practiced in rural or underdeveloped areas where
there was a shortage of mental health personnel.
Consultation became a way of using existing com-
munity personnel (e.g., teachers or ministers) to help
solve the mental health problems of such areas. A
second orientation developed out of the behavioral
tradition. To implement the technology of behavior
modification that had been so successful in laboratory
settings, it was necessary to move into real-life situa-
tions. To do that, people in the patient’s environ-
ment (e.g., home or school) had to be trained to
properly dispense reinforcements for the desired
behavior. Consultation became a way of providing
this training. The third orientation is an organiza-
tional one that emphasizes consultation to industry.
Specialists work with management or work group
leaders to improve morale, job satisfaction, and pro-
ductivity or to reduce inefficiency, absenteeism,
alcoholism, or other problems.
Types of Mental Health Consultation.
Approaches to mental health consultation can be
classified in many ways. Perhaps the most widely
accepted classification is Caplan’s (1970). It includes
the following categories:
- Client-centered case consultation. Here the focus is
on helping a specific client or patient to solve a
current problem. For example, a clinician
might be asked to consult with a colleague on a
diagnostic problem involving a specific patient. - Consultee-centered case consultation. In this
instance, the aim is to help the consultee
enhance the skills that he or she needs to deal
with future cases. For example, a teacher might
be advised on how to selectively reinforce
behavior to reduce classroom disturbances. - Program-centered administrative consultation. The
notion here is to assist in the administration or
management of a specific program. For
instance, a consultant might be hired to set up
an“early warning system”in the schools to
detect potential cases of maladjustment. - Consultee-centered administrative consultation. Here
the aim is to improve the skills of an adminis-
trator in the hope that this will enable her or
him to function better in the future. For
example, a sensitivity group consisting of
administrators might be monitored by a con-
sultant to help enhance the administrators’
communication skills.Techniques and Phases. Several general tech-
niques can enhance the effectiveness of the consult-
ing process. In most cases, the consultation process
will pass through the following phases:- The entry or preparatory phase. In the initial phase,
the exact nature of the consultant relationship
and mutual obligations are worked out. - The beginning or warming-up phase. In this phase,
the working relationship is established. - The alternative action phase. This phase encom-
passes the development of specific, alternative
solutions and strategies of problem solving. - Termination. When it is mutually agreed that
further consultation is unnecessary, termination
follows.
Unfortunately, community mental health cen-
ters have had difficulty providing consultation ser-
vices, especially to schools and community
agencies; the budgetary support has just not been
there (Iscoe & Harris, 1984). What is particularly
troubling about this state of affairs is that there is
empirical support for the efficacy of consultation
(Duffy & Wong, 1996; Medway & Updike, 1985;
Orford, 1992).
Community Alternatives
to Hospitalization
As noted earlier in this chapter, the nation’s mental
hospitals have long been objects of criticism.
Despite the fact that there is a core of“undischarge-
able”patients, there are alternatives to our current
hospital system—alternatives that will provide
environments geared to the goal of enabling
patients to resume a responsible place in society.
Examples of alternatives include the commu-
nity lodge (Fairweather, Sanders, Maynard, &
Cressler, 1969). This is akin to a halfway houseCOMMUNITY PSYCHOLOGY 477