Thoughtful design makes a concise but complete community health center.
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Community mental health centers have been held back by authoritarian administrative structures, inherited from the traditional medical model, from fulfilling their original promise of innovative approaches to mental health and responsiveness to the community. This is a 10-year case history of one mental health center's struggle "to put its own house in order" to further staff morale, productivity, more egalitarian attitudes toward clients, and a sense of partnership with each other and the community. The paper shows the development of democratic structures and processes, how line staff and administrators confronted their taboo on power, the traditional hierarchy among disciplines, staff participation in administration, and their vulnerability within the wider bureaucratic system.
Community participation is a frequently discussed and controversial aspect of the community mental health center program. To many professionals and lay people, the community mental health center concept includes a basic commitment to a participatory process of the community in the planning and implementation of the community mental health center program. However, this commitment is not readily evident in the federal and Pennsylvania regulations. This paper presents an approach taken by the Philadelphia Office of Mental Health and Mental Retardation to insure that its 13 centers and base service units have a meaningful partnership with their catchment area communities. Specifically the paper presents the community participation regulations developed by the Philadelphia office, as well as the conditions that led to the development of these regulations. A conclusion of the paper is that additional regulations are needed to insure that community participation becomes an integral part of the community mental health center program.
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In this paper the belief that nonprofit service organizations and profit-motivated organizations should function separately from each other is questioned. Several of the advantages inherent from a cooperative relationship between comprehensive community mental health centers and the business community for the worker, mental health professional, comprehensive community mental health center, and business are discussed. Possible negative emotional responses against this new alliance are presented and dispelled. A joint effort between comprehensive community mental health centers and the business community is anticipated to develop with the common goal being the promotion of mental health.
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In 1970, a community-based and federally funded dental program was established in Boston. The multiple objectives of this program included the following: provision of dental treatment; education of schoolchildren in dental health; support for community measures of prevention such as water fluoridation; support of job training programs in dental assisting for community residents; employment of community people; and sensitization and training in community health for dental students and auxiliaries. The program provided a number of dental services at a reasonable benefit-cost ratio of 0.87. Other endeavors included the development of a dental health program with community schools and the involvement of dental students in the delivery of care and in screening for children with dental treatment needs.
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Many community mental health centers face seriuos financial problems as they near the end of the federal funding period. The author describes the developments surrounding an extended financial crisis at an inner-city mental health center that eventually was forced to close. Using a crisis theory framework, she examines staff reactions to the crisis and proposes an intervention model in which a consultant is employed to help staff identify and avoid maladaptive coping behavior.
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