Community Psychology and Community Mental Health: A Call for Reengagement

Community psychology is rooted in community mental health research and practice and has made important contributions to this field. Yet, in the decades since its inception, community psychology has reduced its focus on promoting mental health, well‐being, and liberation of individuals with serious mental illnesses. This special issue endeavors to highlight current efforts in community mental health from our field and related disciplines and point to future directions for reengagement in this area. The issue includes 12 articles authored by diverse stakeholder groups. Following a review of the state of community mental health scholarship in the field's two primary journals since 1973, the remaining articles center on four thematic areas: (a) the community experience of individuals with serious mental illness; (b) the utility of a participatory and cross‐cultural lens in our engagement with community mental health; (c) Housing First implementation, evaluation, and dissemination; and (d) emerging or under‐examined topics. In reflection, we conclude with a series of challenges for community psychologists involved in future, transformative, movements in community mental health.     

Engaging Clients,Families, and Communities as Partners in Mental Health

Counselors are being called on to reach beyond the office and clinic to partner with clients, their families, and communities to address mental health and social problems. Counselors need models of collaboration that guide them in building transformative client‐family‐community partnerships. W. J. Doherty and T. J. Mendenhall (2006) presented a model of community‐based collaboration in their article Citizen Health Care: A Model for Engaging Patients, Families, and Communities as Co‐Producers of Health. After reviewing their article, an analysis of a university‐community partnership is used to frame the discussion of the model's implications for counselors and counselor education programs.     

A Feasibility Trial of Mental Health First Aid First Nations: Acceptability,Cultural Adaptation,and Preliminary Outcomes

The Mental Health First Aid First Nations course was adapted from Mental Health First Aid Basic to create a community‐based, culturally safe and relevant approach to promoting mental health literacy in First Nations contexts. Over 2.5 days, the course aims to build community capacity by teaching individuals to recognize and respond to mental health crises. This feasibility trial utilized mixed methods to evaluate the acceptability, cultural adaptation, and preliminary effectiveness of MHFAFN. Our approach was grounded in community‐based participatory research principles, emphasizing relationship‐driven procedures to collecting data and choice for how participants shared their voices. Data included participant interviews (n = 89), and surveys (n = 91) from 10 groups in four provinces. Surveys contained open‐ended questions, retrospective pre‐post ratings, and a scenario. We utilized data from nine facilitator interviews and 24 facilitator implementation surveys. The different lines of evidence converged to highlight strong acceptability, mixed reactions to the cultural adaptation, and gains in participants’ knowledge, mental health first aid skill application, awareness, and self‐efficacy, and reductions in stigma beliefs. Beyond promoting individual gains, the course served as a community‐wide prevention approach by situating mental health in a colonial context and highlighting local resources and cultural strengths for promoting mental well‐being.     

Building Leadership,Capacity, and Power to Advance Health Equity and Justice through Community‐Engaged Research in the Midwest

The Health Equity Advancement Lab (HEAL) at the University of Iowa College of Public Health began in 2012 to support students, researchers, and community members interested in tackling persistent health inequities through a community‐based participatory research (CBPR) approach. Using concepts from critical consciousness theory, we developed an approach to building students’, faculty members’, and community partners’ capacity to engage in CBPR to promote health equity that involved immersion in developing CBPR projects. Our paper describes the evolution of HEAL as a facilitating structure that provides a support network and engages diverse stakeholders in critical reflection as they participate in research to advance health equity, and resulting political efficacy and social action. We describe one HEAL‐affiliated research project that employs a CBPR approach and has a strong focus on providing transformative learning experiences for students, faculty, and community members. We highlight challenges, successes, and lessons learned in the application of critical consciousness as a framework that engages diverse academic and community partners seeking to promote health equity. We argue that critical consciousness is a relevant theoretical framework to promote transformative learning among students, faculty, and community partners to promote health equity research in diverse communities.     

A Return to “The Clinic” for Community Psychology: Lessons from a Clinical Ethnography in Urban American Indian Behavioral Health

Community psychology (CP) abandoned the clinic and disengaged from movements for community mental health (CMH) to escape clinical convention and pursue growing aspirations as an independent field of context‐oriented, community‐engaged, and values‐driven research and action. In doing so, however, CP positioned itself on the sidelines of influential contemporary movements that promote potentially harmful, reductionist biomedical narratives in mental health. We advocate for a return to the clinic—the seat of institutional power in mental health—using critical clinic‐based inquiry to open sites for clinical‐community dialogue that can instigate transformative change locally and nationally. To inform such works within the collaborative and emancipatory traditions of CP, we detail a recently completed clinical ethnography and offer “lessons learned” regarding challenges likely to re‐emerge in similar efforts. Conducted with an urban American Indian community behavioral health clinic, this ethnography examined how culture and culture concepts (e.g., cultural competence) shaped clinical practice with socio‐political implications for American Indian peoples and the pursuit of transformative change in CMH. Lessons learned identify exceptional clinicians versed in ecological thinking and contextualist discourses of human suffering as ideal partners for this work; encourage intense contextualization and constraining critique to areas of mutual interest; and support relational approaches to clinic collaborations.     

Valuing Our Communities: Ethical Considerations for Economic Evaluation of Community‐Based Prevention

Restricted public budgets and increasing efforts to link the impact of community interventions to public savings have increased the use of economic evaluation. While this type of evaluation can be important for program planning, it also raises important ethical issues about how we value the time of local stakeholders who support community interventions. In particular, researchers navigate issues of scientific accuracy, institutional inequality, and research utility in their pursuit of even basic cost estimates. We provide an example of how we confronted these issues when estimating the costs of a large‐scale community‐based intervention. Principles for valuing community members’ time and conducting economic evaluations of community programs are discussed.     

Community-Based Participatory Research for Improved Mental Health

Community-based participatory research (CBPR) focuses on specific community needs, and produces results that directly address those needs. Although conducting ethical CBPR is critical to its success, few academic programs include this training in their curricula. This article describes the development and evaluation of an online training course designed to increase the use of CBPR in mental health disciplines. Developed using a participatory approach involving a community of experts, this course challenges traditional research by introducing a collaborative process meant to encourage increased participation by special populations and narrow the parity gap in effective mental health treatment and services delivery.     

Reducing Disparities in Cancer Screening and Prevention through Community‐Based Participatory Research Partnerships with Local Libraries: A Comprehensive Dynamic Trial

Reduction of cancer‐related disparities requires strategies that link medically underserved communities to preventive care. In this community‐based participatory research project, a public library system brought together stakeholders to plan and undertake programs to address cancer screening and risk behavior. This study was implemented over 48 months in 20 large urban neighborhoods, selected to reach diverse communities disconnected from care. In each neighborhood, Cancer Action Councils were organized to conduct a comprehensive dynamic trial, an iterative process of program planning, implementation and evaluation. This process was phased into neighborhoods in random, stepped‐wedge sequence. Population‐level outcomes included self‐reported screening adherence and smoking cessation, based on street intercept interviews. Event‐history regressions (n = 9374) demonstrated that adherence outcomes were associated with program implementation, as were mediators such as awareness of screening programs and cancer information seeking. Findings varied by ethnicity, and were strongest among respondents born outside the U.S. or least engaged in care. This intervention impacted health behavior in diverse, underserved and vulnerable neighborhoods. It has been sustained as a routine library system program for several years after conclusion of grant support. In sum, participatory research with the public library system offers a flexible, scalable approach to reduce cancer health disparities.     

Implementing Housing First Across Sites and Over Time: Later Fidelity and Implementation Evaluation of a Pan-Canadian Multi-site Housing First Program for Homeless People with Mental Illness

This article examines later fidelity and implementation of a five‐site pan‐Canadian Housing First research demonstration project. The average fidelity score across five Housing First domains and 10 programs was high in the first year of operation (3.47/4) and higher in the third year of operation (3.62/4). Qualitative interviews (36 key informant interviews and 17 focus groups) revealed that staff expertise, partnerships with other services, and leadership facilitated implementation, while staff turnover, rehousing participants, participant isolation, and limited vocational/educational supports impeded implementation. The findings shed light on important implementation “drivers” at the staff, program, and community levels.     

Using Methods That Matter: The Impact of Reflection,Dialogue, and Voice

In recent years, the field of community psychology has given considerable attention to how research and evaluation methods should be designed to support our goals of empowerment and social justice. Yet, as a field, we have given much less attention to whether the use of our methods actually achieves or supports our empowerment agenda. With the primary purpose of beginning to establish the norm of reporting on the impacts of our methods, this paper reports on the findings from interviews of 16 youth and adults who had participated in one participatory evaluation method (Photovoice). Two specific questions were examined: (1) What is the impact of participating in a Photovoice effort; and (2) How does the method of Photovoice foster these impacts? Overall, participants noted that they were significantly affected by their experiences as photographers and through their dialogue with neighbors during Photovoice group sessions. Impacts ranged from an increased sense of control over their own lives to the emergence of the kinds of awareness, relationships, and efficacy supportive of participants becoming community change agents. According to participants, Photovoice fostered these changes by (a) empowering them as experts on their lives and community, (b) fostering deep reflection, and (c) creating a context safe for exploring diverse perspectives. The implications of these findings for the science and practice of community psychology are discussed.     

Advocacy,Partnerships and Client Centered Practice in California

SUMMARY

This article highlights the many accomplishments of California based mental health occupational therapists in fostering liaisons in the community, collaborating with consumers and families and developing innovative programs. It also provides a rationale and theoretical construct for occupational therapists to provide quality interventions while both protecting and expanding their present practice through the use of client centered services.     

Community Mobilization and Community-Based Participatory Research to Prevent Youth Violence Among Asian and Immigrant Populations

Many community mobilization activities for youth violence prevention involve the researchers assisting communities in identifying, adapting, and/or tailoring evidence-based programs to fit the community needs, population, and cultural and social contexts. This article describes a slightly different framework in which the collaborative research/evaluation project emerged from the community mobilization activities. As will be discussed, this collaborative, sustained partnership was possible in the context of the Center on Culture, Immigration and Youth Violence Prevention's (UC Berkeley ACE) community mobilization activities that brought the issue of youth violence, particularly among immigrant and minority populations, to the forefront of many of the community partners' agendas. The East Bay Asian Youth Center (EBAYC) was one of the partners that came to the table, which facilitated the community-based engagement/mobilization. UC Berkeley ACE collaborated with EBAYC to evaluate an after-school program and an alternative probation program serving a diverse youth and immigrant population, including African Americans, Asians, and Hispanics. This article describes UC Berkeley ACE's community mobilization activity and the collaborative partnership with EBAYC, discusses how the evaluations incorporated community-based principles in design and practice, and presents some findings from the evaluations.     

Education and Mental Health: New Directions for Interaction

Traditionally, mental health workers (psychiatrists, psychologists, and social workers) provide diagnostic evaluations and individual or group psychotherapeutic or casework treatment. With the advent of the community mental health movement, a new role model, that of “mental health consultant,” has emerged. This paper outlines the functions of the “mental health consultant” in the Job Corps program as a way of highlighting the functions of the mental health professional working in this new way. Educational, training, and work programs may be enriched by mental health consultation, and the new directions for interaction between education and mental health are described in this paper.     

A Social Ecological Approach to Investigating Relationships Between Housing and Adaptive Functioning for Persons with Serious Mental Illness

This paper seeks to advance mental health—housing research regarding which factors of housing and neighborhood environments are critical for adaptive functioning, health, and recovery for persons with serious mental illness (SMI). Housing and neighborhood environments are particularly important for persons with SMI because of the prevalence of poor housing conditions among this population. Most mental health—housing research has been limited by a focus on problems in environments and functioning. The paper seeks to expand the mental health—housing research agenda to consider protective factors that promote community integration and adaptive functioning. We provide an account of how social ecology theory transformed a research program, from examining individual risk factors to investigating the functioning of persons in the contexts of their housing and neighborhood experiences. The resulting housing environment framework—physical aspects of housing and neighborhoods, social environment of neighborhoods, and interpersonal relationships tied to housing—allows for identification of opportunities for health promotion and facilitation of participation in community-based settings. This program of research draws upon several methods to understand the social experience of persons with SMI living in community settings—survey research, qualitative interviews, Geographic Information Systems, participatory research, and visual ethnography. In this paper, we present how social ecology theory was instrumental in the development of new housing environment measures, the selection of appropriate research methods, and framing research questions that are building a new empirical base of knowledge about promoting adaptive functioning, health, and recovery for persons with SMI living in community settings.     

Adaptation of Nussbaum's Capabilities Framework to Community Mental Health: A Consumer‐Based Capabilities Measure

The capabilities approach provides a rich evaluative framework to guide transformative change in the community mental health system. This study reports the content and construct validity and psychometric properties of a contextualized measure of the extent to which mental health programs foster achieved capabilities. The Achieved Capabilities Questionnaire for Community Mental Health (ACQ‐CMH), adapted from Nussbaum's capabilities framework, was developed previously with consumer collaboration. Content validity was assessed through a collaborative process, involving a panel of eight consumers, staff members, and senior researchers. The resulting shorter version (ACQ‐CMH‐98) was completed by 332 community mental health consumers sampled throughout Portugal. Factor (PCA) analysis, internal consistency reliability, and test–retest reliability over 2 weeks (N = 33) showed good psychometric properties. The resulting six‐factor structure with 48 items explains 48.88% of the total variance (KMO = 0.89; Bartlett p = .00). Internal consistency of the obtained dimensions ranges from .91 to .76. Associations of the measure with recovery, quality of life, and psychological distress scales add further evidence of construct validity. The adaptation of Nussbaum's framework stressed specific components that may enhance understanding and change within the community mental health system.     

Highlighting the Way Forward: A Review of Community Mental Health Research and Practice Published in AJCP and JCP

Articles published in the two most prominent journals of community psychology in North America, the American Journal of Community Psychology (AJCP) and Journal of Community Psychology (JCP), provide a clear indicator of trends in community research and practice. An examination of community psychology's history and scholarship suggests that the field has reduced its emphasis on promoting mental health, well‐being, and liberation of individuals with serious mental illnesses over the past several decades. To further investigate this claim, the current review presents an analysis of articles relevant to community mental health (N = 307) published in the American Journal of Community Psychology (AJCP) and Journal of Community Psychology (JCP) from 1973 to 2015. The review focuses on article characteristics (e.g., type of article and methods employed), author characteristics, topic areas, and theoretical frameworks. Results document a downward trend in published articles from the mid‐1980s to mid‐2000s, with a substantial increase in published work between 2006 and 2015. A majority of articles were empirical and employed quantitative methods. The most frequent topic area was community mental health centers and services (n = 49), but the past three decades demonstrate a clear shift away from mental health service provision to address pressing social issues that impact community mental health, particularly homelessness (n = 42) and community integration of adults with serious mental illnesses (n = 40). Findings reflect both the past and present state of community psychology and suggest promising directions for re‐engaging with community mental health and fostering well‐being, inclusion, and liberation of adults experiencing serious mental health challenges.     

Challenges of Evaluating Multilevel Interventions

This article uses the Comprehensive Mixed-Methods Participatory Evaluation (CMMPE; Nastasi and Hitchcock Transforming school mental health services: Population-based approaches to promoting the competency and wellness of children, Thousand Oaks, CA: Corwin Press with National Association of School Psychologists 2008; Nastasi et al. School-based mental health services: creating comprehensive and culturally specific programs. Washington, DC: American Psychological Association 2004) model as a framework for addressing the multiplicity of evaluation decisions and complex nature of questions related to program success in multilevel interventions. CMMPE defines program success in terms of acceptability, integrity, social or cultural validity, outcomes (impact), sustainability and institutionalization, thus broadening the traditional notions of program outcomes. The authors use CMMPE and an example of a community-based multilevel sexual risk prevention program with multiple outcomes to discuss challenges of evaluating multilevel interventions. The sexual risk program exemplifies what Schensul and Tricket (this issue) characterize as multilevel intervention–multilevel evaluation (M–M), with both intervention and evaluation at community, health practitioner, and patient levels. The illustration provides the context for considering several challenges related to M–M designs: feasibility of randomized controlled trials within community-based multilevel intervention; acceptability and social or cultural validity of evaluation procedures; implementer, recipient, and contextual variations in program success; interactions among levels of the intervention; unanticipated changes or conditions; multiple indicators of program success; engaging multiple stakeholders in a participatory process; and evaluating sustainability and institutionalization. The complexity of multilevel intervention and evaluation designs challenges traditional notions of evaluation research and experimental designs. Overcoming these challenges is critical to effective translation of research to practice in psychology and related disciplines.     

Socially Valued Roles,Self‐Determination,and Community Participation among Individuals Living with Serious Mental Illnesses

Decades after deinstitutionalization, individuals living with serious mental illnesses remain isolated, socially disengaged, and devalued members of communities. Burgeoning research and services need conceptual clarity to improve such social conditions. This qualitative inquiry used grounded theory and participatory approaches to conduct an in‐depth exploration of community participation for individuals living with serious mental illnesses based on key stakeholder perspectives (n = 45). Results revealed that community participation is a multifaceted construct with layers of meaning for individuals living with serious mental illnesses. Overarching themes are contextualized in Self‐Determination Theory and presented with deidentified illustrations. Implications for services, research, and policy are discussed.     

Toward kuleana (responsibility): A case study of a contextually grounded intervention for Native Hawaiian youth and young adults

As a minority ethnic group, Native Hawaiian youth and young adults face an array of issues associated with colonization, such as persistent structural discrimination and the loss of land and indigenous ways of knowing. They are also at risk for a wide range of negative behaviors, including interpersonal violence, suicide, substance use, and juvenile delinquency. This article explores how community youth development, critical pedagogies, and Hawaiian epistemology can help Native Hawaiian young adults cope with such issues. It begins with a brief discussion of critiques on conventional youth violence prevention programs. To address these critiques, three bodies of literature are introduced: 1) community youth development, 2) critical pedagogy, and 3) community epistemology. Data were derived from a single case study of a community-based youth program. The program, located in an impoverished, rural community in Hawai'i, entailed running an organic farm. Seventeen participants were involved in the study. Semi-structured interviews were used to collect data. Utilizing critical indigenous qualitative research, a content analysis of the interviews was conducted to build a working conceptual model. Preliminary findings suggest that a program with key processes of community youth development, critical pedagogies, and Hawaiian epistemology may serve as a vehicle for health and wellness, thus preventing a host of negative behaviors, such as violence. Based on the findings, a critical contextually based approach to violence prevention that focuses on providing opportunities for Native Hawaiian young adults to take an active participatory role in promoting health is proposed.