The Pros And Cons Of The Promotion Of Community Mental Health

. In the 1960s, concurrent with the growing attention on mental health, the promotion of community mental health centers became a major federal initiative after the U.S. passed the Mental Retardation Facilities and Community Mental Health Centers Construction Act in 1963. The construction of mental health centers in local communities exploded. Their bold agenda in transitioning patients out of state psychiatric hospitals and into communities was aimed to promote more humane treatment and foster social reintegration (Blair & Espinoza, 2015). However, a negative and unforeseen consequence of the deinstitutionalization initiative was the resultant increase in the homeless population due to patients not seeking services in their community.
Federal Policies & Organizations. In 1965 President Lyndon Johnson signed into law the Medicare
and Medicaid Bills which was a great milestone for the elderly Americans. Medicare offered a comprehensive healthcare for people 65 and older, and Medicaid provided long-term care for the poor and disabled. Older adults were less likely to suffer from depression caused by their environment, because for the first time they were able to not worry about securing their basic needs. However, this amendment to the SSA had a bias towards long-term care because Medicare did not provide funding for it, only Medicaid did (Kaiser Family Foundation [KFF], 2015).
Another bill that affected American’s elders was the Community Mental Health Act of 1963 and the Social Security Amendments which created new models of inpatient and outpatient care reimbursement for mental health services. Although, services for mental health were being offered at an unprecedented level, chronically depressed older adults had problems paying for psychotherapy and antidepressants due to restrictions Medicare and Medicaid placed on psychiatric hospitalizations, payments for psychotropic and antidepressant medications, and inpatient care. Medicare and Medicaid created new needs for the chronically depressed older adults by facilitating discharges without having a plan in place for continuum care. As a result, since these elderly patients could no longer be admitted into psychiatric hospitals because they were all closing, nursing homes became the institution for elderly patients with depression and other psychiatric disorders (Blaire & Espinoza, 2015
Another federal policy that had a great impact on older adults was the Older Americans Act which created in 1965, the Administration on Aging, within the Department of Health, Education, and Welfare now called the Department of Health and Human services. This law was the base for financial aid by the federal government to assist states and local communities in meeting the needs of older adults. The act was designed to secure adequate income, physical and mental health of older adults, provide meaningful activities and services in the community and restorative services for those who require institutional care to name just a few (Allen, 2011).
1970’s
Socio-political Context. The 1970’s were no less troubling times for our country than the 1960’s. The great issues of civil rights, Vietnam, and counter-culture movements of that preceding decade respected no boundaries and spilled over to the 70’s with the added constitutional crisis of Watergate and the Middle East uncertainty thrown in for good measure.
In the 1970’s social workers were focused on expanding their profession as exhibited by NASW’s first nation-wide membership drive that occurred from 1973 to 1974. Social workers continued to be on the forefront of the civil rights movement promoting the rights of African Americans, women, and gays and lesbians. In reaction to the climate of the times, NASW launched in 1975 the National Committee on Racial and Ethnic Diversity (NCORED) which promoted and encouraged respect for the diversity of cultures, including equality of opportunity in all activities of the association.
Medical & Clinical Advancements.
Building on the advancements of the 1960’s, the nature-nurture debate about depression gained some leverage in 1971 when Martin Roth further describes the endogenous and reactive subtypes of depression. This is an important event because it distinguished reactive depression which is due to some unfortunate event in a person’s life from endogenous depression which is instigated by an internal psychological or neurological condition that does not require a disturbing environmental event (Zimmerman, Coryell, Pfohl, & Stangl, 1986).
In the 1970’s, several theories were introduced such as task-centered, environmental press, and risk and resilience which could all be applied in understanding the phenomenon of geriatric depression, as well inform social work practice. The task-centered approach was introduced by Reid and Epstein in the 1970’s and soon became the predominant treatment for depressed older adults in residential facilities (Dierking, Brown, & Fortune, 1980). The task-centered approach emphasized structure with well-defined activities for the achievement of practice objectives (Reid & Epstein,
1972).
One theory that was introduced was specifically constructed for gerontology was the environmental press theory. Lawton introduced this theory in 1978 and posited that depressed older adults lack the competencies (e.g. physical and functional health, cognitive and affective functioning, and sense of efficacy) that are needed to adapt to their changing environment (Lichtenberg, MacNeill, & Mast, 2000). The risk and resilience theory emerged in 1977 which would become the landmark multi-theoretical approach in social work for understanding how people maintain well-being despite adversity. The risk and resilience theory argued that geriatric depression was due to a lack of resilience in later life from life events such as diagnosis of illness, spousal loss, and loneliness. It prompted many preventative intervention studies in social work research which aimed at increasing resilience in aging to avoid depression in later life (Adams, Sanders, & Auth, 2004).