Satellite Mental Health Facilities∗

Bibliographic Data

ID8375733
AuthorsJulian Wolpert (Princeton University), Michael Dear (McMaster University), RANDI CRAWFORD (City University of New York)
Year1975
Volume65
Issue1
Pages24-33
Publication date1975-03-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueAnnals of the Association of American Geographers (JOURNAL)
Journal identifiersISSN: 0004-5608 • E-ISSN: 1467-8306
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1111/j.1467-8306.1975.tb01015.x
OpenAlexW2093428062
LanguageEN
Citations received33

In the absence of rigorous procedures for prescribing ideal treatment facilities for the mentally disabled, it is difficult to justify the extensive system of mental health clinics and their satellites which has been introduced into residential neighborhoods. The facilities are sited primarily in low income communities which are threatened with institutional saturation. The geographical concentration of satellite mental health facilities is largely explained by the absence of precise locational guidelines, and by a decision process which is fundamentally a conflict between service producer and service funder. Location, per se, is of peripheral concern in this conflict. Conflict resolution is typically achieved by some expedient compromise, in which undue weight is given to the externalities of the proposed allocation. Key Words: CaliforniaClient assignmentCommunity Mental HealthExternalitiesLocational expediencyReleased patients Notes ∗Acknowledgment is made to NIHM (METRO Division) for support under grant MH21108-02 to the Regional Science Research Institute in Philadelphia, Pennsylvania. Wolpert, who was on leave during 1973–74 at the Center for Advanced Study in the Behavioral Sciences, acknowledges the Center for its assistance during the preparation of this paper. The assistance and suggestions of Anthony Mumphrey, Eugene Bardach, John Seley, and Perry Gluckman are acknowledged. 1 A. M. Austin, T. E. Smith, and J. Wolpert, "The Implementation of Controversial Facility-Complex Programs,"Geographical Analysis, Vol. (1970), pp. 315–29. 2 M. J. Dear, The Neighborhood Impact of Mental Health Facility Siting, Discussion Paper Series No. 84 (Philadelphia: Regional Science Research Institute, 1975). 3 Dear, op. cit., footnote 2. 4 The five mandated or essential services are: inpatient, outpatient, partial hospitalization, emergency and consultation, and education services. 5 The satellite process is described in R. Crawford, Decentralization in Community Mental Health Programs, Discussion Paper Series No. 85 (Philadelphia: Regional Science Research Institute, 1975). 6 F. D. Chu and S. Trotter, The Mental Health Complex (Washington, D. C.: Center for Study of Responsive Law, 1972). 7 A selective list of critical reviews of the community mental health program would include L. S. Kubie, "Pitfalls of Community Psychiatry,"Archives of General Psychiatry; Vol. 18 (1968), pp. 257–66; P. R. Dingman, The Case for the State Mental Hospital (Washington, D.C.: National Institute of Mental Health, 1971); G. Jacobson, "Emergency Services in Community Mental Health,"American Journal of Public Health, Vol. 64 (1974), pp. 124 28; A. Sheely and P. Wright, "A State-Wide Epidemiological Assessment of the Effectiveness of Community Mental Health Services,"Journal of Clinical Psychiatry, Vol. 28 (1972), pp. 109 11; and Chu and Trotter, op. cit., footnote 6. 8 W. Ryan, Distress in the City (Cleveland: Case Western Reserve University Press, 1969). 9 C. L. Huffine and T. J. Craig Catchment and Community,"Archives of General Psychiatry, Vol. 28 (1973), pp. 483 88. 10 W. M. Bolman, "Community Control of the Community Mental Health Center,"American Journal of Psychiatry, Vol. 129 (1972), pp. 173 86; W. Fisher, J. Mehr, and P. Truckenbrod, Power, Greed and Stupidity in the Mental Health Racket (Philadelphia: Westminster Press, 1973); L. D. Ozarin, S. Feldman, and F. E. Spaner, "Experience with Community Mental Health Centers,"American Journal of Psychiatry, Vol. 127 (1971), pp. 912 16; and R. Thomson, "The Whys and Why Nots of Consumer Participation,"Community Mental Health Journal, Vol. 9 (1973), pp. 143 50. 11 R. E. Becker, "The Organization and Management of Community Mental Health Services,"Community Mental Health Journal, Vol. 8 (1972), pp. 292 302; C. W. Cobb, "Community Mental Health Services and the Lower Socio-Economic Classes: A Summary of Research Literature on Outpatient Treatment (1963-1969),"American Journal of Orthopsychiatry, Vol. 42 (1972), pp. 404 14; and M. Wachspress, "Goals and Functions of the Community Mental Health Center,"American Journal of Psychiatry, Vol. 129 (1972), pp. 187 90. 12 J. Elinson, E. Padilla, and M. E. Perkins, Public Image of Mental Health (New York: Mental Health Materials Center, 1967). 13 For discussion of current locational strategies, See M. J. Dear, "Locational Analysis for Public Mental Health Facilities," unpublished doctoral dissertation, University of Pennsylvania, 1974 (especially Chapter 3); and W. E. Horton, B. M. Kramer, and P. K. New, "Locational Process: Guidelines for Locating Mental Health Services,"Community Mental Health Journal, Vol. 9 (1973), pp. 270 80. 14 See, for example, C. S. Revelle, D. Marks, and J. C. Liebman, "Analysis of Private and Public Sector Location Models,"Management Science, Vol. 16 (1970), pp. 692 707. 15 Dear, op. cit., footnote 2. 16 The National Institute of Mental Health specifies six variables which contribute to an "accessible program" of services: physical accessibility, visibility, administrative accessibility, economic accessibility, psychological accessibility, and cultural accessibility; National institute of Mental Health, Community Mental Health Care Policy and Standards Manual: Part I (Washington, D.C.: U.S. Government Printing Office, 1971). 17 A. J. Rosenthal and H. Langee The Development of a Service-Oriented Psychiatric Program in a Disadvantaged Area,"American Journal of Psychiatry, Vol. 126 (1970), pp. 1436 43. 18 Ozarin, Feldman, and Spaner, op. cit., footnote 10. 19 Crawford, op. cit., footnote 5. 20 Dear, op. cit., footnote 13. It may be justifiable for some purposes to distinguish between satellites of public facilities, which are designed to provide accessible care to a local resident population, and residential facilities, which are sited in response to locally available support, or simply because zoned residential facilities were available. 21 Cobb, op. cit., footnote 11. 22 D. Garr, personal communication. 23 Private mental health facilities generally follow the medical model of doctors' offices, well-groomed medical centers, and private hospitals. These facilities generally are not in residential neighborhoods, their treatment is more discreet and anonymous, and they do not attract conspicuous numbers of the disabled and the indigent. 24 Chu and Trotter, op. cit., footnote 6. 25 Dear, op. cit., footnote 2. 26 Chu and Trotter, op. cit., footnote 6; R. P. Lorion, "Socio-economic Status and Traditional Treatment Approaches Reconsidered,"Psychological Bulletin, Vol. 79 (1973), pp. 263 70; and F. Perlmutter and H. A. Silverman, "CMHC: A Structural Anachronism,"Social Work, Vol. 17 (1972), pp. 78 84. 27 Chu and Trotter, op. cit., footnote 6; and Fisher, Mehr, and Truckenbrod, op. cit., footnote 10. 28 Bolman, op. cit., footnote 10; and Thomson, op. cit., footnote 10. 29 A more complex model has been outlined in Dear, op. cit., footnote 13 (especially chapter 6). 30 J. M. Stubblebine and J. B. Decker, "Are Urban Mental Health Centers Worth It?"American Journal of Psychiatry, Vol. 127 (1971), pp. 908–12. 31 E. Bardach, Skill Factor in Politics (Berkeley: University of California Press, 1972). 32 Most large United States cities have ghettos of released patients. Field study for this paper was limited to San Francisco, Oakland, and San Jose, California. 33 Much of the statistical data and factual information in this section is based on personal communication from D. Garr. 34 V. Aviram and S. P. Segal, "Exclusion of the Mentally Ill,"Archives of General Psychiatry, Vol. 29 (1973), pp. 126 31; H. R. Lamb and V. Goertzel, "Discharged Mental Patients: Are They Really in the Community?"Archives of General Psychiatry, Vol. 24 (1971), pp. 29–34; and R. Reich, "Care of the Chronically Mentally Ill: A National Disgrace,"American Journal of Psychiatry, Vol. 130 (1973), pp. 911 12

Geography · Mental health · Remote sensing · Satellite · Engineering · Medicine · Urban, Neighborhood, and Segregation Studies

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