Community Mental Health

Edward Seidman and Sabine Elizabeth French

New York University

I. Origins of the Community Mental Health Movement in Twentieth-Century America

II. Principles of Prevention

III. Tertiary Prevention

IV. Secondary Prevention

V. Primary Prevention

VI. Promotion of Well-Being

VII. Conclusions

Deinstitutionalization The movement to reduce the number of patients kept in mental institutions by releasing them to the care of the community. The original intention of this movement was to maintain former patients in the community with a wide array of comprehensive and supportive services. Inoculation Programs Programs that are designed to build and strengthen skills in groups of individuals in order to protect them from, and prepare them for, future difficulties.

Primary Prevention Programs that intervene with a population or setting to reduce the incidence, number of new cases, of one or more emotional disorders. Promotion of Well-Being Programs that foster the development of healthy environments that encourage positive mental health; in turn, these programs reduce the incidence of one or more psychiatric disorders in the population or setting.

Restructuring The alteration of the unwritten rules of a setting in order to facilitate the development of new rules and an environment that facilitates positive mental health; indirectly, such a change reduces the incidence of disorder in the setting.

Risk and Protective Factors Circumstances in an individual's life, a population, or setting that either increase or decrease the chances of suffering from or manifesting problems-in-living. Stressful life events, for example, death of a parent or divorce, and daily hassles are common risk factors, while positive social support is a common protective factor. Secondary Prevention Programs that identify early signs of a disorder and intervene quickly or at the point of a crisis to short-circuit the problem from developing into a full-blown mental health problem. Tertiary Prevention Programs that intervene directly with patients to reduce the duration of their career as a patient, that is, to rehabilitate or treat them; thereby reducing the prevalence of psychiatric disorder in the community.

The confluence of two salient events in the early 1960s—efforts to deinstitutionalize the chronically mentally ill and legislation to create COMMUNITY MENTAL HEALTH centers across the nation— launched the community mental health movement. With the aide of a prevention framework adapted from the field of public health, this movement has continued to evolve and grow. Initial emphases on tertiary prevention, often in the form of alternative community-based methods of treatment for the severely mentally ill, were followed by efforts aimed at early detection and intervention (secondary prevention), for example, suicide prevention telephone ''hotlines.'' In both tertiary and secondary forms of prevention, emotional and behavioral problems, or early antecedents thereof,

Community Mental Health continued to be identified at the level of the individual. Interventions were implemented within institutions in contrast to within communities. However, to reduce the incidence of disorder in the population, primary prevention programs aimed at communities, population groups, or settings were developed and implemented. The positive concept of promoting well-being was a further evolution from the notion of preventing disorder. This article describes, explains, and illustrates with exemplary programs the evolution from tertiary prevention to the promotion of well-being that has characterized the community mental health movement during the second half of the twentieth century.

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