College Mental Health Programs: A Paradigm for Comprehensive Community Mental Health Centers E. Arthur Larson, M.D. Ben Barger, Ph.D., Stuart N. Cahoon, M.D.
ABSTRACT: Some of the dilemmas confronting the Comprehensive Community Mental Health movement are reviewed. Existent paradigms to this movement or aspects of it are documented on various college campuses with special reference to the College Community Mental Health Program present at the University of Florida. The major content of the paper clarifies areas of applicable usefulness such community oriented College Mental Health Programs can serve in overcoming some of the dilemmas of the Comprehensive Community Mental Health movement. University of Florida utilization of the College Community Model for training of the psychiatric resident is outlined.
"REVOLUTION, REALLY?" War-like words can be used to describe dilemmas confronting community psychiatry and comprehensive community mental health centers (Bellak, x964). Their history as a "revolution" (Linn, x968 ) includes a declaration of war on mental illness by President Kennedy in 2963, with Congress providing the financial backing and NIMH the batde plan. Mental health professionals are describing resistances in the struggle; they even question the validity of the concepts which underlie the battle plan. In addition, they report dissension in the ranks, insufficient troop strength, and inadequately prepared leaders. It is hoped that this paper will help reduce the revolutionary conflict, first by concurring with Whittington (x965) that community mental health "is not really a revolution, nor an innovation" (p. 76) but a movement, and secondly and primarily, by drawing attention to the fact that as a movement, many analogous obstacles to this current battle have taken place in College Community Mental Health Programs. Dr. Larson, is chief, Mental Health Service, Department of Studen~ Health and associate professor, Department of Psychiatry, University of Florida, Gainesvilte, Fla. 326o~; Dr. Barger, is director, Student Mental Health Project (NIMH Project Grant No. MH I4789-o3), and professor, Department of Psychology; and Dr. Cahoon, is associate professor, and coordinator for community psychiatry, Department of Psychiatry, University of Florida. He is also a university psychiatrist. This publication and the training programs described herein were sponsored in part by NtMH-83~z. Community Mental Health Journal, Vol. 5 (6), 1969
461
462
Community Mental Health Journal
COLLEGE MENTAL HEALTH PROVIDES PARADIGM Farnsworth (I967) calls college psychiatry a "prototype for Community Psychiatry" (p. 68o). On many college campuses comprehensive mental health programs are a functioning reality; principles of community mental health are in practice. These college mental health programs present a paradigm, or at least a pattern, for the principles of comprehensive community mental health. They can be useful in ending the conflict within the comprehensive community mental health movement, just as a recognized transference paradigm is useful in ameliorating the struggles of psychotherapy. One example of a college mental health program that currently provides a paradigm for community mental health is in operation at the University of Wisconsin (Bolman, et al., i968 ) where a preventive mental health program was attempted and evaluated. Kansas State University (Sinnett, et al., i967) has an operational Rehabilitation Living Unit, demonstrating principles of partial hospitalization in a unique manner, using volunteers and providing methodology for evaluation. The College Center of Boston (Solomon, et al., i967) demonstrates a method of evaluating, treating, and researching the mental health programs of a number of small college "communities" in a coordinated and centralized fashion. On the Chicago Circle Campus of the University of Illinois, Kysar (1966) has described preventive action programs which serve that large urban commuter campus. At Wellesley College and M.I.T. (Snyder, et al., i957, i963), studies have been conducted on the relationship between social system forces and mental health problems and at Princeton (Pervin, I967) instruments have been developed to evaluate the community's mental health needs. A partial literature review of public health oriented college psychiatry has been reported by Reifler (1967). In September, 2963, a conference on "Higher Education and Mental Health" was held at the University of Florida, at which time our community mental health programs, which were founded in I959 on public health principles, were described by Barger and Hall (1963). This program now offers the ten services of a comprehensive community mental health center, many through cooperative efforts with other university and nonuniversity agencies. The foundation of the program is its service base, with emphasis on immediate availability of service, 24-hour emergency coverage, the provision of evaluation with the prescription of a treatment or interventive approach which most clearly meets the student-patient's needs, offering continuity of care until closure or referral, with ease of return to the program. During a weekly evaluation conference, which is not shackled by the time-consuming hindrance of detailed case presentations described by Jacobson (1967), we review the problems of our total new student-patient population (from 2o to 4o student-patients per week) and attempt to identify community areas or subgroups which need programs of prevention or early intervention. These
E. A. Larson, B. Barger, and S. N. Cahoon
463
community action programs are designed with evaluation methodology and are effected frequently with, but sometimes without, grant support (Barger, 9965; Clarke, ~968; Barger, ~968). We have not encountered the obstacle which Furman (1967) has predicted that research will dominate good community service. This paper will refer further to the University of Florida's mental health program for examples of the usefulness of this paradigm. Our total program, however, has been described in greater detail by Barger, Hall, and Larson (2966). USE OF COLLEGE PROGRAMS IN COMMUNITY MENTAL HEALTH MOVEMENT The following are some specific useful roles college mental health programs can serve in the Comprehensive Community Mental Health movement. A. Preventive Program Design and Evaluation, The size and complexities of catchment areas served by most community mental health centers impede the effective evaluation of preventive programs. Evaluation procedures which test the effectiveness of preventive programs can be developed and conducted more easily in the more structured community of a college or university than in the less structured community catchment areas. Thus the college community can provide a "proving ground" for these programs. Compared to a community catchment area, a college population is smaller, more homogeneous, and relatively stable, with demographic data readily available. Information reflecting student distress can be obtained from academic, counseling, health, and disciplinary records. This information and a knowledge of community stress sources is useful in the development of preventive programs, as described by Hall (1966) and by Wright (1964). Many college communities welcome preventive programs and have the computer and human resources needed to speed their evaluation. B. Professional Identity. Within the concepts of comprehensive community mental health and community psychiatry, significant role conflicts especially for psychiatrists and others trained solely in the medical model (in contrast to the public health model) exist (Vaughn, ~967). In our program we find both models essential, with the psychiatrist's special skills serving at the interface between the two. His role as the diagnostician and prescriber, within and between both models, is similar to that suggested by Wallerstein (z968) for the psychoanalyst who wishes to become community oriented. C. Rigid Concepts of Professionalism. Furman (~967) has also reported that rigid concepts of professionalism can obstruct an effective community mental health center. In our college mental health program we have avoided this primarily through an emotional commitment--practiced in word and deed--to view all helping agencies and individuals as integral parts of our university's comprehensive community mental health program. They make
464
Community Mental Health Journal
it comprehensive. We see ourselves as peers of chaplains, reading and speech specialists, residence hall counselors, vocational counselors, administrators, campus police and others, functioning with them in a cooperative effort to generate community mental health programs. Many of these programs are effected as cooperative efforts. D. Insufficient Professional Personnel. Dr. Will Menninger's statement still rings true--that effective mental health programs develop only when we place "brains before bricks." Dr. Henry Schumacher, who initiated the University of Florida's mental health program, realized there could never be a sufficient number of well-trained professional personnel to adequately evaluate and treat the student-patients of a large university if a mental health service were based solely on a medical model. Our consultative efforts over the past nine years have been in part consistent with Leif's (1966) "sub-professional training" concept. We educate others to recognize the early signs of emotional distress, teach appropriate techniques for evaluating the extent of this distress, help increase the expertise of the individual in deciding who needs the more highly trained counselors or therapists, and work at improving the skills of the individual in handling the difficulties within his locale. We add an additional and an essential feature to this training by providing immediately available telephone consultation to these individuals. In addition, we offer our group therapy program as a training forum. Currently, we are establishing a Befriender Program, composed of mature and interested volunteer students who are willing to be-a-friend to lonely and isolated students.
E. Professional Training in Comprehensive Community Mental Health. The inadequate numbers of professionals trained in comprehensive community mental health is an obstacle that has many aspects. First, the small number of established centers that are located near professional training programs inhibits the development of adequate numbers of appropriately trained professionals. In turn, the lack of appropriately trained professionals to staff comprehensive community mental health centers impedes the establishment of truly effective programs. Further, concerns have been voiced in the psychiatric profession that community psychiatry may be a "seduction and betrayal of the resident-student in psychiatry" (Kubie, ~968, p. z65). In addition, if professional training occurs primarily in mental illness-oriented hospitals and clinics, the future mental health professional will remain limited in abilities to effect preventive programs. There will be little exposure to concepts of normality which, according to Grinker (5967), is "topical." This new interest in normality among mental health professionals is essential for, according to Grinker, when we "speak of prevention and rehabilitation, we should know what we wish to maintain or revive." College Community Mental Health Programs do not provide a total answer, of course, to these training obstacles. However, they can provide part of the answer, at least in locales where professional training programs are lo-
E. A. Larson, B. Barger, and S. N. Cahoon
465
cated on or near a college campus which practices comprehensive community mental health principles. In these locales the mental health professional trainee can obtain training in comprehensive community mental health concepts and methods, and can practice these without their dominating any classical training experience. Within an interdisciplinary program, training in these concepts can be provided for any of the mental health professions. The following is one example. TRAINING PROGRAM EXAMPLE: COMMUNITY PSYCHIATRY USING COLLEGE COMMUNITY AS MODEL COMMUNITY One of the authors, serving as Coordinator of Community ~Psychiatry Education Programs for the Department of Psychiatry, College of Medicine, of the University of Florida, has set up a specific rotation for advanced psychiatric residents (usually third year) using the University Mental Health Program as a training base. This rotation is for a period of three months full-time during which the resident becomes familiar with and involved in the total university community, its political and administrative structure, the power bases, the helping network, and areas of conflict. The university population and organization provide an excellent model community for training in the concepts and practices of community psychiatry. Once the resident is familiar with these principles, he should be able to apply them to any community, organization, or catchment area. Participating with the staff of the Mental Health Program, the resident will learn the process of rapid screening, evaluation, and crisis intervention. This experience will be oriented to the importance of supporting the student's coping and adjustive maneuvers, and intervening in his social networks at the points of stress and conflict. Learning the many available resources for help within the university community, the resident will learn to utilize the supporting and caring individuals in the "living space" of the student. With appropriate instruction and supervision, the resident will be involved in mental health consultation within the university community. He may serve as consultant to residence hall counselors, the Office of Student Affairs, student organizations, fraternities, and others. The aim of this experience will be to have the resident learn to expand and support the positive mental health operations of the consultee. The resident will need to learn to function as a peer rather than as "the authority" in order to permit the consultee to use the special knowledge of the consultant while retaining responsibility for his own operations. In addition, exposure to nonpatient university students will provide opportunities to reflect on the various conceptualizations of normality as recently reviewed by Sabshin (~967). The resident will participate in the administrative meetings of the mental health program and will also visit nearby Community Mental Health
466
Community Mental Health Journal
Centers with the coordinator for the purpose of studying various administrative organization plans. In addition, the process and problems of planning, funding, and operating community mental health programs and centers will be discussed in detail. The resident will be asked to make an evaluation of a community mental health center with the purpose of developing his own creative ideas for improving the programs and operation of the center. He may elect to do the same kind of creative evaluation of the university's mental health program as well. Each resident will be helped and encouraged to select, gain entry into, and participate with some segment of the university community in the planning of positive mental health goals. He might participate with a student organization, a dormitory, a church group, a minority group. This involvement will equip him to enter directly stressful areas of the "general" community, and participate as a member of a community group in an attempt to effect functional communication, resolve conflicts, and support constructive social roles. Thus the resident will have a basic experience in the process of interaction and reconciliation as he collaborates as an equal member without the special sanctions and licenses of the "psychiatrist." To keep this experience relevant and topical, the student newspaper, the Office of Student Affairs, student government, protest groups, and others will serve as sources of information leading to the selection of the specific project. Didactic presentations of epidemiology, principles of preventive (public health) psychiatry, and concepts of community psychiatry along with the usual case oriented agency consultations will be a part of the experience, usually provided earlier (first or second year) in the residency. CONCLUSION Principles of community mental health are practiced on many college and university campuses. Within these settings much can be learned that will aid the Comprehensive Community Mental Health movement. While some types of problems and patients confronting the general community catchment areas will not be found on college campuses, it is possible to establish a training program that utilizes the college community as a model combined with additional experience in general community settings. REFERENCES Barger, B. (dir.) Preventive action in college mental health. National Institute of Mental Health, Grant No. MH 24789-o3-I965. Barger, B. College mental health: early identification as a preventive measure. Paper presented at Orthopsychiatric Association Workshop, March 2968, Chicago, Ill. Barger, B., and Hall, E. (Eds.) Higher education and mental health: proceedings of a conference, September,I963 , Universityof Florida. Barger, B.; Larson, E. A.; and Hall, E. Preventive action in college mental health. Journal of the American College Health Association, 1966 , I5, 8o-93.
Bellak, L. (Ed.) Community psychiatry and community mental health. New York: Grune & Stratton, 1964.
E. A. Larson, B. Barger, and S. N. Cahoon
467
Bolman, William M., and Halleck, Seymour L. The evaluation of a preventive psychiatric program: report of failure. Paper presented at American Psychiatric Association meeting, I968, Boston. Clarke, Carl (dir.) Marriage and college life. National Institute of Mental Health Grant No. MH I5o4I-I968. Farnsworth, Dana L. Editor's notebook: the growing importance of college psychiatry. American Journal of Psychiatry, 1967, 124, 68o-68I. Furman, Sylvans. Obstacles to the development of community mental health centers. Amercan Journal of Orthopsychiatry, I967, 124, 68o-681. Grinker, Roy R., Sr. Editorial: perspectives on normality. Archives of General Psychiatry, 1967, 17, 257. Jacobson, Avrohm. A critical look at the community psychiatric clinic. American Journal of Psychiatry, I967, 124, i4-2o. Kubie, Lawrence S. Pitfalls of community psychiatry. Archives of General Psychiatry, i968,
i8, 257-266. Kysar, John E. Preventive psychiatry on the college campus. Community Mental Health Journal, 1966, z, 27-34. Leif, Harold I. Sub-professional training in mental health. Archives of General Psychiatry,
I966, 15, 660-664 9 Linn, Lewis. The fourth psychiatric revolution. American Journal of Psychiatry, i968, I24, 1o43-Io48. Pervin, Lawrence A. The college as a social system. Journal of Higher Education, i967, 38, 317-322. Reifler, Clifford B.; Liptzin, Myron, B.; and Fox, J. Thomas. College psychiatry as public health psychiatry. American Journal of Psychiatry, 1967, 124, 662-67I. Sabshin, Melvin. Psychiatric perspectives on normality. Archives of General Psychiatry, 1967, "r7 258-264. Sinnett, E. R.; Wiesner, E. F.; and Friesen, W. S. Dormitory half-way house. Rehabilitation Record, 1967, 8, 34-37. Snyder, Benson R. College environment as a factor in mental health. Student Medicine,
I957 , 6, 7-i8. Snyder, Benson R., and Kaufman, Irving. The identity crisis in the university setting. Journal of the American College Health Association, i963, 1I, 259-276. Solomon, Philip; Patch, Vernon D.; Sturrock, John B.; and Wexler, Donald. A new approach to student mental health in small colleges: a multiple college mental health center.
American Journal of Psychiatry, 1967, 124, 658-661. Vaughn, Rufus. Report delivered at Inter-University Forum for Educators in Community Psychiatry, Baylor University, October, i967. Wallerstein, Robert S. The challenge of community mental health movement to psychoanalysis. American Journal of Psychiatry, I968, I24, io49-1o56. Whittington, H. G. The third psychiatric revolution--really? Community Mental Health Journal, i965, 1, 73-80. Wright, J. J. Environmental stress evaluation and achievement in a student community. Journal of the American College Health Association, i964, i2, 325-326.
ABSTRACT: Some of the dilemmas confronting the Comprehensive Community Mental Health movement are reviewed. Existent paradigms to this movement or aspects of it are documented on various college campuses with special reference to the College Community Mental Health Program present at the University of Florida. The major content of the paper clarifies areas of applicable usefulness such community oriented College Mental Health Programs can serve in overcoming some of the dilemmas of the Comprehensive Community Mental Health movement. University of Florida utilization of the College Community Model for training of the psychiatric resident is outlined.
"REVOLUTION, REALLY?" War-like words can be used to describe dilemmas confronting community psychiatry and comprehensive community mental health centers (Bellak, x964). Their history as a "revolution" (Linn, x968 ) includes a declaration of war on mental illness by President Kennedy in 2963, with Congress providing the financial backing and NIMH the batde plan. Mental health professionals are describing resistances in the struggle; they even question the validity of the concepts which underlie the battle plan. In addition, they report dissension in the ranks, insufficient troop strength, and inadequately prepared leaders. It is hoped that this paper will help reduce the revolutionary conflict, first by concurring with Whittington (x965) that community mental health "is not really a revolution, nor an innovation" (p. 76) but a movement, and secondly and primarily, by drawing attention to the fact that as a movement, many analogous obstacles to this current battle have taken place in College Community Mental Health Programs. Dr. Larson, is chief, Mental Health Service, Department of Studen~ Health and associate professor, Department of Psychiatry, University of Florida, Gainesvilte, Fla. 326o~; Dr. Barger, is director, Student Mental Health Project (NIMH Project Grant No. MH I4789-o3), and professor, Department of Psychology; and Dr. Cahoon, is associate professor, and coordinator for community psychiatry, Department of Psychiatry, University of Florida. He is also a university psychiatrist. This publication and the training programs described herein were sponsored in part by NtMH-83~z. Community Mental Health Journal, Vol. 5 (6), 1969
461
462
Community Mental Health Journal
COLLEGE MENTAL HEALTH PROVIDES PARADIGM Farnsworth (I967) calls college psychiatry a "prototype for Community Psychiatry" (p. 68o). On many college campuses comprehensive mental health programs are a functioning reality; principles of community mental health are in practice. These college mental health programs present a paradigm, or at least a pattern, for the principles of comprehensive community mental health. They can be useful in ending the conflict within the comprehensive community mental health movement, just as a recognized transference paradigm is useful in ameliorating the struggles of psychotherapy. One example of a college mental health program that currently provides a paradigm for community mental health is in operation at the University of Wisconsin (Bolman, et al., i968 ) where a preventive mental health program was attempted and evaluated. Kansas State University (Sinnett, et al., i967) has an operational Rehabilitation Living Unit, demonstrating principles of partial hospitalization in a unique manner, using volunteers and providing methodology for evaluation. The College Center of Boston (Solomon, et al., i967) demonstrates a method of evaluating, treating, and researching the mental health programs of a number of small college "communities" in a coordinated and centralized fashion. On the Chicago Circle Campus of the University of Illinois, Kysar (1966) has described preventive action programs which serve that large urban commuter campus. At Wellesley College and M.I.T. (Snyder, et al., i957, i963), studies have been conducted on the relationship between social system forces and mental health problems and at Princeton (Pervin, I967) instruments have been developed to evaluate the community's mental health needs. A partial literature review of public health oriented college psychiatry has been reported by Reifler (1967). In September, 2963, a conference on "Higher Education and Mental Health" was held at the University of Florida, at which time our community mental health programs, which were founded in I959 on public health principles, were described by Barger and Hall (1963). This program now offers the ten services of a comprehensive community mental health center, many through cooperative efforts with other university and nonuniversity agencies. The foundation of the program is its service base, with emphasis on immediate availability of service, 24-hour emergency coverage, the provision of evaluation with the prescription of a treatment or interventive approach which most clearly meets the student-patient's needs, offering continuity of care until closure or referral, with ease of return to the program. During a weekly evaluation conference, which is not shackled by the time-consuming hindrance of detailed case presentations described by Jacobson (1967), we review the problems of our total new student-patient population (from 2o to 4o student-patients per week) and attempt to identify community areas or subgroups which need programs of prevention or early intervention. These
E. A. Larson, B. Barger, and S. N. Cahoon
463
community action programs are designed with evaluation methodology and are effected frequently with, but sometimes without, grant support (Barger, 9965; Clarke, ~968; Barger, ~968). We have not encountered the obstacle which Furman (1967) has predicted that research will dominate good community service. This paper will refer further to the University of Florida's mental health program for examples of the usefulness of this paradigm. Our total program, however, has been described in greater detail by Barger, Hall, and Larson (2966). USE OF COLLEGE PROGRAMS IN COMMUNITY MENTAL HEALTH MOVEMENT The following are some specific useful roles college mental health programs can serve in the Comprehensive Community Mental Health movement. A. Preventive Program Design and Evaluation, The size and complexities of catchment areas served by most community mental health centers impede the effective evaluation of preventive programs. Evaluation procedures which test the effectiveness of preventive programs can be developed and conducted more easily in the more structured community of a college or university than in the less structured community catchment areas. Thus the college community can provide a "proving ground" for these programs. Compared to a community catchment area, a college population is smaller, more homogeneous, and relatively stable, with demographic data readily available. Information reflecting student distress can be obtained from academic, counseling, health, and disciplinary records. This information and a knowledge of community stress sources is useful in the development of preventive programs, as described by Hall (1966) and by Wright (1964). Many college communities welcome preventive programs and have the computer and human resources needed to speed their evaluation. B. Professional Identity. Within the concepts of comprehensive community mental health and community psychiatry, significant role conflicts especially for psychiatrists and others trained solely in the medical model (in contrast to the public health model) exist (Vaughn, ~967). In our program we find both models essential, with the psychiatrist's special skills serving at the interface between the two. His role as the diagnostician and prescriber, within and between both models, is similar to that suggested by Wallerstein (z968) for the psychoanalyst who wishes to become community oriented. C. Rigid Concepts of Professionalism. Furman (~967) has also reported that rigid concepts of professionalism can obstruct an effective community mental health center. In our college mental health program we have avoided this primarily through an emotional commitment--practiced in word and deed--to view all helping agencies and individuals as integral parts of our university's comprehensive community mental health program. They make
464
Community Mental Health Journal
it comprehensive. We see ourselves as peers of chaplains, reading and speech specialists, residence hall counselors, vocational counselors, administrators, campus police and others, functioning with them in a cooperative effort to generate community mental health programs. Many of these programs are effected as cooperative efforts. D. Insufficient Professional Personnel. Dr. Will Menninger's statement still rings true--that effective mental health programs develop only when we place "brains before bricks." Dr. Henry Schumacher, who initiated the University of Florida's mental health program, realized there could never be a sufficient number of well-trained professional personnel to adequately evaluate and treat the student-patients of a large university if a mental health service were based solely on a medical model. Our consultative efforts over the past nine years have been in part consistent with Leif's (1966) "sub-professional training" concept. We educate others to recognize the early signs of emotional distress, teach appropriate techniques for evaluating the extent of this distress, help increase the expertise of the individual in deciding who needs the more highly trained counselors or therapists, and work at improving the skills of the individual in handling the difficulties within his locale. We add an additional and an essential feature to this training by providing immediately available telephone consultation to these individuals. In addition, we offer our group therapy program as a training forum. Currently, we are establishing a Befriender Program, composed of mature and interested volunteer students who are willing to be-a-friend to lonely and isolated students.
E. Professional Training in Comprehensive Community Mental Health. The inadequate numbers of professionals trained in comprehensive community mental health is an obstacle that has many aspects. First, the small number of established centers that are located near professional training programs inhibits the development of adequate numbers of appropriately trained professionals. In turn, the lack of appropriately trained professionals to staff comprehensive community mental health centers impedes the establishment of truly effective programs. Further, concerns have been voiced in the psychiatric profession that community psychiatry may be a "seduction and betrayal of the resident-student in psychiatry" (Kubie, ~968, p. z65). In addition, if professional training occurs primarily in mental illness-oriented hospitals and clinics, the future mental health professional will remain limited in abilities to effect preventive programs. There will be little exposure to concepts of normality which, according to Grinker (5967), is "topical." This new interest in normality among mental health professionals is essential for, according to Grinker, when we "speak of prevention and rehabilitation, we should know what we wish to maintain or revive." College Community Mental Health Programs do not provide a total answer, of course, to these training obstacles. However, they can provide part of the answer, at least in locales where professional training programs are lo-
E. A. Larson, B. Barger, and S. N. Cahoon
465
cated on or near a college campus which practices comprehensive community mental health principles. In these locales the mental health professional trainee can obtain training in comprehensive community mental health concepts and methods, and can practice these without their dominating any classical training experience. Within an interdisciplinary program, training in these concepts can be provided for any of the mental health professions. The following is one example. TRAINING PROGRAM EXAMPLE: COMMUNITY PSYCHIATRY USING COLLEGE COMMUNITY AS MODEL COMMUNITY One of the authors, serving as Coordinator of Community ~Psychiatry Education Programs for the Department of Psychiatry, College of Medicine, of the University of Florida, has set up a specific rotation for advanced psychiatric residents (usually third year) using the University Mental Health Program as a training base. This rotation is for a period of three months full-time during which the resident becomes familiar with and involved in the total university community, its political and administrative structure, the power bases, the helping network, and areas of conflict. The university population and organization provide an excellent model community for training in the concepts and practices of community psychiatry. Once the resident is familiar with these principles, he should be able to apply them to any community, organization, or catchment area. Participating with the staff of the Mental Health Program, the resident will learn the process of rapid screening, evaluation, and crisis intervention. This experience will be oriented to the importance of supporting the student's coping and adjustive maneuvers, and intervening in his social networks at the points of stress and conflict. Learning the many available resources for help within the university community, the resident will learn to utilize the supporting and caring individuals in the "living space" of the student. With appropriate instruction and supervision, the resident will be involved in mental health consultation within the university community. He may serve as consultant to residence hall counselors, the Office of Student Affairs, student organizations, fraternities, and others. The aim of this experience will be to have the resident learn to expand and support the positive mental health operations of the consultee. The resident will need to learn to function as a peer rather than as "the authority" in order to permit the consultee to use the special knowledge of the consultant while retaining responsibility for his own operations. In addition, exposure to nonpatient university students will provide opportunities to reflect on the various conceptualizations of normality as recently reviewed by Sabshin (~967). The resident will participate in the administrative meetings of the mental health program and will also visit nearby Community Mental Health
466
Community Mental Health Journal
Centers with the coordinator for the purpose of studying various administrative organization plans. In addition, the process and problems of planning, funding, and operating community mental health programs and centers will be discussed in detail. The resident will be asked to make an evaluation of a community mental health center with the purpose of developing his own creative ideas for improving the programs and operation of the center. He may elect to do the same kind of creative evaluation of the university's mental health program as well. Each resident will be helped and encouraged to select, gain entry into, and participate with some segment of the university community in the planning of positive mental health goals. He might participate with a student organization, a dormitory, a church group, a minority group. This involvement will equip him to enter directly stressful areas of the "general" community, and participate as a member of a community group in an attempt to effect functional communication, resolve conflicts, and support constructive social roles. Thus the resident will have a basic experience in the process of interaction and reconciliation as he collaborates as an equal member without the special sanctions and licenses of the "psychiatrist." To keep this experience relevant and topical, the student newspaper, the Office of Student Affairs, student government, protest groups, and others will serve as sources of information leading to the selection of the specific project. Didactic presentations of epidemiology, principles of preventive (public health) psychiatry, and concepts of community psychiatry along with the usual case oriented agency consultations will be a part of the experience, usually provided earlier (first or second year) in the residency. CONCLUSION Principles of community mental health are practiced on many college and university campuses. Within these settings much can be learned that will aid the Comprehensive Community Mental Health movement. While some types of problems and patients confronting the general community catchment areas will not be found on college campuses, it is possible to establish a training program that utilizes the college community as a model combined with additional experience in general community settings. REFERENCES Barger, B. (dir.) Preventive action in college mental health. National Institute of Mental Health, Grant No. MH 24789-o3-I965. Barger, B. College mental health: early identification as a preventive measure. Paper presented at Orthopsychiatric Association Workshop, March 2968, Chicago, Ill. Barger, B., and Hall, E. (Eds.) Higher education and mental health: proceedings of a conference, September,I963 , Universityof Florida. Barger, B.; Larson, E. A.; and Hall, E. Preventive action in college mental health. Journal of the American College Health Association, 1966 , I5, 8o-93.
Bellak, L. (Ed.) Community psychiatry and community mental health. New York: Grune & Stratton, 1964.
E. A. Larson, B. Barger, and S. N. Cahoon
467
Bolman, William M., and Halleck, Seymour L. The evaluation of a preventive psychiatric program: report of failure. Paper presented at American Psychiatric Association meeting, I968, Boston. Clarke, Carl (dir.) Marriage and college life. National Institute of Mental Health Grant No. MH I5o4I-I968. Farnsworth, Dana L. Editor's notebook: the growing importance of college psychiatry. American Journal of Psychiatry, 1967, 124, 68o-68I. Furman, Sylvans. Obstacles to the development of community mental health centers. Amercan Journal of Orthopsychiatry, I967, 124, 68o-681. Grinker, Roy R., Sr. Editorial: perspectives on normality. Archives of General Psychiatry, 1967, 17, 257. Jacobson, Avrohm. A critical look at the community psychiatric clinic. American Journal of Psychiatry, I967, 124, i4-2o. Kubie, Lawrence S. Pitfalls of community psychiatry. Archives of General Psychiatry, i968,
i8, 257-266. Kysar, John E. Preventive psychiatry on the college campus. Community Mental Health Journal, 1966, z, 27-34. Leif, Harold I. Sub-professional training in mental health. Archives of General Psychiatry,
I966, 15, 660-664 9 Linn, Lewis. The fourth psychiatric revolution. American Journal of Psychiatry, i968, I24, 1o43-Io48. Pervin, Lawrence A. The college as a social system. Journal of Higher Education, i967, 38, 317-322. Reifler, Clifford B.; Liptzin, Myron, B.; and Fox, J. Thomas. College psychiatry as public health psychiatry. American Journal of Psychiatry, 1967, 124, 662-67I. Sabshin, Melvin. Psychiatric perspectives on normality. Archives of General Psychiatry, 1967, "r7 258-264. Sinnett, E. R.; Wiesner, E. F.; and Friesen, W. S. Dormitory half-way house. Rehabilitation Record, 1967, 8, 34-37. Snyder, Benson R. College environment as a factor in mental health. Student Medicine,
I957 , 6, 7-i8. Snyder, Benson R., and Kaufman, Irving. The identity crisis in the university setting. Journal of the American College Health Association, i963, 1I, 259-276. Solomon, Philip; Patch, Vernon D.; Sturrock, John B.; and Wexler, Donald. A new approach to student mental health in small colleges: a multiple college mental health center.
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