Communicating in a community mental health system.

In a multicentered mental health system in which the population has a choice of several treatment facilities, common problems such as geographical distance and infrequent contacts between agencies lead to interagency distrust, unrealistic expectations about patient care, and fears of being overburdened by other agencies. These problems are compounded by the passive bureaucratic attitude which pervades many community mental health systems: unwillingness to do more than the minimum; cunning efforts to send difficult patients to other parts of the mental health system (such as "sending patients back to the community"); and secrecy about the minimal amount of work being done and therapeutic failures. Thus, it is easy for a patient to be lost in the shuffle of a state hospital or to be transferred to a day center where he can be ignored so long as he is compliant. If he protests, he can be sent back to the state hospital and be either medicated or isolated. In both facilities, it is possible to make a minimal effort for continuing and coordinated care, and to refuse to openly confront the need for responsible care-giving. This situation is most likely to exist where senior staff are univolved and uninterested, and where government budgets and regulations make staff feel helpless. After being confronted with these system level problems, the author instituted an interagency meeting of a multicentered community mental health center, designed to meet the need for coordination and communication among various agencies within a given system. This paper articulates a general theoretical understanding of the organizational task and the group process of this type of meeting. Within this framework a specific case is analyzed and discussed.