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Most mental health care today takes place not in hospital settings, but rather in a range of community-based organizations. This chapter lays out the scope of community mental health care and outlines the major approaches and findings in social scientific and organizational research done on specialist mental health care settings. While the average (non-office-based) specialty community mental health organization is private and nonprofit, public funds make up a large portion of the support for community care. While psychiatrists continue to play a prominent role in community mental health, there are a range of workers providing services in non-hospital settings. The chapter groups existing research on community mental health care organizations by the theoretical lens the studies use in their analysis. The approaches differ in levels of analysis as well as in which “slice” of organizational life they focus on. Important insights into the operation of community mental health care come from research in each theoretical tradition. For discussion, readers might ask what a client presenting for mental health care in the community can expect to encounter. How is the clinical work of mental health care workers shaped by the type of organization where they provide care?
Introduction
In an era when the mental hospital was the most common organization for treating mental illness in the US, some of the most durable contributions to social scientific and organizational thought arose from studies of these settings (Belknap, 1956; Caudill, 1958; Goffman, 1961; Perrow, 1965; see Scheid & Greenberg, 2007). Further, using the tools from social science and organization studies gave a different understanding of these facilities than a solely clinical view would afford, and these investigations led to changes in how mental health care is delivered (see, for instance, Grob, 1991a; Lieberman & Ogas, 2015).
The system of today is much different, with a wider, more diverse array of organizations providing mental health care, many of which are non-institutional and community-based. Understanding these community-based organizations – their nature, their challenges – through the lens of social science and organizational studies holds the same potential for insight (and perhaps change) as those classic studies. This chapter aims to outline what we know about the organizations providing mental health care today, with an emphasis on community-based specialty facilities.
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