Herzl R. Spiro

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.

Anticonvulsant Activity and Selective Inhibition of NAD-Dependent Oxidations by 1,4-Disubstituted Piperazines

Several 1-(1-aryl-3-ethylthiocarbamido)-4-(arylaminothiocarbonyl)piperazines were synthesized, characterized by their sharp melting points and elemental analyses and evaluated for anticonvulsant activity. All disubstituted piperazines at a dose of 100 mg/kg i.p. provided 10-90% protection against pentylenetetrazol-induced convulsions in mice. These disubstituted piperazines selectively inhibited the in vitro oxidation of nicotinamide adenine dinucleotide (NAD)-dependent oxidation of pyruvate, alpha-ketoglutarate, beta-hydroxybutyrate and NADH by rat brain homogenates. The NAD-independent oxidation of succinate remained unaltered. The anticonvulsant activity possessed by disubstituted piperazines was unrelated with their ability to selectively inhibit respiratory activity of rat brain homogenates. Amongst 1-(substituted benzyl)-4-(substituted benzoyl)piperazines exhibiting central nervous system (1, 2) depressant activity it was found that 1-(2-chlorobenzyl)-4-(2-chlorobenzoyl)piperazine possessed maximum activity (2). The ability of piperazine carbamides (3) and piperazinothiocarbamides to possess anticonvulsant activity (4) prompted synthesis of 1-(1-aryl-3-ethylthiocarbamido)-4-(arylaminothiocarbonyl)piperazines and evaluation of their anticonvulsant activity. The effects of these disubstituted piperazines were also investigated on the in vitro respiratory activity of rat brain homogenates in an attempt to elucidate the biochemical mechanism of action for their anticonvulsant activity.

Correlation between Antiinflammatory and Antiproteolytic Properties of Substituted Benzylidenes

Twelve substituted benzylidenes were evaluated for antiinflammatory activity against carrageenin-induced edema in rats. The protection afforded by these compounds at a dose of 100 mg/kg, i.p., ranged from 30 to 60%. Sodium salicylate (100 mg/kg, i.p.), used as a reference drug, exhibited a 30% antiinflammatory activity under similar experimental conditions. The in vitro effects of substituted benzylidenes were also investigated on the activity of trypsin during hydrolysis of bovine serum albumin, serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, and endogenous lipid peroxide formation by liver homogenates. These results have provided some correlation between antiinflammatory and antiproteolytic properties of substituted benzylidenes.

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.