Community-Based Mental Health is Here and More Important Than Ever
February 27, 2015 1 Comment
Fear and guilt are the emotions Dr. Bruce Perry described after driving a patient and her family home on a cold day following a session in his office. As a fellow in Child and Adolescent Psychiatry at the University of Chicago in 1987, he knew such intrusion into a patient’s life simply was not done. It took him two weeks to work up the nerve to confess his transgression. Suprisingly, his supervisor exclaimed, “Great! We should do home visits with all of our patients!” Then he wanted to hear more about this experience, which incidentally provided Dr. Perry with more insight into his patient than he ever could have obtained in the office.
The Shift to Community-Based Services
In adult mental health, case management has become crucial, as deinstitutionalization and state hospital closings have forced reintegration and reduced options for inpatient treatment. Case managers are highly involved in the patient’s day-to-day life, including multiple visits to the home in a week, helping with anything that would increase safety and stability in the community.
The 90’s saw a shift in child and youth mental health services as well. Youth Villages, which at the time provided only residential treatment services for youths in the juvenile justice and child welfare system in Tennessee, added community-based services. After interviewing over 126 children’s service officials to determine service gaps in West Tennessee, intensive in-home counseling for troubled families emerged as a significant need. By 1995, Youth Villages had a full continuum of care in place, focused on preventing residential treatment placement or returning children and youth to their families as quickly as possible.
Why In-Home, Community-Based Services?
When I started working as a family advocate and mentor for a child abuse prevention agency in 2007, I was ignorant that there had once been a bias toward institutional and office-based treatment. The value of serving consumers in their homes and communities is almost intuitive at this point, particularly in rural, resource-deprived areas of the country. As I interview applicants for child and youth psychiatric crisis positions, I have yet to meet anyone who does not see the value of:
- Assessing children and families in their own comfortable, familiar environment;
- Seeing the strengths and needs of the family in the place where they actually “live and breathe;”
- Going where the need exists, rather than expecting families to bring their needs into the office; and
- Being able to interact with community providers and supports face-to-face and in-the-moment.
These are not only clinically sound reasons to serve children and families in the community, but they are also reasons I came to work for the Youth Villages Specialized Crisis Services in 2009.
We are in a particularly exciting and challenging time for crisis services in Tennessee. With the high cost of emergency department visits, less availability of psychiatric hospital beds, and a dearth of outpatient service options (sometimes due to insurance limitations), individuals and families experiencing crisis need professionals who are strong advocates and creative clinicians who come to them in the community and effectively bridge service gaps.
Thankfully, we have matured in the mental health field. We have outgrown our fears about inappropriate involvement in our clients’ lives and have seen the value of meeting them where they are, not just emotionally or mentally, but in a physical and ecological sense as well. Coupled with the current fiscal challenges and service gaps, community-based services are definitely here to stay, and they are more important than ever.
Visit http://www.youthvillages.org/join-our-team to learn more. Glen Gaugh is a Program Supervisor for Specialized Crisis Services with Youth Villages in West Tennessee.