from the sociological literature; and (d) the implications of the above for new policies and programs that include an assessment of the costs of community. We hope that this article will contribute both to a realistic evaluation and to consideration of alternative community intervention strategies. The Search for an Ideology The Initial Critique Changes in professional practices and theories often follow a dialectic of the following sort: Established programs come under attack for their most obvious and visible failures; questions are then raised about their supporting ideology or legitimating theory; new programs are tried experimentally; and new ideologies emerge to legitimate them. The continuing cycle of change in mental health practice and theory has followed a similar dialectic. Community mental health may be seen as both a reaction and an innovation. The chronology of events marking its development is difficult to disentangle because both The authors contributed equally to this paper. We are grateful to Dan A. Lewis and James G. Kelly for comments on earlier drafts. Portions of this paper were presented at the American Psychological Association convention, Washington, DC, August 1982. Reprint requests should be sent to Albert Hunter,
The Availability of Integrated Care in a National Sample of Therapeutic Communities
Journal of Behavioral Health Services & Research
Therapeutic communities (TCs) for substance abusers are oriented toward changing the entire person as a means for facilitating a drug-free future. This vision parallels ideas such as integrated care for the treatment of co-occurring substance abuse and psychiatric conditions. The extent to which integrated services are available in TCs has not been documented. Using data from a national sample of 345 TCs, this paper examines the availability of integrated care in TCs and the structural and cultural characteristics of TCs that offer integrated care. The results indicate that a substantial portion of TCs in this sample admit clients with co-occurring disorders (70.7%), and as many as half of the TCs offer integrated care. TCs that offer integrated care show increased use of professional staff, individual psychotherapy, and a less confrontational milieu, but notably, retain many of the “essential elements” of the traditional TC model.
Journal of Epidemiology & Community Health, 2007
Background: Community-care networks are a partnership between the local police force, housing corporations, general social services, specialised home care and mental healthcare services. The networks were set up to improve the healthcare for patients with (chronic) psychiatric problems through local cooperation between different agencies operating in underprivileged areas. Objective: To evaluate the effects of community-care networks on psychiatric emergency contacts, hospitalisation and involuntary admission. Design: An ecological intervention design was used, comparing neighbourhoods with and without a community-care network. Mean numbers and standardised ratios of psychiatric emergency contacts, hospitalisation rates and involuntary admissions were assessed over a 10-year period, covering the early stages and the years in which community-care networks were fully operational. Setting: Underprivileged neighbourhoods in the city of Rotterdam, The Netherlands. Patients: Inhabitants aged 20-64 years living in these neighbourhoods. Results: Standardised ratios for contact with psychiatric emergency services were higher in the neighbourhoods where community-care networks were set up (standardised ratios = 137, 95% CI 121 to 145 in the network neighbourhoods vs standardised ratios = 107, 95% CI 96 to 119 in the control neighbourhoods). Number of admissions and standardised ratios for involuntary admissions were lower in the community-care network neighbourhoods than in the control neighbourhoods (standardised ratios = 123, 95% CI 95 to 157 vs standardised ratios = 152, 95% CI 120 to 191). Conclusions: Community-care networks have a significant impact on the use of mental healthcare services. These networks may be an important tool in the prevention of involuntary admissions.
2007
Assertive Community Treatment (ACT) is considered the primary service-delivery vehicle for integrating individuals with severe mental illness into the community. Research on the model suggests that it has been helpful in aiding service users to achieve basic levels of integration including stabilized housing and maintaining financial and social security (Bond, Drake, Mueser & Latimer, 2001; Mueser, Bond, & Drake, 2001). However, critics of the model emphasize its limited success in enabling higher-order aspects of integration such as mainstream employment, recreation and socialization (Estroff, 1981; Gomory, 1998, 2001, 2002a, 2002b). These are fundamental criticisms given the significant investment in the model by policy makers. The rationale for the failure to promote higher-order integration typically rests on two central assumptions: a) service users are incapable of realizing full integration; and b) practitioners lack the training, skills, and philosophical base required to foster full integration. By focusing on the personal and professional characteristics of practitioners and service users, these views serve to obscure organizing structures operating at organizational, systemic, and social levels that encourage common ways of thinking about and carrying out community integration practice. The concern of this thesis is to explicate the impact of these organizing structures on the everyday practices engaged in by individual practitioners. In particular this thesis focuses on how practice becomes shaped by external structures that overrule both personal and professional values and intentions. The current study used the method of institutional ethnography to examine the impact of organizing structures of ACT in shaping how community integration practice is conceptualized, carried out, and Thank you to the members of my committee, Dr. Christine Overall, Dr. Will Boyce, and Dr. Margaret Jamieson, for the extensive time and effort you devoted to editing and commenting on numerous versions of this work. Your insightful feedback and support were integral in shaping this dissertation.
Who's in the lions' den?: The community's perception of community care for the mentally ill
Psychiatric Bulletin, 1996
Most long-stay patients discharged from psychiatric hospitals under community care policy are being accommodated in suburban communities. The communities' attitudes have a major bearing on the success of this policy. A census of perceptions of psychiatric services was conducted in two areas prior to the opening of long-stay supported houses for the mentally ill. Many respondents (37%) had a negative perception of psychiatric treatment in hospital. Most (82%) had heard of community care policy but few (29%) knew about the imminent opening of supported houses for the long-term mentally HI in their own street. Most respondents (66%) were against the closure of psychiatric hospitals and many saw It as a cost cutting exorcise. The majority agreed with the idea of long-stay patients being discharged into smaller units in the community although a substantial minority (20%) thought it would have a bad effect on the local community. An overwhelming majority of respondents (91%) thought i...
Collaboration Strategies for Reforming Systems of Care: A Toolkit for Community-Based Action
International Journal of Mental Health, 2005
The mental health delivery system in the United States is fragmented and disorganized resulting in inappropriate and inconstent care. The cost of mental illness has led to devastating effects on personal lives at an enormous financial cost. Successful community collaboration efforts are worth forming to enhance public health systems. Key stages of successful collaboration include identifying stakeholders, defining a shared vision, implementation, and developing momentum. Reforming systems of care begins at the local level as community collaboratives begin to develop their status in the community, become an important stakeholder voice, and promote action.