Arthur J. Naparstek

Neighborhood networks for humane mental health care

One.- 1 In Search of a Human Scale.- 2 The Need for a Micromodel.- 3 Alienation and Community: People, Policy, and Power.- 4 Cycles and Circles: An Overview of Federal Policies in Mental Health and Human Services.- 5 Achieving Human Scale: A Policy Framework for Building Partnerships.- Two.- 6 Preliminary Assumptions and Principles.- 7 The Model: A Community Mental Health Empowerment Model.- 8 First Stages: Methodology, Organization, and Evaluative Data Prior to Empowerment.- 9 The Model in Action - Baltimore.- 10 The Model in Action-Providence and Milwaukee.- 11 Advantages of a Neighborhood Support Systems Approach.- 12 Issues and Limitations.- 13 A Direction for the Next Decade.- Appendix: Survey Instrument-Community Leader and Helper Survey.- References.

Alienation and Community

Alienation and community are central concepts of the modern political and social sciences. Each term is laden with value implications; each is open to a confusing array of applications. Although many studies and policy papers have employed the community or the neighborhood as their focal point, no single definition of either term has won universal acceptance. Many definitions that work well in a single theoretical construct have proven difficult in practice. The neighborhood has recently been idealized in popular culture as a bygone urban Utopia, suitable for nostalgic reminiscence and panegyric, not as an arena for hardheaded political action. We have a number of useful and/or attractive definitions, none of which may be reliably employed in all circumstances. How one uses the terms obviously depends on what one wishes to do with them.

The Neighborhood and Family Services Project

There is a growing realization today that mental health problems cannot be met by the services of professionals alone. The Report to the President from the President’s Commission on Mental Health (1978) states that despite improvements in the current mental health service system, there are millions of Americans who remain unserved, underserved, or inappropriately served. Among those groups most underserved, as noted by the commission, are ethnic and racial minorities, the aged, and the urban poor. The commission specifically stresses the importance of community support systems (informal helping networks including friends, clergy, natural helpers, self-help groups, etc.) in meeting the needs of underserved populations and generally strengthening and maintaining the mental health of the citizenry.

The Model in Action—Providence and Milwaukee

The two original target cities in our project were Baltimore, Maryland, and Providence, Rhode Island, where we expected to work through existing community organizations. Planning commenced several years before the formal submission of a grant application to NIMH in 1974. In 1972 and 1973, community groups had been contacted to assess potential interest.

A Direction for the Next Decade

The empowerment of the voluntary and community sectors and the disencumberment of large, complex health institutions from clumsy government operation are the two principal issues confronting us in the field of mental health in the 1980s.

Preliminary Assumptions and Principles

The Community Mental Health Empowerment Model is based on a framework of assumptions and principles supported by a significant body of literature. Research outlined in this chapter touches upon issues of social class, ethnicity, and mental health; underserved and inadequately served population groups; community support systems; competency and power; and community and professional roles. While it is not intended to be a review of all pertinent literature in these areas, the summary here demonstrates that the assumptions underlying the authors’ model are logically based on previous work.

Issues and Limitations

The Community Empowerment Model is not a panacea for the community mental health movement or a blueprint that all other communities ought to follow step-by-step. This was a useful, successful experience, but a model cannot serve as all things to all people. The critical reader will by now recognize that there are inherent limitations in this model as in others. Moreover, these are difficult issues that must be addressed in any effort to adopt the model to other neighborhoods. Some of these concerns have been raised at conference presentations of the project. Agency professionals have posed others, and project staff have also cited issues that need to be dealt with in efforts to adopt these ideas and examples elsewhere. This chapter addresses the chief issues and limitations identified in the practical implementation and testing of the model, as well as our consideration of the limits of the conceptual framework.

The Model in Action—Baltimore

South East Baltimore is a community known throughout the city for its ethnic diversity. People of Polish, Czechoslovakian, Russian, German, Greek, and Italian origin are all found here. In 1970, over 99,000 people—comprising 11% of the city’s population—lived in South East, most of them in well-kept rowhouses, some of which date back to the late eighteenth century.

Achieving Human Scale

Mental health professionals have earnestly sought to bring services into the community arena. Although the community mental health movement has had a profound impact on service delivery, neither providers nor consumers have been satisfied with developments during the past decade. Services tend to be delivered in a fragmented manner. They are often offered in an inefocient, duplicative, and bureaucratically confusing fashion. There is a distinct lack of accountability in the various delivery systems. There is failure to minister to prolonged needs or even to provide comprehensive analysis of clients’ problems.

The Need for a Micromodel

Mental health and human services are being reassessed once again today. But the purpose of these studies is in good part misdirected. Analysts are attempting to define issues in a period of economic scarcity. Distribution of services has historically tended to follow the dollar. Consequently, major emphasis has been placed on such matters as financial accountability, cost effectiveness, and efficiency. These are salient “dollar issues,” which one must not lose sight of, but such fiscal exercises offer no service insights.