Community Mental Health Principles: A 40-Year Case Study

Community Mental Health Principles: A 40-Year Case Study

By the time Congress had passed the Community Mental Health Centers (CMHC) Act of 1963, community-based services for people with serious mental illnesses were in place in several locations around Missouri, and more were planned for the future. Beginning in 1960, the Missouri mental health agency developed detailed plans and budgets for the establishment of comprehensive community-based treatment centers that would shift acute mental healthcare away from state-operated mental hospitals. The availability of these plans thrust Missouri into the forefront of CMHC grant recipients, in both the public and private sectors.

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The 40th anniversary of President John F. Kennedy’s signing of the CMHC Act provided the backdrop for a review of the principles of the CMHC movement nationwide, and an analysis of the extent to which they still define community mental healthcare in this pioneering state. In early 2003, I interviewed 17 direct observers of the evolution of community mental healthcare in Missouri for their first-person reflections. These interviews were incorporated as a key element of my book Made in Missouri: The Community Mental Health Movement and Community Mental Health Centers 1963-2003. The range of their personal experiences spread from 1950 to the present. In addition, the CEOs of Missouri’s 22 private not-for-profit CMHCs contributed in-depth descriptions of program development in their service areas, including descriptions of current and planned programs. These interviews provide a unique case study of the viability of eight CMHC principles (listed below).

Responsibility for a specified population. This principle has been sustained in Missouri in large part because the Department of Mental Health (DMH) incorporated it as the first condition for designation of a local mental health center as the exclusive agent (known as administrative agent) of DMH funding in its service area. Over four decades, the number of service areas has been reduced and some CMHCs, especially in rural areas, have earned administrative agent status for several service areas.

Focus on prevention and early intervention. Missouri CMHCs were required to include prevention and early intervention in their service array (both hallmarks of the public health approach); it was a strategy to reduce demand for services over time. Unfortunately, federal funding for these services was not available until the CMHC program was well underway. In Missouri, state funding for primary prevention programs was suspended in the early 1980s because of budget cuts. Despite these obstacles, prevention and early intervention are alive and well in CMHCs throughout the state. In some cases, they are ongoing programs; in other cases, the concepts are embodied in immediate large-scale interventions on the scene of natural and man-made disasters.

Treating people with mental illnesses in their home communities. When asked about treating people in their home communities, Dr. Morty Lebedun, retired CEO of TriCounty Mental Health Services in North Kansas City, spoke for all Missouri CMHCs w………………..