My daughter Jessye, who's graduating from college, tells me she wants to go to work in community mental health. She's excited by many aspects of the field, particularly case management with women and children. As a 25-year veteran of the struggles of community mental health, I listen to my daughter and think unworthy thoughts on the order of "Get an MBA!" At the same time, I admire my daughter's sense of purpose, and I instinctively understand her passion.
Jessye will make her own career choice, of course, but her selection process is prompting me to reflect on mine. After a quarter-century in the field, would I still recommend community mental health as a career? Part of me believes that no reasonable person would choose this work, especially not now. Beset by chronic budgetary constraints, invasive regulations, heavy caseloads, frequent crises, and insufficient respect from society at large, community mental health today seems like a Sisyphean career choice. At the very least, it qualifies as what Michael White called a "problem-saturated narrative."
It didn't start out that way. Officially launched in 1963 when President John F. Kennedy signed into law the Community Mental Health Act, the CMH movement was born of equal parts idealism, political will, and commonsense thinking. The plan was to build 2,000 mental health centers throughout the country, most located in low-income communities. Each center would offer a soup-to-nuts menu of services, from inpatient and outpatient treatment, to 24/7 emergency services, to drug and alcohol treatment, to day programs and more. The dream that drove the plan was to make high-quality, comprehensive mental health services accessible to everyone who needed them, especially poor people who'd previously gone without care or whose "treatment" had consisted of hard time in state mental hospitals. There was excitement in the air, a sense of agency and optimism about making meaningful social change through empowering clients and communities.
Almost from the start, psychotherapists saw in CMH work the chance to develop therapeutic approaches that would address the multilevel, interwoven troubles of families, rather than merely treating the symptoms of individuals. Salvador Minuchin developed structural family therapy from his work with "families of the slums" in West Philadelphia, and through the 1970s, family therapy was virtually identified with community mental health.