Community Mental Health Journal
Volume 2, Number 2, Summer, 1966
PROBLEM
ORIENTED MENTAL
POLITICAL HEALTH
SCIENCE
IN
RALPH STRAETZ, PH.D. ANDELENA PADILLA, PH.D.*
In delineating the role of political science in mental health, we begin with the source of pressures for governmental intervention or activity. Pressures may come from individuals of some political influence or from formal and informal groups. These groups may begin to appear themselves, or be represented at governmental administrative offces or in legislative halls. Some constituencies made up of individuals considered stigmatized or antisocial, such as the mentally ill or the poverty stricken, have more difficulty in becoming organized. They have to wait for an enlightened few to organize them. Their cause suffers from a considerable political lag.
The opportunity for political science research in the substantive areas of mental health lies primarily in raising questions leading to clearly defined problem definition and orientation. The systematic conceptualization of problems will also sharpen the choice of methods and techniques. These are requirements of science which become most critical when different disciplines of knowledge converge into an unclearly defined, extremely rich, controversial, and challenging field such as mental health. Today, mental health with all its attributes of controversy and role confusion, is in a state of transition. Psychiatry is being pulled by its need to gain acceptance from the rest of medicine while its problems of concern as a technology link it to the social sciences and to social and political action (Caplan, 1965; Kelly and Newbrough, 1961). Other mental health serv-
ice disciplines are facing similar problems. Meanwhile, specialized a p p r o a c h e s within traditional academic disciplines and professions have emerged. Questions about professional identity and the unique contributions of the social science disciplines to mental health have been raised; possibly as resistance to the absorption of academic disciplines by a professional practice or technology, or by the diminution of professional competence. Professional domains and boundaries have been crossed or poached upon; and interdisciplinary and multidisciplinary teams of researchers continue to face the problems of finding a modus operandi as part and parcel of their research operation. These are only a few of the problems that have existed for a long time in mental health, a field in which no individual discipline is tradition. ally fully equipped to deal with solely, or even to dominate. SOME NEW PROBLEMS IN MENTAL HEALTH In recent years, it has been widely accepted that major social, administrative, political, and technological changes have occurred in the field of mental health. Some 10 years ago, a trend started to develop, in this and other countries, when the census of patients in mental hospitals began to decrease. It now became possible to release patients who had been in mental hospitals for years. Back wards could be turned into therapeutic communities, and the disfunctional effects of total institutions
*Dr. Ralph Straetz, a policital scientist, is Professor of Government and Director of the NIMH Training Program for Political Scientists in Mental Health at New York University. Dr. Elena Padilla, an anthropologist, is Adjunct Professor of Government and Associate Director of the NIMH Training Program at NYU.
109
110
THE COMMUNITY MENTAL HEALTH JOURNAL
began to be recognized. New York State passed the first legislation in the United States creating local community mental health boards, and now the majority of states are allowing their communities to share the responsibility for the mentally ill, epileptic, retarded, and for other such groups. The increased role played by the federal government through the National Institute of Mental Health and other agencies have given continuous impetus and stimulus to these developments. These swift patterns of change culminated in 1963 with the late President Kennedy's national mental health program which enlarged the responsibilities of the federal government even beyond the expectations of the recommendations of the Joint Commission for Mental Health and Illness. All these actions were based on public policy and are today setting the structure, direction, and future of the mental health specialities and of mental health research. A rearrangement and reorganization of activities in mental health will be needed. Social science disciplines are facing their most important challenge in regard to basic questions of theoretical concern: social, behavioral, cultural, psychological and political. Social policy research (Freeman, 1963) will be concerned with questions of effectiveness, adequacy of services, meeting needs, organizing constituents, change in individual behavior through programmed or other special learning instruction, etc. Other questions of relevance will face the social and political scientist, administrator, practitioner, and citizen. For example, how will a comprehensive, continuous process of local-state-federal planning in mental health affect other areas of public policy, social movements, and citizen interest and activity (Cottrell, 1964; Brauch, 1961)? Or how can the job market absorb the mentally retarded as productive persons, when the economy is moving rapidly towards automation and increased technological skills? Or how can manpower shortages be met with present patterns of professional domains and relations among professionals? These are some of the compelling
problems facing social science research and training in mental health. Up to now these have been issues for discourse in many conferences, but not the concern of organized training and research effort (Srole, 1965). Last year, NIMH was supporting 333 predoctoral and post-doctoral research trainees in the social sciences through 54 university departments at a cost of slightly more than two million dollars. Better than $1.6 million of these funds went to sociology departments for training 264 students. More than $200,000 went to the anthropology departments for 33 students, and $45,600 to psychology departments for 14 students. Fewer than 10 trainees each went to medical school behavioral science departments, and to departments of economics and political science (Vincent, 1965). From this distribution, it appears that the interest of social scientists in mental health training has been unequal among the social sciences which can contribute to the mental health effort. It is possible that their role needs further public attention and clarifica. tion. PROBLEMS FOR POLITICAL SCIENCE IN MENTAL HEALTH
Three years ago, a training program for political scientists was started at New York University with a specialization in mental health. The goal of the program was to train research oriented political scientists to have specialized knowledge about and be concerned with the inter- and intragovernmental problems of mental health. In general, the concern was for the whole scope of government as it affects mental health. Major mental health activities today --planning, research, training, and services --are part of and involved in public policy from the local community to the national level. In delineating the role of political science in mental health, we begin with the source of the pressures for governmental intervention or activity. Pressures may come fore individuals of some political influence or from formal and informal groups. These groups may begin to appear
RALPH STRAETZ AND ELENA PADILLA
themselves, or may be represented by their group representative at governmental administrative ot~ces or in legislative halls. Some constituencies, made up of individuals considered strange or anti-social, such as the mentally ill or the poverty stricken, have more ditl~culty in becoming organized, and thus have to wait for an enlightened few to organize them. Their cause suffers from a considerable political lag. What is the constituency of mental health? Are professionals over represented ? Are minority groups under represented? Are the poor and underprivileged represented as they are in the poverty boards? To what extent does the leadership of mental health associations and planning groups only represent the existing power structure? What are the political forces; the power relationships within communities which make for mental health policies? How feasible is it to have comprehensive mental health services without altering profoundly the power relations within and among the mental health professions? Can mental health be comprehensive without taking into account other issues of social policy? Another concern of political scientists in mental health is that maze known as the legislative process, often the graveyard of important legislation. We are concerned with the problems of political roles, of party leaders, of group leaders, of the various involved professions, of administrators throughout the hierarchy and, not the least important, the role of the client or patient and former client or former patient. Our concerns about these topics are in the dimensions, context, and strategies of the whole political community as regards mental health or political behavior in mental health. In the administrative sphere, the political scientist is interested in all areas; from the regulation by licensing of private agencies, institutions, and professions to programming in a wide variety of administrative units at the same governmental levels, or at different levels. These units may be cooperating, competing, complementing, duplicating or just ignoring each
111
other. Political science has a special interest in the politics of planning and in producing policy oriented research which will yield creative plans. Their death on drawing boards or in regional planning groups, because the planners did not understand the political process, should be prevented. All these are substantive links between political science and mental health. Interesting case and institutional studies involving the politics of mental health would include: psychologists who object to the primacy written into the laws for their medically trained colleagues; power struggles between psychiatry and the rest of medicine; suppliers and contractors who have a stake in a certain kind of mental health structure or complex; and communities who do not want a large mental hospital closed down any more than a navy yard or a factory. These are some of the reasons why NYU is training political scientists in the problems of government and mental health. The strong role of the private sector in the field of mental health adds both zest and interest to the problems of political science research. In directing attention to mental health, the political scientist might begin by examining the existing bureaucratic structure primarily on the local level, and identifying its relationship with the local power structure both within and without the field of mental health. Similarly local-state, local-federal, and state-federal relationships and programming would need examination, evaluation, and identification. Two problem areas can be singled out: ' the role and political dimension of one particular group, i.e., the psychologists in the mental health bureaucracy; and the structure of local governmental organization of mental health facilities. This year, a memorandum signed by the past president of the New York State Psychological Association, who was a member of the New York State Planning Committee, the president of the New York State Psychological Association, and the executive director of the New York State Mental Health Planning Committee projected several positions.
112
THE COMMUNITY MENTAL HEALTH JOURNAL
The first position urged that "federal funds for construction of community mental health centers . . . should be constructed as 'free standing' centers apart from the hospitals." The expressed reason was to prevent the new centers from being subordinate to the existing hospitals and thereby burden themselves with irrelevant medical influences. Free standing institutions might make possible a new orientation to mentally disturbed persons based on conceptualizations from all the behavioral and social science disciplines. The second position accepted the recommendation for future state hospitals with a limit for 1,000 beds. But perhaps more important was the suggestion that programming leading toward the creation of "therapeutic communities" be vigorously explored as leading eventually to the complete replacement of the state hospital as a place for the protection and treatment of the seriously disturbed. In the third position, the New York State Psychological Association strongly urged that "the gates be opened to insure that talented persons from all the disciplines are drawn into the public program." As is generally known, for this to be true and possible, psychiatrists would have to accept members of other disciplines as peers "rather than as technical or ancillary subordinates." This issue, the statement went on to say, would have to be faced squarely at the state level "because the public interest is involved." Also urged was a policy in which all positions, from Mental Hygiene Commissioner down, be filled "by persons on the basis of training, experience and competence rather than on the basis of identity as a member of a particular profession," and that the concept of 'psychiatrist in charge' as the final authority in mental health matters, as stated in the regulation of the Department of Mental Hygiene, was not acceptable to psychology. Similarly, resolutions proposed to the American Psychological Association by the New York State Association in 1964, but never pushed to a vote, suggested that the Committee on Relations be recharged to
take under continuous study those developments in the field which might result in increased domination of the mental health field by psychiatry. Furthermore, it was proposed that a statement be formulated, published and disseminated widely among psychologists, psychiatrists, and govern. ment agencies at all levels asserting the following policy: that the training of psychologists in the field of human behavior ranked second to no other learned discipline; that psychologists would not accept directions from others as to proper applications of psychology, and that psychologists would demand that they share responsibility only with the patient in those situations in which they are serving their proper functions to determine under what conditions and at what times consultation with non-psychological personnel was to be undertaken with regard to those functions (Newbrough, 1964). Each of these professional positions has strong political consequences since the aim is obviously to restructure the mental health establishment in order to permit extensive shifts in role relationships and administrative patterns. One resolution, for example, was blunt enough to demand that the Secretary of Health, Education, and Welfare appoint a psychologist as the next director of the National Institute of Mental Health. In addition to such matters of professional status, the New York State Association expressed strong opposition to giving departments of mental health, or mental health boards in our cities and communities, direct or indirect control of mental health service. They suggested limiting these agencies to what public administrators usually call staff as opposed to line or operational activity. These psychologists say that the primary cause of failure of government mental health activity agencies, in their view, was the tendency to place all authority roles under one discipline--psychiatry. Here is a fascinating pattern of intra and inter group relationships. Group roles of psychologists are involved especially vis-avis psychiatrists but also vis-a-vis the American Psychiatric Association and its
RALPH STRAETZ AND ELENA PADILLA
leadership role which is written into law, into departmental regulations, and found throughout its interpersonal relationships with political officials. The influence of group size; the identification of group norms, especially the repeated concern with something called the "public" and something else called "public interest;" the success or failure of group power (success in the field of licensing, failure in such attempts as that to remove the medical requirement for directors of the new community mental health centers) ; the various problems of prestige and status - - a l l are areas calling for examination of the relationships to the decisions that become public policy. More specific studies must be made of access to legislative councils (national, state, and local), access to strategically placed party and nonparty individuals, the development of rules and regulations which make psychologists second class professionals, the use of litigation to achieve professional equity, and of cooperative arrangements with other professional organizations having the same goals. Much more could be learned from such research; moreover, it would avoid the naivet6 of requesting a cabinet official to appoint a psychologist as director of NIMH. One wonders if the New York State Association, in recommending that neither the new city departments of mental health nor the community mental health boards have any operational responsibility, in any way studied the nature or the functioning of the existing boards throughout the state. Or did the Association, for example, watch the local board in New York City, with only funding and idea producing power, attempt to cope with seven other older and powerful line agencies? Rather than to decry the centralized authorities of the local mental health boards, which may or may not exist, why isn't research carried out on the effectiveness of their operational activities: the extent to which they have been idea-producing mechanisms, their role in the field of research, the extent to which some professionals are over-represented or minority groups are under-represented, the
113
extent to which board membership only represents the existing power structure, and the prime question as to whether or not boards should be advisory only with the responsibility centered in the hands of the professional director. Why don't board members and professional department heads increase their lobbying activities? Should membership and chairmanship of boards be rotated? What are the relationships among mental health agencies, regional, city, and county planning agencies, housing authorities, poverty groups, and urban renewal agencies? When we know the answer to some of these questions, perhaps psychologists and other social scientists can contribute to optimal structural organization for governmental mental health activity in a more rational and valid manner. Political science can assist in tha achievement of this goal. REFERENCES
BRAUCH,M. C. Comprehensiveplanning as a field of study. In H. S. Perloff (Ed.), Planning and the urban community. Carnegie Inst. of Technology and the U. of Pitt. Press, 1961. Pp. 198212. CAPLAN, G. Community psychiatry--introduction and overview.In S. E. Goldston (Ed.), Concepts o/community psychiatry: a/ramework/or training. HEW PHS Publication No. 1319, 1965. Pp.
3-18. COTTRELL,L. S., JR. Social planning, the competent community and mental health. In Urban America and the planning o/ mental health services.
Group for the Advancement of Psychiatry, Symposium No. 10, 1954. Pp. 391-402. FREEr~AN, H. E. The strategy of social policy research. Social Wel/are Forum, 1963. KELLY, J. G., & NEWBRO~C~r,J. R. Community mental health research: some dimensions and policies. Paper read at Amer. Psychol. Assn., N.Y.C., 1961. NEWBROUCrr,J. R. Clinical psychology:phoenix or dead duck. In Con/erence proceedings, pro/es. sional preparation o] clinical psychologists. In cooperation with Mr. Sinai Hospital, Baltimore: Md. Dept. of M. H., 1964. Pp. 8-24. SROLE,L. Selected SociologicalPerspectives. In S. E. Goldston (Ed.), Concepts of community psychiatry: a frameworkfor training. HFWrns Publication No. 1319, 1965. Pp. 33-46. u C. E. Support for research training in an. thropologyunder the National Institute of Mental Health training program. American ~4nthro. pologist, 1965, 67, 754-761.
Volume 2, Number 2, Summer, 1966
PROBLEM
ORIENTED MENTAL
POLITICAL HEALTH
SCIENCE
IN
RALPH STRAETZ, PH.D. ANDELENA PADILLA, PH.D.*
In delineating the role of political science in mental health, we begin with the source of pressures for governmental intervention or activity. Pressures may come from individuals of some political influence or from formal and informal groups. These groups may begin to appear themselves, or be represented at governmental administrative offces or in legislative halls. Some constituencies made up of individuals considered stigmatized or antisocial, such as the mentally ill or the poverty stricken, have more difficulty in becoming organized. They have to wait for an enlightened few to organize them. Their cause suffers from a considerable political lag.
The opportunity for political science research in the substantive areas of mental health lies primarily in raising questions leading to clearly defined problem definition and orientation. The systematic conceptualization of problems will also sharpen the choice of methods and techniques. These are requirements of science which become most critical when different disciplines of knowledge converge into an unclearly defined, extremely rich, controversial, and challenging field such as mental health. Today, mental health with all its attributes of controversy and role confusion, is in a state of transition. Psychiatry is being pulled by its need to gain acceptance from the rest of medicine while its problems of concern as a technology link it to the social sciences and to social and political action (Caplan, 1965; Kelly and Newbrough, 1961). Other mental health serv-
ice disciplines are facing similar problems. Meanwhile, specialized a p p r o a c h e s within traditional academic disciplines and professions have emerged. Questions about professional identity and the unique contributions of the social science disciplines to mental health have been raised; possibly as resistance to the absorption of academic disciplines by a professional practice or technology, or by the diminution of professional competence. Professional domains and boundaries have been crossed or poached upon; and interdisciplinary and multidisciplinary teams of researchers continue to face the problems of finding a modus operandi as part and parcel of their research operation. These are only a few of the problems that have existed for a long time in mental health, a field in which no individual discipline is tradition. ally fully equipped to deal with solely, or even to dominate. SOME NEW PROBLEMS IN MENTAL HEALTH In recent years, it has been widely accepted that major social, administrative, political, and technological changes have occurred in the field of mental health. Some 10 years ago, a trend started to develop, in this and other countries, when the census of patients in mental hospitals began to decrease. It now became possible to release patients who had been in mental hospitals for years. Back wards could be turned into therapeutic communities, and the disfunctional effects of total institutions
*Dr. Ralph Straetz, a policital scientist, is Professor of Government and Director of the NIMH Training Program for Political Scientists in Mental Health at New York University. Dr. Elena Padilla, an anthropologist, is Adjunct Professor of Government and Associate Director of the NIMH Training Program at NYU.
109
110
THE COMMUNITY MENTAL HEALTH JOURNAL
began to be recognized. New York State passed the first legislation in the United States creating local community mental health boards, and now the majority of states are allowing their communities to share the responsibility for the mentally ill, epileptic, retarded, and for other such groups. The increased role played by the federal government through the National Institute of Mental Health and other agencies have given continuous impetus and stimulus to these developments. These swift patterns of change culminated in 1963 with the late President Kennedy's national mental health program which enlarged the responsibilities of the federal government even beyond the expectations of the recommendations of the Joint Commission for Mental Health and Illness. All these actions were based on public policy and are today setting the structure, direction, and future of the mental health specialities and of mental health research. A rearrangement and reorganization of activities in mental health will be needed. Social science disciplines are facing their most important challenge in regard to basic questions of theoretical concern: social, behavioral, cultural, psychological and political. Social policy research (Freeman, 1963) will be concerned with questions of effectiveness, adequacy of services, meeting needs, organizing constituents, change in individual behavior through programmed or other special learning instruction, etc. Other questions of relevance will face the social and political scientist, administrator, practitioner, and citizen. For example, how will a comprehensive, continuous process of local-state-federal planning in mental health affect other areas of public policy, social movements, and citizen interest and activity (Cottrell, 1964; Brauch, 1961)? Or how can the job market absorb the mentally retarded as productive persons, when the economy is moving rapidly towards automation and increased technological skills? Or how can manpower shortages be met with present patterns of professional domains and relations among professionals? These are some of the compelling
problems facing social science research and training in mental health. Up to now these have been issues for discourse in many conferences, but not the concern of organized training and research effort (Srole, 1965). Last year, NIMH was supporting 333 predoctoral and post-doctoral research trainees in the social sciences through 54 university departments at a cost of slightly more than two million dollars. Better than $1.6 million of these funds went to sociology departments for training 264 students. More than $200,000 went to the anthropology departments for 33 students, and $45,600 to psychology departments for 14 students. Fewer than 10 trainees each went to medical school behavioral science departments, and to departments of economics and political science (Vincent, 1965). From this distribution, it appears that the interest of social scientists in mental health training has been unequal among the social sciences which can contribute to the mental health effort. It is possible that their role needs further public attention and clarifica. tion. PROBLEMS FOR POLITICAL SCIENCE IN MENTAL HEALTH
Three years ago, a training program for political scientists was started at New York University with a specialization in mental health. The goal of the program was to train research oriented political scientists to have specialized knowledge about and be concerned with the inter- and intragovernmental problems of mental health. In general, the concern was for the whole scope of government as it affects mental health. Major mental health activities today --planning, research, training, and services --are part of and involved in public policy from the local community to the national level. In delineating the role of political science in mental health, we begin with the source of the pressures for governmental intervention or activity. Pressures may come fore individuals of some political influence or from formal and informal groups. These groups may begin to appear
RALPH STRAETZ AND ELENA PADILLA
themselves, or may be represented by their group representative at governmental administrative ot~ces or in legislative halls. Some constituencies, made up of individuals considered strange or anti-social, such as the mentally ill or the poverty stricken, have more ditl~culty in becoming organized, and thus have to wait for an enlightened few to organize them. Their cause suffers from a considerable political lag. What is the constituency of mental health? Are professionals over represented ? Are minority groups under represented? Are the poor and underprivileged represented as they are in the poverty boards? To what extent does the leadership of mental health associations and planning groups only represent the existing power structure? What are the political forces; the power relationships within communities which make for mental health policies? How feasible is it to have comprehensive mental health services without altering profoundly the power relations within and among the mental health professions? Can mental health be comprehensive without taking into account other issues of social policy? Another concern of political scientists in mental health is that maze known as the legislative process, often the graveyard of important legislation. We are concerned with the problems of political roles, of party leaders, of group leaders, of the various involved professions, of administrators throughout the hierarchy and, not the least important, the role of the client or patient and former client or former patient. Our concerns about these topics are in the dimensions, context, and strategies of the whole political community as regards mental health or political behavior in mental health. In the administrative sphere, the political scientist is interested in all areas; from the regulation by licensing of private agencies, institutions, and professions to programming in a wide variety of administrative units at the same governmental levels, or at different levels. These units may be cooperating, competing, complementing, duplicating or just ignoring each
111
other. Political science has a special interest in the politics of planning and in producing policy oriented research which will yield creative plans. Their death on drawing boards or in regional planning groups, because the planners did not understand the political process, should be prevented. All these are substantive links between political science and mental health. Interesting case and institutional studies involving the politics of mental health would include: psychologists who object to the primacy written into the laws for their medically trained colleagues; power struggles between psychiatry and the rest of medicine; suppliers and contractors who have a stake in a certain kind of mental health structure or complex; and communities who do not want a large mental hospital closed down any more than a navy yard or a factory. These are some of the reasons why NYU is training political scientists in the problems of government and mental health. The strong role of the private sector in the field of mental health adds both zest and interest to the problems of political science research. In directing attention to mental health, the political scientist might begin by examining the existing bureaucratic structure primarily on the local level, and identifying its relationship with the local power structure both within and without the field of mental health. Similarly local-state, local-federal, and state-federal relationships and programming would need examination, evaluation, and identification. Two problem areas can be singled out: ' the role and political dimension of one particular group, i.e., the psychologists in the mental health bureaucracy; and the structure of local governmental organization of mental health facilities. This year, a memorandum signed by the past president of the New York State Psychological Association, who was a member of the New York State Planning Committee, the president of the New York State Psychological Association, and the executive director of the New York State Mental Health Planning Committee projected several positions.
112
THE COMMUNITY MENTAL HEALTH JOURNAL
The first position urged that "federal funds for construction of community mental health centers . . . should be constructed as 'free standing' centers apart from the hospitals." The expressed reason was to prevent the new centers from being subordinate to the existing hospitals and thereby burden themselves with irrelevant medical influences. Free standing institutions might make possible a new orientation to mentally disturbed persons based on conceptualizations from all the behavioral and social science disciplines. The second position accepted the recommendation for future state hospitals with a limit for 1,000 beds. But perhaps more important was the suggestion that programming leading toward the creation of "therapeutic communities" be vigorously explored as leading eventually to the complete replacement of the state hospital as a place for the protection and treatment of the seriously disturbed. In the third position, the New York State Psychological Association strongly urged that "the gates be opened to insure that talented persons from all the disciplines are drawn into the public program." As is generally known, for this to be true and possible, psychiatrists would have to accept members of other disciplines as peers "rather than as technical or ancillary subordinates." This issue, the statement went on to say, would have to be faced squarely at the state level "because the public interest is involved." Also urged was a policy in which all positions, from Mental Hygiene Commissioner down, be filled "by persons on the basis of training, experience and competence rather than on the basis of identity as a member of a particular profession," and that the concept of 'psychiatrist in charge' as the final authority in mental health matters, as stated in the regulation of the Department of Mental Hygiene, was not acceptable to psychology. Similarly, resolutions proposed to the American Psychological Association by the New York State Association in 1964, but never pushed to a vote, suggested that the Committee on Relations be recharged to
take under continuous study those developments in the field which might result in increased domination of the mental health field by psychiatry. Furthermore, it was proposed that a statement be formulated, published and disseminated widely among psychologists, psychiatrists, and govern. ment agencies at all levels asserting the following policy: that the training of psychologists in the field of human behavior ranked second to no other learned discipline; that psychologists would not accept directions from others as to proper applications of psychology, and that psychologists would demand that they share responsibility only with the patient in those situations in which they are serving their proper functions to determine under what conditions and at what times consultation with non-psychological personnel was to be undertaken with regard to those functions (Newbrough, 1964). Each of these professional positions has strong political consequences since the aim is obviously to restructure the mental health establishment in order to permit extensive shifts in role relationships and administrative patterns. One resolution, for example, was blunt enough to demand that the Secretary of Health, Education, and Welfare appoint a psychologist as the next director of the National Institute of Mental Health. In addition to such matters of professional status, the New York State Association expressed strong opposition to giving departments of mental health, or mental health boards in our cities and communities, direct or indirect control of mental health service. They suggested limiting these agencies to what public administrators usually call staff as opposed to line or operational activity. These psychologists say that the primary cause of failure of government mental health activity agencies, in their view, was the tendency to place all authority roles under one discipline--psychiatry. Here is a fascinating pattern of intra and inter group relationships. Group roles of psychologists are involved especially vis-avis psychiatrists but also vis-a-vis the American Psychiatric Association and its
RALPH STRAETZ AND ELENA PADILLA
leadership role which is written into law, into departmental regulations, and found throughout its interpersonal relationships with political officials. The influence of group size; the identification of group norms, especially the repeated concern with something called the "public" and something else called "public interest;" the success or failure of group power (success in the field of licensing, failure in such attempts as that to remove the medical requirement for directors of the new community mental health centers) ; the various problems of prestige and status - - a l l are areas calling for examination of the relationships to the decisions that become public policy. More specific studies must be made of access to legislative councils (national, state, and local), access to strategically placed party and nonparty individuals, the development of rules and regulations which make psychologists second class professionals, the use of litigation to achieve professional equity, and of cooperative arrangements with other professional organizations having the same goals. Much more could be learned from such research; moreover, it would avoid the naivet6 of requesting a cabinet official to appoint a psychologist as director of NIMH. One wonders if the New York State Association, in recommending that neither the new city departments of mental health nor the community mental health boards have any operational responsibility, in any way studied the nature or the functioning of the existing boards throughout the state. Or did the Association, for example, watch the local board in New York City, with only funding and idea producing power, attempt to cope with seven other older and powerful line agencies? Rather than to decry the centralized authorities of the local mental health boards, which may or may not exist, why isn't research carried out on the effectiveness of their operational activities: the extent to which they have been idea-producing mechanisms, their role in the field of research, the extent to which some professionals are over-represented or minority groups are under-represented, the
113
extent to which board membership only represents the existing power structure, and the prime question as to whether or not boards should be advisory only with the responsibility centered in the hands of the professional director. Why don't board members and professional department heads increase their lobbying activities? Should membership and chairmanship of boards be rotated? What are the relationships among mental health agencies, regional, city, and county planning agencies, housing authorities, poverty groups, and urban renewal agencies? When we know the answer to some of these questions, perhaps psychologists and other social scientists can contribute to optimal structural organization for governmental mental health activity in a more rational and valid manner. Political science can assist in tha achievement of this goal. REFERENCES
BRAUCH,M. C. Comprehensiveplanning as a field of study. In H. S. Perloff (Ed.), Planning and the urban community. Carnegie Inst. of Technology and the U. of Pitt. Press, 1961. Pp. 198212. CAPLAN, G. Community psychiatry--introduction and overview.In S. E. Goldston (Ed.), Concepts o/community psychiatry: a/ramework/or training. HEW PHS Publication No. 1319, 1965. Pp.
3-18. COTTRELL,L. S., JR. Social planning, the competent community and mental health. In Urban America and the planning o/ mental health services.
Group for the Advancement of Psychiatry, Symposium No. 10, 1954. Pp. 391-402. FREEr~AN, H. E. The strategy of social policy research. Social Wel/are Forum, 1963. KELLY, J. G., & NEWBRO~C~r,J. R. Community mental health research: some dimensions and policies. Paper read at Amer. Psychol. Assn., N.Y.C., 1961. NEWBROUCrr,J. R. Clinical psychology:phoenix or dead duck. In Con/erence proceedings, pro/es. sional preparation o] clinical psychologists. In cooperation with Mr. Sinai Hospital, Baltimore: Md. Dept. of M. H., 1964. Pp. 8-24. SROLE,L. Selected SociologicalPerspectives. In S. E. Goldston (Ed.), Concepts of community psychiatry: a frameworkfor training. HFWrns Publication No. 1319, 1965. Pp. 33-46. u C. E. Support for research training in an. thropologyunder the National Institute of Mental Health training program. American ~4nthro. pologist, 1965, 67, 754-761.
