Culture and the Restructuring of Community Mental Health

Book excerpt: Examining the issues of treatment, organizational planning, and research, this multidimensional study offers a critique of both the theoretical and programmatic aspects of providing mental health services to traditionally underserved populations. Focusing on minority groups, the book uses the case of Hispanics to illustrate the largely unaddressed need for services that are relevant to social groups with diverse cultural and linguistic backgrounds. Vega and Murphy maintain that the present service system is socially insensitive, that mental health services in the United States were never designed to serve a multicultural population, and that, in general, those who dominate the current mental health system from administrator-clinicians to bureaucrats and politicians do not know how to direct their services to minority groups. Calling for fundamental reconceptualization and change, the book argues for community-based planning and intervention as an enlightened and necessary alternative, and provides a detailed description of such a program in terms of both philosophy and method. The eight chapters offer a reassessment based on understanding not only the rationale for these necessary services, but also the important philosophical and pragmatic issues that have resulted in the current, inadequate system; they provide the new thinking necessary to reframe the objectives of mental health services for cultural minorities. The early chapters explore some of the critical junctures in the community mental health movement between 1946 and 1981, the development of theory in the movement's early days, and the thrust of community-based intervention--the culture-specific methodology that has not been well-understood or implemented. Chapters 4 and 5 focus on the relationship between medicalization and the degradation of culture and on the reconceptualization of knowledge, order, illness, and intervention. The last three chapters analyze an example of community-based intervention in operation, and citizen involvement and the political aspects of community-based policies are reviewed. This timely discussion of the requirements for a socially responsible and community-based services delivery program lays the theoretical foundation for a future public mental health system. As such, it will prove invaluable and important reading for advanced undergraduate and graduate students in the health and human services areas, including social work, clinical psychology, and medical sociology; it also has much to offer professional administrators and planners. Culture and the Restructuring of Community Mental Health has been designed to meet the needs of both academics and practitioners.