Chapter 33: Understanding Governmental Structures for Mental Health by D. Ozarin
Planning and delivery of mental health services are both a public and a private responsibility. Federal, state, and local public agencies have statutory authority and public funds to carry out their tasks. Private groups and individuals participate through their agencies, organizations, and through philanthropy. Coordination and cooperation of effort between the public and private sectors are necessary for optimal functioning of the mental health care system. This chapter outlines the governmental structure for mental health which also provides for participation of private groups and individuals through various types of advisory councils.
The National Institute of Mental Health, part of the Public Health Service in the Department of Health, Education and Welfare, is the federal agency with major responsibility for development of mental health services, mental health research, training, and continuing education for all types of professional and subprofessional manpower. Federal funds are also granted to state public health programs ($66,000,000 in the fiscal year 1969) Community mental health receives a minimum of 15 percent of each state’s allotment, and 70 percent of the grant is available to support services in communities for which both public and private nonprofit groups may apply. Other federal programs also provide funds for mental health — related purposes including Medicare, Medicaid, Vocational Rehabilitation, Office of Economic Opportunity, Office of Aging, and Office of Education. Recent legislation provides support for construction of community mental health centers and initial operation of new services in them.
A mental health staff is located in each of the nine regional DHEW offices to administer the NIMH program and to consult with public and private groups who desire assistance. (See list at the end of this chapter.)
Each state has designated a state-level agency called the Mental Health Authority to administer the federal community mental health grant. This Authority may be the same agency which administers the state mental hospitals. More than thirty states have passed community mental health service acts or other legislation which makes funds available on a continuing basis to match local public or private nonprofit expenditures for mental health services.
State community mental health acts usually require that a local mental health board be established on a county or multi-county basis to serve as an administrative or policy-making board or as an advisory body. The board, usually appointed by the local government, in turn appoints an administrator of the local program.
Involvement by Clergymen
Clergymen and congregants have been involved in mental health programs for many years, the former usually in the role of pastoral counselor and therapist and the latter as volunteers in a variety of mental health and mental health — related settings. Both serve as members of boards operating mental health facilities.
Each mental hospital, clinic, or other facility uses clergymen and volunteers in keeping with the philosophy and practice of the facility and staff. The newer community mental health programs are developing broad community-based programs which are expanding the traditional roles of pastors and citizens.
In the Far West, a mental health center has established a panel of fifty qualified community professionals who accept patients for individual and group psychotherapy after screening and evaluation at the mental health center The center pays a small fee to the panel members and retains responsibility for the patient’s total treatment program. Several qualified clergy are on the panel of therapists.
In a Midwestern city of 50,000, a marriage counseling center begun by a group of clergymen and based in a local general hospital which furnished secretarial service, is to be incorporated into the new mental health center established in the community. The clergymen will continue to provide counseling as part of the center’s activity.
An innovative school program carried out at a mental health center in New York uses parent-tutors to assist in remedial reading, which often is needed by children showing maladaptive behavior. The parent-tutors receive three preliminary training sessions in a special reading method followed by group supervision on a weekly basis. About seventy-five parents from public and parochial schools are involved.
In a ghetto of New York, an Interfaith Counseling Service has been organized with a membership of more than one hundred local clergymen who refer their troubled parishioners to the center for help for a broad variety of problems in living. The Council holds workshops for parents, couples, single people, and young people; helps to develop local community leaders; provides training in counseling for ministers and qualified laymen; and serves in an advisory capacity to the neighborhood educational system. The agency’s brochure states, “Our plans are geared toward providing alternatives to the use of destructive means to cope with feelings of frustration, isolation or helplessness. We aim to place appropriate responsibility on residents to create the kind of community atmosphere in which they will choose to live.” The service, directed by a clergyman, employs two trained social workers, and a nearby mental health center provides part-time services of a psychiatrist to consult, teach, and supervise.
The Prairie View Mental Health Center in Newton, Kansas, whose roots were in a small mental hospital established under the sponsorship of the Mennonite Mental Health Service, has an administrator who is an ordained clergyman. This center won the top Mental Hospital Achievement Award of the American Psychiatric Association in 1968.
New roles for clergy and congregants in community organization and consumer participation are also developing. The establishment and maintenance of a community mental health program requires planning, organization, funding, interpretation to and support by the public, support by legislative bodies, and an ongoing dialogue between the provider (sources of funding and professional staff) and the consumer (user of therapeutic and preventive services)
Clergy have filled prominent roles as officers and board members of mental health agencies and associations; most boards include one or more clergymen. Their skills in community organization have been put to good use. They are also in key positions to channel information from the public into the mental health agency and vice versa. They are strong molders of public opinion. Congregants also are represented on boards and are in a position to provide a link between the agency and the community.
Recent federal legislation has given a prominent role to the consumer or user of health services. P.L. 89-749, Comprehensive Health Planning and Public Health Services Amendments of 1966, requires that a state health-planning council be established and that a majority of the membership shall consist of representatives of consumers of health services. Other health-related legislation also provides for consumer advisory representation and participation in shaping the services to be made available to individuals and their communities. Members of various governmental advisory councils are usually appointed by governing officials or bodies. Advisory councils are also often established to assist regional and local planning and service agencies.
Through membership on planning and other types of public and private councils and boards, clergy and congregants can fill key roles in shaping and furthering community mental health programs.
NIMH Regional Offices Mental Health Programs
Region I, Boston, Mass.
John F. Kennedy Fed. Bldg.
Boston, Mass. 02203
Phone: Code 617, 223-6824
Office Hours: 8:30-5:00
Conn., Maine, Mass,, N.H., R.I., Vermont
Region II, New York, N.Y.
26 Federal Plaza
New York, N.Y. 10007 Phone: Code 212, 264-2567
Office Hours: 8:30-5:00
Del., N.J., N.Y., Pa.
Region III, Charlottesville, Va.
220 7th Street, N.E.
Charlottesville, Va. 22001
Phone: Code 703, 296-5171
Office Hours: 8:00-4:30
D.C., Ky., Md., Puerto Rico, N.C., Virgin Is., Va., W. Va.
Region IV, Atlanta, Ga.
50 7th St., N.E.
Atlanta, Ga. 30323
Phone: Code 404, 526-5231 Office Hours: 8:00-4:30
Ala., Fla., Ga., Miss., S.C., Tenn.
Region V, Chicago, Ill.
New P.O. Bldg.
433 W. Van Buren Street
Chicago, Ill. 60607
Phone: Code 312, 353-5226
Office Hours: 8:15-4:45
Ind., Ill., Mich., Ohio, Wis.
Region VI, Kansas City, Mo.
601 East 12th Street
Kansas City, Mo. 64106
Phone: Code 816, FR 4-3791 Office Hours: 8:00-4:45
Iowa, Minn., Kansas, Mo., Neb., N. Dak., S. Dak.
Region VII, Dallas, Texas
1114 Commerce Street
Dallas, Texas 75202
Phone: Code 214, RI 9-3426
Office Hours: 8:15-4:45
Ark., La., N.M., Okla., Texas
Region VIII, Denver, Col..
Federal Off. Building 19th and Stout Streets
Denver, Colorado 80202
Phone: Code 303, 297-3177 Office Hours: 8:00-4:30
Colorado, Idaho, Montana, Utah, Wyoming
Region IX, San Francisco, Calif.
Federal Office Building
50 Fulton Street
San Francisco, Calif. 94102
Phone: Code 415, 556-2215
Alaska, Ariz., Calif., Guam, Hawaii, Nev., Oreg., Wash., Am. Samoa, Wake Island