COMMUNITY MENTAL HEALTH CENTERS

In 1963 Congress passed the Community Mental Health Centers Act, authorizing an appropriation of 150 million dollars to finance up to two-thirds of the cost of construction of comprehensive treatment facilities in communities throughout the country. This act was the direct outcome of COMMUNITY PSYCHIATRY President Kennedy’s message to Congress asking for “a bold new approach,” as well as recommendations made by the Joint Commission on Mental Illness and Health in 1961, and by the National Congress on Mental Illness and Health held by the American Medical Association in 1962. The object of these centers is to offer a practical alternative to the inadequate and costly custodial care generally given mental patients: “The persons treated in these community centers need never leave home for the strange and lonely mental hospital which for years has been a world apart.” The entire plan has been made possible by the development of new techniques, such as tranquilizing drugs, and by the growing evidence that many people who would ordinarily be “put away” can be treated through part-time hospitalization or outpatient care in their own communities. Experiments along these lines led to the idea of assembling all services into one community entity, so that treatment could be individually tailored to the patient’s needs and given without having him leave his family or, in most cases, his job or school. According to present proposals, the plan for each center must be an integral part of a comprehensive state plan, but it must at the same time reflect the special needs and resources of each community. In general, a comprehensive mental health center should offer these services, though not necessarily under one roof: (1) Inpatient treatment for emergency cases, or those needing twenty-four-hour care for a limited time; (2) outpatient programs offering individual and group treatment to adults, children, and families without a waiting period; (3) hospitalization on a day basis for patients able to return home at night and on weekends, and on a night basis for those who can work or attend school; (4) consultation to physicians, clergymen, schools, health departments, and welfare agencies concerning emotional problems of individuals; (5) full diagnostic services prior to admission; (6) rehabilitation through vocational, educational, and social programs for both current patients and former hospital patients; (7) pre-care and aftercare, including foster homes or halfway houses, and home visiting; (8) training for all types of mental health personnel; (9) research and evaluation of results. Implementation of these services will require a full complement of psychiatrists, general practitioners, clinical psychologists, psychiatric social workers, mental health nurses, occupational therapists and counselors, research specialists, and volunteers from the community. Although the federal government provides most of the funds for planning and building these centers, local communities must supply the leadership that will secure public acceptance, and the unified direction that is necessary to co-ordinate all services into one all- embracing agency. So far it has been found that a new center can best get its start through expanding the services of an existing agency, such as a general hospital which already provides inpatient, outpatient, day, night, and home care; a county health department already providing clinics, rehabilitation service and specialized treatment units for alcoholics, delinquents and disturbed children; or a community or county psychiatric center that offers emergency treatment, family therapy, and consultation to agencies, courts and schools. In some areas, however, a comprehensive center may have to start from scratch by developing a basic treatment program on an inpatient, outpatient, and day-care basis. In any case, it is hoped that the concept of community care will usher in a new era in dealing with the mental health problem. See JOINT COMMISSION ON MENTAL ILLNESS AND HEALTH.