INTRODUCTION AND HISTORY OF COMMUNITY PSYCHOLOGY:THE ENVIRONMENT

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Clinical Psychology (PSY401)

Lecture 37

INTRODUCTION AND HISTORY OF COMMUNITY PSYCHOLOGY

At least since the appearance of psychoanalysis, the helping professions have sought to alleviate problems

by one form of therapy or another. Some approaches have emphasized insight; others have sought to change

behavior more directly. Whatever the differences in approaches, their basic common focus has been on the

individual who has already developed psychological problems. By and large, clinical psychology has been a

psychology of the individual.

At the theoretical level, therapists have long accepted the idea that all behavior (pathological or otherwise)

is a joint product of situational and personal factors. Yet in their day-to-day therapeutic efforts, the

emphasis of clinicians was generally on one-to-one therapy of some sort. The troubled individual engaged

the help of an expert, and by this act he or she submitted to the role of patient. The clinician treated; the

patient responded. However, given the rate of mental health problems in the world today, some have

questioned whether this general approach is a reasonable one. For them, a relatively newer approach,

community psychology, shows great promise for addressing mental health problems.

PRINCIPLES OF COMMUNITY PSYCHOLOGY

What "causes" problems?

Problems develop due to an interaction over time between the individual, social setting, and systems (e.g.,

organizations); these exert a mutual influence on each other.

How are problems defined?

Problems can be defined at many levels, but particular emphasis is placed on analysis at the level of the

organization and the community or neighborhood.

Where is community psychology practiced?

Community psychology is typically not practiced in clinics, but rather out in the field or in the social

context of interest.

How are services planned?

Rather than providing services only for those who seek help, community psychologists proactively assess

the needs and risks in a community.

What is the emphasis in community psychology interventions?

An emphasis is placed on prevention of problems rather than treatment of existing problems.

Who is qualified to intervene?

Attempts are made to share psychology with others via consultation; actual interventions are often carried

out through self-help programs or through trained non-psychologists/

HISTORY

Let us begin by trying to identify exactly that community psychology is. Then we can move to those events

that gave rise to the movement. Given above are the set of principles that characterize community

psychology, including assumptions regarding the causes of problems, the variety of levels of analysis that

can be used to define a problem, where community psychology is practiced, how services are planned, the

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emphasis on prevention, and the willingness to "give psychology away" by consulting with self help

programs and non psychologists.

THE COMMUNITY PSYCHOLOGY PERSPECTIVE

Community psychology has been described as an approach to mental health that emphasizes the role of

environmental forces in creating and alleviating problems (Zax & Specter, 1974). Rappaport (1977) finds it

more useful to talk about community psychology in terms of a perspective than to attempt a formal

definition. The major aspects of this perspective are cultural relativity, diversity, and ecology (the fit

between persons and the environment).

This perspective implies several things.

First, community psychologists should not be concerned exclusively with inadequate environments or

persons. Rather, they should direct their attention to the fit between environments and persons-a fit that may

or may not be good.

Second, community psychologists should emphasize the creation of alternatives through identifying and

developing the resources and strengths of people and communities. Thus, the focus is on action directed

toward the competencies of persons and environments rather than their deficits.

Third, the community psychologist is likely to believe that differences among people and communities are

desirable. Societal resources, therefore, should not be allocated according to one standard of competence.

The community psychologist does not become identified with a single social norm or value, but instead

looks to the promotion of diversity.

In Rappaport's (1977) view, three sets of concerns define the community psychology perspective: human

resource development, political activity, and science. In many ways, these are antagonistic elements.

Political activists are often impatient and deride more traditional clinicians as bringing society too little too

late. Clinicians, in turn, often criticize activists as unprofessional and overly concerned with hawking their

own visions of the world. Both groups often regard scientists as too far removed from real problems to

know what is going on in the world (the "ivory tower" syndrome).

The scientists, in turn are appalled by activists and clinicians alike; both are seen as shockingly willing to

act on the basis of invalidated hunches and lack of data or, worst of all, without a viable theory to guide

them. However, true societal changes vis-a-vis mental health will require the cooperation of each of these

"camps." For example, scientists must provide data to support and direct the efforts of clinicians and

political activists, and political activists must assist with funding for scientists so that they can conduct the

research that is needed. After all, each camp has the common goal of improved well-being and mental

health for individuals, communities, and the larger society.

Whatever else community psychology may be, it is not a field that emphasizes an individual disease or

individual treatment model (Iscoe, 1982). The focus is preventive rather than curative. Further, individuals

and community organizations are encouraged to take control of and master their own problems (via

empowerment) so that traditional professional intervention will not be necessary (Orford, 1992).

CHRONOLOGY AND CATALYZING EVENTS

In 1955, the U.S. Congress passed legislation creating the joint Commission on Mental Health and Illness.

Its report encouraged the development of a community mental health concept and urged a reduction in the

population of mental hospitals.' Based on the premise that psychological distress and the development of

mental disorders were influenced by adverse environmental conditions, President Kennedy called for a

"bold new approach" to prevent mental disorder. The so-called Kennedy Bill of 1963 funded the

construction of mental health centers. Their aims were to promote the early detection of mental health

problems, treat acute disorders, and establish comprehensive delivery systems of services that would

prevent the "warehousing" of chronic patients in mental hospitals (Bloom, 1973).

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The American Psychological Association endorsed the desirability of community residents' participating in

all these decisions (Smith & Hobbs, 1966) and helped focus attention on the concept of community

approaches and participation. A conference held in 1965 is regarded by many as the "official" birth of

community psychology (Zax & Specter, 1974). At Swampscott, Massachusetts, a group of psychologists set

out to review the status of the field and to plot a future course of development for the place of psychology in

the community mental health movement.

Shortly after this conference, the Division of Community Psychology was organized within the American

Psychological Association. Soon The Community Mental Health Journal and the American Journal of

Community Psychology began publication. Textbooks began to appear, including books by Zax and

Specter (1974), Heller and Monahan (1977), Rappaport (1977), Mann (1978), Heller, Price, Reinharz,

Riger, and Wandersman (1984), and more recently, Orford (1992), Duffy and Wong (1996), and Levine

and Perkins (1997). Reviews began to appear regularly in the Annual Review of Psychology, and handbooks

have been published. Courses in community psychology and programs of graduate training have been

established, and there are even books now on the history of community mental health.

To flesh out the foregoing chronology, it will be helpful to pinpoint several issues or concerns that have

catalyzed the emergence of community psychology.

TREATMENT FACILITIES:

Although the mental hospital population in the United States peaked at about 500,000 in the mid-1950s,

socially oriented clinicians continued to press for alternatives to the costly, inefficient, and often largely

custodial hospitalization of patients. Three factors combined at about this time to markedly reduce the

population of mental hospitals: the advent of psychotropic medications, a more liberal discharge

philosophy, and better treatment in mental hospitals. But as more patients were being discharged, often

under heavy medication, and as patients who formerly would have been hospitalized were no longer

admitted, the need for better community treatment and supportive services became evident. In some ways a

cause but in other ways and effect of these events, the community philosophy was beginning to gain a

foothold.

A problem with many mental hospitals was their lack of trained therapists. Regarded by laypersons as a

realistic means for solving difficult emotional problems, hospitalization itself often created nearly as many

problems as it alleviated. Over the years, mental hospitals (particularly those run by the states) too often

became warehouses or custodial bins. Care was often marginal and sometimes downright inhumane. Pro-

fessional staff was severely lacking in numbers and sometimes in quality. Indeed, many still argue (and

have demonstrated empirically) that hospitalization is not an especially effective treatment strategy.

PERSONNEL SHORTAGE:

Even as more clinical psychologists and psychiatrists were trained; demands for their services outstripped

their increase in numbers. Many of the newcomers were entering private practice, and others were being

diverted into teaching or research. In any event, the supply of trained professionals for service in hospitals

and clinics was hardly keeping pace with the demand. A number of trends (Albee, 1959, 1968; Arnhoff,

1968) all seemed to coalesce to produce critical shortages of hospital and clinic personnel. To grapple with

these shortages, it became imperative that new sources of personnel be sought, that more effective use be

made of professional time, and that new models of coping with human problems be developed. Albee

(1959, 1968) predicted that it would be literally impossible to train enough mental health professionals to

meet existing and future needs, and recommended that prevention be pursued as a strategy.

QUESTIONS AROUND PSYCHOTHERAPY:

In the 1950s, people began to question not just the efficiency of psychotherapy but also its effectiveness.

Some began to wonder if it was not just intra psychic factors that created problems, but the interaction

between person and society. At the same time, because psychotherapy was expensive and more and more

clinicians and psychiatrists were going into private practice, economic factors were pushing therapy beyond

the reach of the poor and disadvantaged. The relationship between mental illness and social class had been

documented by Hollingshead and Redlich (1958). Now, it seemed, there was also a relationship between

social class and the availability of psychotherapy.

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ROLE OF THE MEDICAL MODEL:

We know the widespread role of the medical model and some of the discontent with it. The 1960s ushered

in a climate in which institutional prerogatives and traditionalist beliefs came under attack. That climate

produced listeners who were more willing to accept attacks on traditional views about mental illness. All of

this contributed to an increased tendency to look for the social-community antecedents of problems in

lining, rather than internal biological or psychological etiological agents.

The general activism of the 1960s also catalyzed the long-standing discontent of many clinicians with a role

that relegated them to waiting passively for society's casualties to walk in the door. Would not an activist

role that took mental health services to the people be more consonant with a social-community model? If

so, such a role would also provide a measure of autonomy from the dominance of the medical profession.

We must not overstate these developments, however. After all a major current trend in clinical psychology

has been a headlong rush into private practice. Such behavior is hardly a rejection of the medical model or

an acceptance of the social-community approach.

THE ENVIRONMENT:

Another force that helped shape the community psychology movement was a greater awareness of the

importance of social and environmental factors in determining people's behavior and problems. Poverty,

discrimination, pollution, and crowding were being recognized as potent factors. Providing people with

choices and enhancing their well-being required that psychologists pay attention to these factors that they

go beyond a reflexive consideration of the early childhood determinants of people's personalities.

The emotional problems of large numbers of people may be influenced by poverty, unemployment, job dis-

crimination, racism, diminished educational opportunities, sexism, and other social factors. Such influences

are hardly the ones proposed by psychoanalytic and other theories that seek answers in internal dynamics.

To this point, we have tried to sketch an overall perspective and chronology of community psychology. In

the process, we have alluded to several important concepts. Now we will take a closer look at some of these

concepts.

THE CONCEPT OF COMMUNITY MENTAL HEALTH

The 1955 Joint Commission on Mental Health and Illness made several basic recommendations that set the

tone for the subsequent development of community psychology-a tone that still resonates in accord with

political and financial pressures across the nation. These recommendations were

(1) More and better research into mental health phenomena;

(2) A broadened definition of who may provide mental health services;

(3) That mental health services should be made available in the community;

(4) That an awareness should be fostered that mental illness can stem from social factors (such as ostracism

and isolation); and

(5) That the federal government should support these recommendations financially.

In 1963, federal funds were provided to help in the construction and staffing of comprehensive mental

health centers across the United States. To qualify for these funds, a community mental health center had

to provide five essential services:

(1) Inpatient care;

(2) Outpatient care;

(3) Partial hospitalization (for example, the patient works during the day but returns to the hospital at night);

(4) Round-the-clock emergency service; and

(5) Consultation services to a variety of professional, educational, and service personnel in the community.

Beyond these required services, it was hoped that the mental health centers would also provide

(1) Diagnostic services,

(2) Rehabilitation services,

(3) Research,

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(4) Training, and

(5) Evaluation.

THE CONCEPT OF PREVENTION

The idea of prevention is the guiding principle that has long been at the heart of public health programs in

this country. Basically, the principle asserts that, in the long run, preventive activities will be more efficient

and effective than individual treatment administered after the onset of diseases or problems (Felner, Jason,

Moritsugu, & Farber, 1983). That such approaches can work is graphically illustrated by Price, Cowen,

Lorion, and Ramos-McKay (1988). Their book, Fourteen Ounces of Prevention, describes 14 model

prevention programs for children, adolescents, or adults. Prevention programs for adults have been de-

veloped and implemented as well.

Primary Prevention:

This type of prevention represents the most radical departure from the traditional ways of coping with

mental health problems. The essence of the notion-of primary prevention can be seen in Caplan's (1964)

emphasis on "counteracting harmful circumstances before they have had a chance to produce illness".

Albee (1986) points out, however, that the complexity of human problems often requires preventive

strategies that depend on social change and redistribution of power. For many in society, this is not a highly

palatable prospect. Some examples of primary prevention include programs to reduce job discrimination,

enhance school curricula, improve housing, teach parenting skills, and provide help to children from single-

parent homes. Also grouped under this heading are genetic counseling, Head Start, prenatal care for

disadvantaged women, Meals on Wheels, and school lunch programs.

Secondary Prevention:

This involves programs that promote the early identification of mental health problems and prompt

treatment of problems at an early stage so that mental disorders do not develop. The basic idea of secondary

prevention is to attack problems while they are still manageable, before they become resistant to

intervention. Often this approach suggests the screening of large numbers of people. These people are not

seeking help, and they may not even appear to be at risk. Such screening may be carried out by a variety of

community service personnel, including physicians, teachers, clergy, police, court officials, social workers,

and others. Early assessment is followed, of course, by appropriate referrals.

An example of secondary prevention is the early detection and treatment of those individuals with

potentially damaging drinking problems (Alden, 1988). A further example is the Rochester Primary Mental

Health Project pioneered by Emory Cowen, which began in 1957. The project systematically screens

primary-grade children for risk of school maladjustment. The development of early detection and

prevention programs in several states has been described by Cowen, Hightower, Johnson, Sarno, and

Weissberg (1989).

Tertiary Prevention:

The goal of tertiary prevention is to reduce the duration and the negative effects of mental disorders after

their occurrence. Thus, tertiary prevention differs from primary and secondary prevention in that its aim is

not to reduce the rate of new cases of mental disorder, but to lessen the effects of mental disorder once

diagnosed.

A major focus of many tertiary programs is rehabilitation. This can range from increasing vocational

competence to enhancing the client's self-concept. The methods used may be counseling, job training, and

the like. Whether the purpose of a program is to teach better independent living skills to those with mental

retardation or to restore the social skills of recently discharged patient with a diagnosis of schizophrenia, the

goal is the prevention of additional problems. Although their language is a bit different, tertiary preventive

programs are not very different from person-oriented programs based on a deficit philosophy. However, it is

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important to remember that all forms of prevention are distinguished by their attempts to reduce the rates of,

or problems associated with, mental disorder on a community-wide (or population-wide) basis.

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