the role of prevention as paramount. This implied
early detection and work with schools, police
departments, social service agencies, businesses,
and other organizations. The idea of personal deficit
was replaced by the view that the social system had
failed to provide an appropriate environment. A
community mental health center, then, must not
merely set about remedying individual deficits but
must do everything it could to enable the system to
function better. Consultation was given promi-
nence, as was the development of new community
resources. Going beyond Smith and Hobbs, some
even argued that the center should be the central
coordinator of all social systems in the community.
The goal was to reach those who needed services
and in particular those who were so often excluded
from services (the poor, the indigent, minorities).
New methods to meet mental health needs were
encouraged (e.g., crisis intervention and group
treatment). Advocacy of social action programs to
improve housing, employment, and opportunity
took precedence over the one-to-one therapy ses-
sion. The role of the therapist was replaced by that
of the social change agent.
Many of the foregoing antecedents had an
idealistic tone. Nevertheless, in the 1960s, many
community centers became operational. Some
approximated the hopes of Smith and Hobbs.
Others were more in the mold of older clinical
approaches even though they used a community
language. Some have been smooth-running enter-
prises, but others have created community tensions
and controversy. For many reasons (including cut-
backs in federal funding beginning in 1968), the
goal of establishing 2,000 centers by 1975 was not
realized. In fact, by 1974, only 540 centers had
been established with funds from the Community
Mental Health Centers Act. Despite the recom-
mendations of President Carter’s Commission on
Mental Health in 1977 that more emphasis should
be placed on“serving the underserved”(children,
elderly, ethnic minorities, and rural inhabitants),
fewer funds were appropriated specifically for com-
munity mental health centers over the subsequent
years. State and local governments failed to fill the
financial gaps. Today, there is a declining number
of community mental health centers, and it is
unclear whether this trend will reverse.The Concept of Prevention
The idea ofpreventionis the guiding principle that
has long been at the heart of public health programs
in the United States (Boglan & Hinds, 2009; Insti-
tute of Medicine [IOM], 1994; National Research
Council and Institute of Medicine [NRC-IOM],
2009). Basically, the principle asserts that, in the
long run, preventive activities will be more efficient
and effective than individual treatment adminis-
tered after the onset of diseases or problems (Felner,
Jason, Moritsugu, & Farber, 1983). That such
approaches can work is graphically illustrated by
Price, Cowen, Lorion, and Ramos-McKay
(1988). Their classic book,Fourteen Ounces of Pre-
vention, describes 14 model prevention programs for
children, adolescents, or adults. Box 16-2 presents
an overview of one of these programs that targets
preschool children from low-income families.
Prevention programs for adults have been
developed and implemented as well. Box 16-3 pre-
sents an overview of the JOBS program, which was
designed to assist adults who have recently lost their
employment.Primary Prevention. This type of prevention
represents the most radical departure from the tradi-
tional ways of coping with mental health problems.
Theessenceofthenotionofprimary preventioncan be
seen in Caplan’s (1964) emphasis on“counteracting
harmful circumstances before they have had a chance
to produce illness”(p. 26). Albee (1986) points out,
however, that the complexity of human problems
often requires preventive strategies that depend on
social change and the redistribution of power. For
many in society, this is not a highly palatable pros-
pect. Some examples of primary prevention include
programs to reduce job discrimination, enhance
school curricula, improve housing, teach parenting
skills,andprovidehelptochildrenfromsingle-
parent homes. Also grouped under this heading are
genetic counseling, Head Start, prenatal care for dis-
advantaged women, Meals on Wheels, and school466 CHAPTER 16