It is now over 50 years later than when I went to work in Baltimore. For me time offers not perspective as much as confirmation. The only perspective I find is that I can now clearly see the roots of my deep mistrust of the truth and wisdom of older white men. In fairness there is diversity among them but in our present age the fact of their rule is distressing in so many regards.
Designing a Delivery System
The community mental health movement came with a multi-part design. I was stationed in an outpatient facility which meant I was to consult with the community and deliver services. That seems simple enough. Go out and get acquainted so you get referrals and then give therapy with the psychiatrists giving medication as necessary. What fools we mortals be!
What we found immediately was that we had a lot of learning to do. The community was challenging to put it mildly. They were in serious need and mental health services were not at the top of their list.
The Existing System
There already was a mental health system in place. At the hospital nearby people could come for service. Since it was a medical school there were medical students who often were giving service in six week rotations—with little prior experience. Then there were residents. I’ll save you the agony of all the details but they were not acquainted with the needs of the community either and so could not respond effectively.
At the time psychiatric residents were committed to giving intensive psychotherapy. The local residents were not exactly candidates so they often simply got medication. We immediately found a fundamental truth. The biggest enemy of mental health in the area was the stress of poverty. So they suffered from depression and anxiety. Duh!!!
The System We Designed
Each of us took a morning walk-in clinic. We assessed the person’s problems and then spent the afternoon on the phone arranging appropriate services and getting information about availability among a lot of other things. For example, if they had a physically ill child who was not getting service or inappropriate service we sought appropriate help. Every center had a Vocational Rehabilitation Counselor who got a lot of referrals. Very many of these people needed training and/or education. A job or a better job had a very beneficial effect on their mental health along with the experience of hope.
Not So Simple
Did we have the support of higher ups? Sometimes, but often not. The older white men generally wanted to preserve the existing system and were primarily interested in the aura of getting the money for a grant to a new glamorous type of program. They loved the aura and wanted to look good to each other. Daily we were in the position of fending off orientations and demands which did not serve our community well. One of my common responses was “We’ll get back to you” or ”Let me look at alternatives.”
Allies With the Community
We had to develop relationships with the community so we could respond to their real needs. In that era of the beginning of the civil right movement the community became contentious and interesting. Assertions of community needs and objections to the mistreatment of black men began at that time. There were issues about health services. At one point growing activism led to a difficult public hearing and I found myself sitting next to the state head of the mental health system who was clueless. Other times we were visited by arrogant “consultants” from Washington who we had to endure.
I’ll leave it there for now. It was rough and tumble and never-ending as we fought for the people of the community. You might think we would have had allies from the professions but they were too often few and far between.
Another Major Wave of Change
In some ways we didn’t understand what we were seeing either. In the end the establishment brought down the community mental health movement. As the young rebels left, the clinics in the community were closed and the old ways resumed. I tell the full story in my book Whatever Happened to Community Mental Health.
But two things came out of the era that proved to have a long wave and import for our future. One was the civil rights movement and in the next post I’ll go into the other one.
Gaia’s Majesty-Mission Called: Women in Power by Roger B. Burt
Roger B. Burt’s Amazon home page
Creating Characters and Plots by Roger B. Burt
Stepfamilies: Professionals and Stepcouples in Partnership
Whatever Happened to Community Mental Health by Roger B. Burt