depression found that those who participated in a
peer-support intervention (usually a peer-support
group) showed better outcomes than depressed
individuals who received treatment as usual without
peer support (Pfeiffer et al., 2011).
CONCLUDING COMMENTSIn a relatively short time, the community emphasis
has become a force that has led clinical psycholo-
gists to reexamine many of their old assumptions.
But there are important questions that must be con-
fronted as we conclude our discussion of this field.
Questions of EffectivenessYears ago, Cowen (1967, 1973, 1978) raised the
question of how much the community movement
has accomplished beyond that accomplished by
more traditional mental health approaches. The
question was whether excitement and rhetoric
had masked what was really very little substantive
change. For example, Cowen (1973) could find
relatively few research reports in the Community
Mental Health Journalthat provided concrete data.
The papers also notably failed to address issues of
prevention—a notion central to the community
approach. Rappaport (1977) stated that no evidence
really existed that U.S. communities had shown
improved mental health. He even went so far as
to suggest that the community mental health
movement’s greatest accomplishment may have
been that it opened up new careers for persons
who were formerly not part of the movement.
Although for years there was more rhetoric
than implementation with regard to prevention
programs (Iscoe & Harris, 1984), intervention is
one of the cornerstones of the community move-
ment. The question remains, however, whether the
field really knows enough about the causes of men-
tal health problems to mount large-scale, successful
preventive programs. Fortunately, recent reports
evaluating the effectiveness of a wide range of pre-
vention programs lead us to a state of cautious opti-
mism (e.g., Durlak & Wells, 1997; Felner, DuBois,
& Adan, 1991; Institute of Medicine, 1994).
Whereas many early reports regarding the efficacy
of prevention programs were disappointing, com-
munity psychologists were able to learn from these
failures and incorporate changes into new programs
(Felner et al., 1991). For example, increased focus
was placed on modifying psychological processes
underlying various mental disorders, and interven-
tions were designed to be more intensive and to
extend over longer periods of time. The Institute
of Medicine report (1994) on preventing mental
illness presented a group of 39 exemplary interven-
tion programs (with demonstrated effectiveness)
that targeted infants, preschoolers, elementary-age
children, adolescents, adults, or the elderly. Like-
wise, a newer summary of prevention efforts
(NRC-IOM, 2009) summarizes a number of effec-
tive prevention efforts aimed at childhood maltreat-
ment, academic failure, violence, conduct disorder,
depression, substance abuse, and anxiety, for exam-
ple. Finally, Biglan and Hinds (2009) offer evidence
for successful prevention programs reducing sub-
stance use and antisocial behavior and a directive
for prevention programs that will simultaneously
address multiple additional issues by focusing on
cross-cutting community factors (e.g., prosocial
behavior).
Issues remain, to be sure. For example, there
are questions regarding how intervention programs
should be disseminated and by whom, how the
programs are to be maintained over time (funding
issues), and the need to train more researchers who
are qualified to design, implement, and evaluate
preventive interventions (Institute of Medicine,
1994; NRC-IOM, 2009; Orford, 1992, 2008;
Thornicroft et al., 2010). For example, the IOM
report (1994) estimated that only about 10 new
prevention experts are produced a year; training
programs and financial support are needed to
increase this woefully low number.Values, Power, and Civil Rights
Clearly, the community movement seeks to bring
about social change and the reorganization of social
institutions. The goal of such changes is undoubtedly480 CHAPTER 16