Community Ment Health J (2015) 51:383384

DOI 10.1007/s10597-015-9878-0

OBSERVATION

Rebranding Community Mental Health

Kenneth Minkoff1,2

 Springer Science+Business Media New York 2015

What do we mean by Community Mental Health; what

does it mean to be a Community Psychiatrist? One assumes these are easy questions to answer, but the responses
are not as simple as they may seem.
Lets start with some simple history: Community mental
health as a term originated over 50 years ago. Related to
the work of seminal pioneers like Erich Lindemann, the
term originally referred to addressing the mental health
needs of an entire community, rather than just individual
patients, and to engaging in community consultation that
would leverage natural caregivers to respond to crises and
promote community health. This concept was transformed
by the Community Mental Health Center Act (1963),
which led to the first wave of federally funded community
mental health centers in the mid to late sixties and early
seventies. Although many of these centers initially aspired
to broad community missions, their development was
heavily influenced by the de-institutionalization movement
of the same time period, and the concept of community
mental health evolved to include and focus on service in
the community (as opposed to in the hospital or in the
institution) for adults with chronic and severe mental illness and children with severe emotional served in the
public sector. Finally, because the generativity of community mental health arose from several broad social
movements (community focus and community organizing;
publicly funded and organized mental health service delivery in catchment areas across the nation; the de-institutionalization and liberation of individuals who had
& Kenneth Minkoff
kminkov@aol.com
1

ZiaPartners, Inc., San Rafael, CA, USA

Department of Psychiatry, Harvard, Cambridge, MA, USA

been trapped in institutions for decades), community

mental health and community psychiatry have long been
associated with a cutting edge movement in response to
the challenge of providing innovative services for those
most in need and least able to pay.
So what is community mental health; what does it mean
to be a community psychiatrist? And perhaps the key issue:
does this all mean the same thing now as it did 50 years
ago? Some questions might help us determine a response:
1.

2.

3.

Is community mental health only about services in the

community (location or setting)? OR
Do we consider hospitals part of the community? And if
so, do inpatient units constitute part of the community
mental health system, and are inpatient psychiatrists
actually community psychiatrists? What about jails and
prisons, juvenile detention centers, and nursing homes?
Are those institutions part of our community as well?
Are people who work in those institutions part of the
community mental health system?
Is community mental health (or community psychiatry)
only about services to those with serious mental illness
or with serious emotional disturbances (type of patients
served)? OR
Are we now in an era where we are looking at the
mental health needs of the entire population in any
community, so that the impact of ALL mental health
conditions on total population health is now a subject
of great importance?
Is community mental health (or community psychiatry)
only about public sector services (payer source)? OR
Are we now recognizing that the boundary between
private and public funding is increasingly blurred
(Medicaid MCOs are a major example), so that
regardless of insurance type (or lack thereof), we have

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4.

5.

6.

7.

Community Ment Health J (2015) 51:383384

to think about managing limited resources to care for

populations in need?
Is community mental health (or community psychiatry)
only about what happens in community mental health
centers or related organizations (site location)? OR
Are we finding those boundaries are blurring as well
as mental health services are provided in health
centers, in child welfare programs, in juvenile justice
programs, in schools, in brain injury programs, and so
onAND by private practitioners who are often
finding a need to work, at least some of their time, in
organized delivery systems?
Is community mental health (or community psychiatry)
only about mental health (diagnostic category)? OR
Are we now addressing mental health and substance use
disorders together (as behavioral health) in an
integrated manner, as we realize that co-occurring
conditions are an expectation, not an exception? Are we
increasingly addressing behavioral health and health
conditions together in an integrated manner, particularly
when associated with poorer outcomes and higher
costs? If so, are health settings working with individuals
with complex health conditions practicing community
mental health? Are psychiatrists working with health
centers and hospitals community psychiatrists?
Is community mental health (or community psychiatry)
about providing mental health and/or substance use
disorder treatment services solely to seriously ill
patients in need (engagement and treatment philosophy)? OR
Is our whole philosophy shifting away from treating
disorders to treating people who have disorders using
recovery and resiliency based approaches to service
delivery, from providing care to patients to working as
partners, from community institutions to trauma
informed care with an emphasis on equalizing power
dynamics, from treatment to prevention, early intervention, and community consultation?
And perhaps the most important question: Are we still
on the cutting edge? Are we still at the front end of
the movement? Are we attracting the most radical
forward thinking elements in our field? (capacity for
innovation) OR
Are people more excited about other concepts, terms,
and ideas like: primary health behavioral health
integration? Triple Aim, population health, accountable care organizations? Recovery oriented systems
and peer driven services? Trauma informed systems?
Do present-day providers view community mental
health and community psychiatry as last century ideas?

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These are scary and challenging ideas to contemplate,

but it is important that we do.
For the past year or more, the American Association of
Community Psychiatrists (AACP) has been facing this issue head on. As an organization, we strongly believe that
the values, principles and knowledge that have informed a
half century of working with very complex populations in
very challenging systems are the foundation of the road
that lies ahead as the entire health system and additional
partner systems (e.g. criminal justice and child welfare) are
coming to realize what we have known for a very long
timeindividuals and families with mental health and
substance use needs are highly prevalent in all populations,
and have significant impact on individual, family, and
community health, as well as costs and outcomes in every
possible domain. Behavioral health is a public health
emergency with much more profound impact than almost
anything else you can think of, yet it has been marginalized
for years. We believe that the knowledge base of community mental health and community psychiatry can be the
organizing force that takes us to the next level as a society,
to address this challenge
Thats all very well and good, but it doesnt work if all
we are is a legend in our own minds. Thats why we have
started to take a serious look at who we are, what we do,
what it means in the current world to use the terms community mental health and community psychiatrist. We are
thinking that there may need to be better terms, better
definitions, or possibly a complete rebranding, so that the
knowledge base from the past is reconfigured into language
for the future.
We dont know the answers, yet. At our last two
strategic board retreats (most recently in February, 2015),
however, these issues are front and center, and we are
starting, slowly, to formulate our ideas.
One of the key decisions we made as a Board is that we
need to take the conversation wider. We want to involve all
of our members (who are all journal subscribers) but also
all of the other readers of the Journal as well. Lets get all
of the ideas flowing. Lets open a dialogue.
We will be keeping this conversation and these ideas
moving in each issue of the journal going forward through
the course of the next few years. Please send your letters
and ideas to the editor. Join AACP if you havent already.
Attend the board meetings (which are held in conjunction
with the APA Fall and Spring meetings). Contribute to
discussion boards on our website and our list serve. This is
an exciting time. As Eldridge Cleaver once said (and who
remembers him any more?): if youre not part of the solution, youre part of the problem. Join the conversation.