Community Mental Health Ideology Scale: Social Work Norms Nolan E. Penn, Ph.D.* Frank Baker, Ph.D. Herbert C. Schulberg, Ph.D.
ABSTRACT:The present study reports mean scores obtained by two groups of professionals deeply involved in the community mental health movement on the Community Mental Health Ideology Scale. Professional social workers and social work graduate students were not included in the scale ,takers original criterion group. The high mean scores obtained by these groups led the authors to the conclusion that social workers show the potential for a strong role in the "third phase" of mental health care and delivery. An awareness that mental health theory had entered a new era labeled "the third phase" (Group for the Advancement of Psychiatry, Committee on Medical Education, 1962) or the "third psychiatric revolution" (Bellak, 1964; Hobbs, 1964) and that there was a growing organized collectivity of individuals drawn from a variety of mental health specialties identifying themselves under labels such as "preventive psychiatry," "public health psychiatry," and "community psychiatry or community mental health" led Baker and Schulberg (1967) to attempt the development of a Community Mental Health Ideology (CMHI) Scale. The CMHI Scale was designed to measure individual commitment to community mental health or to those new groups of commonly held beliefs that a significant future course for mental health delivery is to redefine social action in the treatment of mental illness and the promotion of mental health. There are 38 items, refined from a larger pool of items, contained in the CMHI Scale. Items were written to include content relevant to the following conceptual issues: social treatment goals, total community involvement, primary prevention, and comprehensive continuity of care. Various professional groups selected from a nationwide sample, including psychiatrists, psychologists, and occupational therapists, were treated in the initial development of the CMHI Scale. The scale is arranged in a Likert format wherein respondents are asked to circle one of six categories for each item: strongly agree, moderately agree, or slightly agree; and slightly disagree, moderately disagree, or strongly disagree. On positively worded items, strong agreement was scored 7 and strong disagreement was scored 1, with intermediate scores given to other levels of agreement and disagreement. Reverse scoring was used for negatively worded items. When no clear response was given, a score of 4 was assigned to that item. Following are some examples of CMHI Scale items: *Dr. Penn is Professor of Psychiatry, University of California, San Diego, School of Medicine, La ]olla, California 92037. Dr. Baker is Associate Professor of Psychology and Research Director, Laboratory of Community Psychiatry, at the Harvard Medical School, Boston, Massachusetts. Dr. Sehulberg is Professor of Clinical Psychiatry, University of Pittsburg School of Medicine, Pittsburg,. Pennsylvania. Community Mental Health Journal, Vol, 12(2) 1976
211
212
Community Mental Health Journal
1. The locus of mental illness m u s t be viewed as extending b e y o n d the individual and into the family, the c o m m u n i t y , and society. 2. The responsible mental health professional s h o u l d become an agent for social change. 3. The mental health specialist s h o u l d seek to extend his effectiveness by w o r k i n g t h r o u g h other people. 4. A mental health p r o g r a m should direct particular attention to g r o u p s of people w h o are potentially vulnerable to upsetting pressures.
Reliability for the CMHI Scale is sufficiently high. The Cronbach alpha (generalized Kuder-Richardson formula 20) for the group of respondents on which the scale was originally tested was .94. The split-half reliability was .95 and test-retest reliability was .92 (Baker & Schulberg, 1967). Construct validity evidence indicates that the CMHI Scale adequately discriminates groups in their degree of orientation to community mental health ideology. Applications of the scale by Langston (1970) and Penn, Baker, and Schulberg (1968) indicate that it is quite sensitive to varying ideological patterns and able to discriminate among professional disciplines and work groups. Nine criterion groups of mental health professionals were used to determine whether the scales adequately discriminated known groups in their degree of orientation to community mental health ideology (Table 1). Omitted from the criterion groups was information regarding nurses and TABLE 1 Distribution of SMHI Scores of Professional Social Workers
CRITERION GROUPS & OTHERS
Professional
S o c i a l Workers (2nd t e s t ) 3
Harvard Postdoctorals Professional
Social'Workers
(lst test) 3
Harvard Visiting Faculty Community Psychologists
N
MEAN SCORES
STANDARD DEVIATIONS
36
244.47
16.15
205-266
57
239.79
19.48
~65-262
45
239.11
18.95
196-264
15
234.60
20.01
160-204
RANGE
23
234.43
14.68
195-264
Graduate P s y c h i a t r i c Nursing Students 1
386
232.97
18.04
150-266
Graduate Social Work Students 2
155
230.03
20.44
154-266
25
221.96
24.06
173-260
Amer. Psycho1. Assoc. (Div. 12)
79
217.89
22.10
159-258
Amer. Occupational Therapy Assoc.
85
207.69
21.07
161-243
Society for Biological Psychiatry
29
206.28
32.97
131-253
175
198.93
37.02
92-265
46
194.52
31.23
125-259
Columbia Postdoctorals
American Psychiatric Assoc. American Psychoanalytic Assoc. 1Howard,Baker (1969) 2penn, Baker, Schulberg (unpubl.) 3present study sample
Nolan E. Penn and Frank Baker
213
social workers. These are very important professions involved in the delivery of mental health care to communities. Information regarding nurses was obtained later by Howard and Baker (1971). The purpose of this article is to report information on two groups of social workers; social work graduate students and professional social workers. METHOD In the New England area 155 social work students attending four graduate schools of social work were administered the CMHI Scale. In one school the scale was completed during a class session. In two schools the scales were handed to the students to be completed and returned by the next scheduled class meeting. In another school the scales were mailed directly to each student in a packet containing a self-addressed and stamped return envelope. Completed returns were very high for all groups and 100% for the latter group, All students participated voluntarily in this study. This is also true for the professional social workers who completed the CMHI Scale during a 20-minute period provided by their workshop group leaders. The workshop was designed to inform professional social workers from differing parts of their state about community mental health beliefs and activities in the Boston area. All scales administered were completed and returned,
RESULTS The mean score for social work graduate students was exceeded only by Harvard postdoctorals, Harvard visiting faculty, and community psychologists of the original criterion groups (Table 1). A later study (Howard & Baker, 1971) revealed that their mean score was exceeded also by the graduate psychiatric nursing students mean score. The mean scores of our sample of professional social workers were very
TABLE 2
Basic CMHI Scale Data for the 9 Original Criterion Groups and for Graduate Psychiatric Nursing Students, Graduate Social Work Students, and Professional Social Workers 9 .
M - - 2 3 9 . / I , SD : / 8 9 5 ,
N:45, RANGE: / 9 6 - 2 6 6
X M--244 47 i S P : / 6 /5, N : 3 6 ; RANGE= 2 0 5 - 266 X
.
w
z
9 FIRSTTEST SCORES
/
~
///~
8
4
2
191-200
w
0 Z
I
211-220
I
201- 210
I
231- 240
I
221-230
t
CMHI SCORES(grouped)
251- 260
'1
241- 250
I
I
261-270
214
Community Mental Health Journal
high a n d greater t h a n all criterion g r o u p m e a n s on the second test. These professional social w o r k e r s w e r e highly e x p e r i e n c e d a n d came f r o m a variety of m e n t a l health settings, including state hospitals for the psycholigically disturbed, correctional institutions, schools for the m e n t a l l y a n d behaviorally h a n d i c a p p e d , a n d m e n t a l health o u t p a t i e n t clinics. T h e y h a d a m e a n age of 40.56 years, a v e r a g e d 37 m o n t h s in their p r e s e n t s u p e r v i s o r y or assistant s u p e r v i s o r y positions, a v e r a g e d 139.5 m o n t h s of e m p l o y m e n t as professional social w o r k e r s , a n d all h a d m a s t e r ' s degrees a n d m a n y h a d c o m p l e t e d w o r k t o w a r d a doctoral degree. T h e y w e r e tested on t w o occasions, 7 w e e k s apart. A l t h o u g h the first a n d s e c o n d test m e a n difference is not statistically significant, the r a n g e of the s e c o n d test scores for social w o r k professionals is m u c h m o r e c o m p r e s s e d . Their lowest scores are higher t h a n for all other groups, excepting c o m m u n i t y psychologists. Table 2 s h o w s the distribution of scores for professional social workers. The findings r e p o r t e d here s p e a k strongly for the potential a n d future role of social w o r k in the " t h i r d p h a s e " of m e n t a l health care a n d delivery. This additional i n f o r m a t i o n s h o u l d be helpful to further investigations of attitudes t o w a r d s c o m m u n i t y m e n t a l health. REFERENCES Baker, F., & Schulberg, H. C. The development of a community mental health ideology scale. Community Mental Health Journal, 1967, 3, 216-225. Bellak, S. Communi~ psychiatry and community mental health. New York: Grune & Stratton, 1964. Group for the Advancement of Psychiatry Committee on Medical Education. The pre-clinical teaching of psychiatry (Report No. 54). New York: Author, 1962. Hobbs, N. Mental health's third revolution. American Journal of Orthopsychiatry, 1964, 34, 822-833. Howard, L., & Baker, F. Ideology and role function of the nurse in community mental health. Nursing Research, 1971, 20, 450M54. Langston, R. D., Community mental health centers and community mental health ideology. Community Mental Health Journal, 1970, 6, 387-392. Penn, N. E., Baker, F., & Schulberg, H. C. Survey of community mental health attitudes among social work students. (Unpublished, 1973).
ABSTRACT:The present study reports mean scores obtained by two groups of professionals deeply involved in the community mental health movement on the Community Mental Health Ideology Scale. Professional social workers and social work graduate students were not included in the scale ,takers original criterion group. The high mean scores obtained by these groups led the authors to the conclusion that social workers show the potential for a strong role in the "third phase" of mental health care and delivery. An awareness that mental health theory had entered a new era labeled "the third phase" (Group for the Advancement of Psychiatry, Committee on Medical Education, 1962) or the "third psychiatric revolution" (Bellak, 1964; Hobbs, 1964) and that there was a growing organized collectivity of individuals drawn from a variety of mental health specialties identifying themselves under labels such as "preventive psychiatry," "public health psychiatry," and "community psychiatry or community mental health" led Baker and Schulberg (1967) to attempt the development of a Community Mental Health Ideology (CMHI) Scale. The CMHI Scale was designed to measure individual commitment to community mental health or to those new groups of commonly held beliefs that a significant future course for mental health delivery is to redefine social action in the treatment of mental illness and the promotion of mental health. There are 38 items, refined from a larger pool of items, contained in the CMHI Scale. Items were written to include content relevant to the following conceptual issues: social treatment goals, total community involvement, primary prevention, and comprehensive continuity of care. Various professional groups selected from a nationwide sample, including psychiatrists, psychologists, and occupational therapists, were treated in the initial development of the CMHI Scale. The scale is arranged in a Likert format wherein respondents are asked to circle one of six categories for each item: strongly agree, moderately agree, or slightly agree; and slightly disagree, moderately disagree, or strongly disagree. On positively worded items, strong agreement was scored 7 and strong disagreement was scored 1, with intermediate scores given to other levels of agreement and disagreement. Reverse scoring was used for negatively worded items. When no clear response was given, a score of 4 was assigned to that item. Following are some examples of CMHI Scale items: *Dr. Penn is Professor of Psychiatry, University of California, San Diego, School of Medicine, La ]olla, California 92037. Dr. Baker is Associate Professor of Psychology and Research Director, Laboratory of Community Psychiatry, at the Harvard Medical School, Boston, Massachusetts. Dr. Sehulberg is Professor of Clinical Psychiatry, University of Pittsburg School of Medicine, Pittsburg,. Pennsylvania. Community Mental Health Journal, Vol, 12(2) 1976
211
212
Community Mental Health Journal
1. The locus of mental illness m u s t be viewed as extending b e y o n d the individual and into the family, the c o m m u n i t y , and society. 2. The responsible mental health professional s h o u l d become an agent for social change. 3. The mental health specialist s h o u l d seek to extend his effectiveness by w o r k i n g t h r o u g h other people. 4. A mental health p r o g r a m should direct particular attention to g r o u p s of people w h o are potentially vulnerable to upsetting pressures.
Reliability for the CMHI Scale is sufficiently high. The Cronbach alpha (generalized Kuder-Richardson formula 20) for the group of respondents on which the scale was originally tested was .94. The split-half reliability was .95 and test-retest reliability was .92 (Baker & Schulberg, 1967). Construct validity evidence indicates that the CMHI Scale adequately discriminates groups in their degree of orientation to community mental health ideology. Applications of the scale by Langston (1970) and Penn, Baker, and Schulberg (1968) indicate that it is quite sensitive to varying ideological patterns and able to discriminate among professional disciplines and work groups. Nine criterion groups of mental health professionals were used to determine whether the scales adequately discriminated known groups in their degree of orientation to community mental health ideology (Table 1). Omitted from the criterion groups was information regarding nurses and TABLE 1 Distribution of SMHI Scores of Professional Social Workers
CRITERION GROUPS & OTHERS
Professional
S o c i a l Workers (2nd t e s t ) 3
Harvard Postdoctorals Professional
Social'Workers
(lst test) 3
Harvard Visiting Faculty Community Psychologists
N
MEAN SCORES
STANDARD DEVIATIONS
36
244.47
16.15
205-266
57
239.79
19.48
~65-262
45
239.11
18.95
196-264
15
234.60
20.01
160-204
RANGE
23
234.43
14.68
195-264
Graduate P s y c h i a t r i c Nursing Students 1
386
232.97
18.04
150-266
Graduate Social Work Students 2
155
230.03
20.44
154-266
25
221.96
24.06
173-260
Amer. Psycho1. Assoc. (Div. 12)
79
217.89
22.10
159-258
Amer. Occupational Therapy Assoc.
85
207.69
21.07
161-243
Society for Biological Psychiatry
29
206.28
32.97
131-253
175
198.93
37.02
92-265
46
194.52
31.23
125-259
Columbia Postdoctorals
American Psychiatric Assoc. American Psychoanalytic Assoc. 1Howard,Baker (1969) 2penn, Baker, Schulberg (unpubl.) 3present study sample
Nolan E. Penn and Frank Baker
213
social workers. These are very important professions involved in the delivery of mental health care to communities. Information regarding nurses was obtained later by Howard and Baker (1971). The purpose of this article is to report information on two groups of social workers; social work graduate students and professional social workers. METHOD In the New England area 155 social work students attending four graduate schools of social work were administered the CMHI Scale. In one school the scale was completed during a class session. In two schools the scales were handed to the students to be completed and returned by the next scheduled class meeting. In another school the scales were mailed directly to each student in a packet containing a self-addressed and stamped return envelope. Completed returns were very high for all groups and 100% for the latter group, All students participated voluntarily in this study. This is also true for the professional social workers who completed the CMHI Scale during a 20-minute period provided by their workshop group leaders. The workshop was designed to inform professional social workers from differing parts of their state about community mental health beliefs and activities in the Boston area. All scales administered were completed and returned,
RESULTS The mean score for social work graduate students was exceeded only by Harvard postdoctorals, Harvard visiting faculty, and community psychologists of the original criterion groups (Table 1). A later study (Howard & Baker, 1971) revealed that their mean score was exceeded also by the graduate psychiatric nursing students mean score. The mean scores of our sample of professional social workers were very
TABLE 2
Basic CMHI Scale Data for the 9 Original Criterion Groups and for Graduate Psychiatric Nursing Students, Graduate Social Work Students, and Professional Social Workers 9 .
M - - 2 3 9 . / I , SD : / 8 9 5 ,
N:45, RANGE: / 9 6 - 2 6 6
X M--244 47 i S P : / 6 /5, N : 3 6 ; RANGE= 2 0 5 - 266 X
.
w
z
9 FIRSTTEST SCORES
/
~
///~
8
4
2
191-200
w
0 Z
I
211-220
I
201- 210
I
231- 240
I
221-230
t
CMHI SCORES(grouped)
251- 260
'1
241- 250
I
I
261-270
214
Community Mental Health Journal
high a n d greater t h a n all criterion g r o u p m e a n s on the second test. These professional social w o r k e r s w e r e highly e x p e r i e n c e d a n d came f r o m a variety of m e n t a l health settings, including state hospitals for the psycholigically disturbed, correctional institutions, schools for the m e n t a l l y a n d behaviorally h a n d i c a p p e d , a n d m e n t a l health o u t p a t i e n t clinics. T h e y h a d a m e a n age of 40.56 years, a v e r a g e d 37 m o n t h s in their p r e s e n t s u p e r v i s o r y or assistant s u p e r v i s o r y positions, a v e r a g e d 139.5 m o n t h s of e m p l o y m e n t as professional social w o r k e r s , a n d all h a d m a s t e r ' s degrees a n d m a n y h a d c o m p l e t e d w o r k t o w a r d a doctoral degree. T h e y w e r e tested on t w o occasions, 7 w e e k s apart. A l t h o u g h the first a n d s e c o n d test m e a n difference is not statistically significant, the r a n g e of the s e c o n d test scores for social w o r k professionals is m u c h m o r e c o m p r e s s e d . Their lowest scores are higher t h a n for all other groups, excepting c o m m u n i t y psychologists. Table 2 s h o w s the distribution of scores for professional social workers. The findings r e p o r t e d here s p e a k strongly for the potential a n d future role of social w o r k in the " t h i r d p h a s e " of m e n t a l health care a n d delivery. This additional i n f o r m a t i o n s h o u l d be helpful to further investigations of attitudes t o w a r d s c o m m u n i t y m e n t a l health. REFERENCES Baker, F., & Schulberg, H. C. The development of a community mental health ideology scale. Community Mental Health Journal, 1967, 3, 216-225. Bellak, S. Communi~ psychiatry and community mental health. New York: Grune & Stratton, 1964. Group for the Advancement of Psychiatry Committee on Medical Education. The pre-clinical teaching of psychiatry (Report No. 54). New York: Author, 1962. Hobbs, N. Mental health's third revolution. American Journal of Orthopsychiatry, 1964, 34, 822-833. Howard, L., & Baker, F. Ideology and role function of the nurse in community mental health. Nursing Research, 1971, 20, 450M54. Langston, R. D., Community mental health centers and community mental health ideology. Community Mental Health Journal, 1970, 6, 387-392. Penn, N. E., Baker, F., & Schulberg, H. C. Survey of community mental health attitudes among social work students. (Unpublished, 1973).
