Somehow we have a dream that a stable and glorious future will open before us. It is unlikely. Our lives are not ours alone because we share it with family and intimates, but also must share it with the world at large which is not under our control. But the past has a way of reaching out to us which is not necessarily a bad thing. It may tell us about how the world is and such things as the variability of opportunity.
From My Past
In 1967 (yikes that’s a long time ago) I took a job in the inner city of Baltimore. I was one of the first people hired in one of the first community mental health programs in the country. I was just leaving Duke with my doctorate in hand and I was definitely ready to depart academia. The whole idea of community mental health was to bring mental health services to the public using a public health model. It was a marvelous idea.
Wait a Minute!
But there was not just one problem. Communities are different, and because of that the whole idea of applying the medical model to our inner lives was flawed and established practice is not so easily changed.
I was given an office and told to give service. But there was no one there except for a woman social worker. She led me out into the city and steadily the staff grew. Young professionals learned about the community and what it needed. It was tumultuous and fascinating.
Wait Another Minute!
But in some ways the least of our problem was adapting services to a poverty environment in chaos. An even larger problem proved to be the conservatism of the mental health establishment. All they wanted was the grant money and the glory of having landed funding for a “glamorous” enterprise. They had been providing services by psychiatric residents and medical students on six week rotations. We dug in our heels. The people of that community needed reliable ongoing services, not a series of inexperienced people passing out medication. Granted, our group of twenty somethings were inexperienced, but we were dedicated as a group to learning fast and meeting real needs.
What We Concluded
What we found was a need for life management in a form of partnership. Many “mental health” problems were an outgrowth of the dynamics of the poverty environment more than anything else. Of course, it was much more complicated than that but that is a rough outline. But we had found that a highly beneficial set of services and programs could have been focused.
In the End
At last though, those in power are in power after all. In time the bright eyed, groundbreaking young people moved on and the higher powers invoked a retrenchment. The community based clinics were closed, staff was withdrawn to a central building and business as usual restored.
Across the country the reform movement of that era was coming to an end. And with its end came the end of community mental health. I tell the whole story in my book Whatever Happened to Community Mental Health.
Now the Lesson
Yes, community mental health came too soon and its time is still not yet at least until we get through our present upheaval when a younger generation with vision may take power.
But, looking back we can see something. On the street we learned a huge amount about such communities, but all the data was kept in our heads and used to formulate a highly focused, problem solving service system. If a system with managers of more vision were to be devised now, the information technology at our fingertips could help us sift, store, integrate and develop data for a viable system. And it could be adapted to fit the community at hand—whatever its form. Then we would truly have a community mental health system, but probably with a more refined name. And if we had had information technology we could have documented and built.
Coming back to one of my original points, I can see that something from the past can be brought forward to a much more adapted use at a future time when new tools and vision are available.
What recognitions are you bringing forward?