The Comprehensive Community Mental Health Center as a Field Placement for Graduate Social Work Students Ted R. Watkins, A.C.S.W. *
ABSTRACT: The comprehensive community mental health center, as a new organization, has many characteristics that make it a unique setting for the training of social workers. The organization's struggles for identity create a fluidity that requires the development of flexibility greatly needed in the mental health professions. Students can make valuable contributions to the functioning of the center if allowed to become fully involved in its activities. A generation gap may exist between senior staff, trained in traditional settings, and new staff and students whose orientations are more relevant to community practice.
During the early 1960s the Final Report of the Joint Commission on Mental Illness and Health, President K e n n e d y ' s challenge to find "a bold n e w a p p r o a c h " in mental health services, and the e n a c t m e n t of the C o m m u n i t y Mental Health Centers Act of 1963, occurring in rapid succession, signaled the b e g i n n i n g of a m o v e m e n t t o w a r d the d e v e l o p m e n t of a more effective model for the delivery of mental health services. The years following the legislation of 1963 have b e e n m a r k e d b y near frantic activity b y states and local c o m m u n i t i e s in efforts to put the " c o m m u n i t y mental health center" concept into practice. That there has b e e n m u c h m o v e m e n t is evident in the increase in the n u m b e r of n e w programs and facilities available for the prevention and treatment of mental illness and mental retardation. Progress, h o w ever, in terms of effectiveness and efficiency of the services is considerably less evident. Nevertheless the c o m p r e h e n s i v e c o m m u n i t y mental health center is n o w generally seen as the most p r o m i s i n g m o d e l for the delivery of mental health services. HISTORICAL BACKGROUND The c o m m u n i t y mental health m o v e m e n t has faced n u m e r ous difficulties in putting into practice relatively u n t r i e d concepts. There has b e e n b r o a d (though not universal) acceptance b y mental health professionals of the goals of (a) continuity of care, (b) a full range of services readily available to the service seeker in his o w n c o m m u n i t y , (c) greater e m p h a s i s on p r i m a r y and secondary p r e v e n t i o n of mental disability, and (d) the g e a r i n g of service to the peculiar needs of the various groups w i t h i n the catchment area, including the disadvantaged, w h o in the past have not fit into the patient role in a
* Mr. Watkins is Assistant Professor of Social Work at the Graduate School of Social Work, University of Texas at Arlington, Arlington, Texas 76010. Community Mental Health Journal, Vol. 11(1), 1975
27
28
Community Mental Health Journal
manner complementary to our traditional treatment models. Acceptance of these goals has not necessarily been accompanied by the ability to achieve them. The lag between the specification of goals and the kn'owledge of how to achieve them has resulted in the expenditures of large amounts of money and efforts that have, to this point, perhaps brought as much frustration as success. Mental health professionals typically have been trained to function in wellestablished, structured agencies or in private practice, but not in new, innovative, loosely structured organizations that are still defining their purposes and groping for realistic means to accomplish idealistic ends. Community mental health centers in their early years have been characterized by extreme fluidity of structure. Most centers have come into existence rather suddenly, either as entirely new organizations or as mixed bags of preexisting specialized agencies, each with its own identity, goals, and tradition of means for accomplishing these goals. Before maximally effective service can begin in either the completely new center or the composite of preexisting specialized agencies, a basic identity crisis must be worked through, which includes clearly defining the role the agency will fill in the community, specifying goals, and deciding on appropriate steps toward the accomplishment of these goals. This complicated process of establishing identity is made more difficult by the fact that the whole ideology of community mental health has only recently gained full recognition in professional circles and is as yet meaningfully incorporated by only a few. A situation exists in which " n e w " organizations staffed by " n e w " persons (that is, inexperienced in the "community" mental health field) are attempting to administer " n e w " (innovative) programs, based on a new body of theory. While struggling with the identity crisis, finding what it is and where it is going, an agency will undergo many changes, typically including rapid growth as new programs are funded; changes in focus as the basic goals of the organization are redefined; shifts in formal and informal staff power structure as each staff member finds his place in the organization's pecking order; and day-to-day shifts in the individual staff member's role as he collides with others w h o s e functional territory overlaps his own. These instabilities within the new community mental health centers are testing the adaptive abilities of the professionals working in them. The fluidity of structure involving these several factors offers many challenges to social work students placed in corn munity mental health centers for their field practicum. In past years, graduate schools of social work often tried to limit their clinical field placement settings to agencies that were stable in terms of agency function, staff composition and relationships, and methods of service delivery, so that the student would have a maximally consistent environment in which to add an experiential component to his academic learning about clients, formal agency structure, social work practice, and himself in relation to these factors. Field placement in the community mental health center in the 1970s does not offer stability or consistency. The student finds himself not in a controlled laboratory setting, but in a tempest of activity in which change is one of the most conspicuous characteristics. This fluidity has advantages and disadvantages for the student.
Ted R. Watkins
29
MINIMAL PROCEDURAL RESTRAINTS The looseness of structure and paucity of rigid rules and procedures give the student the freedom to use himself and his skills in the manner that seems to be best for the client in the specifiC circumstances of the moment. The student can thus focus on the client and his needs, taking the most expedient route to helping the client with a m i n i m u m of concern about whether this is the usual or routine procedure for the agency. Bureaucratic restraints seldom impinge on the helping process in the community mental health center. The result is not only that the student has a less constricted learning experience; he also develops an orientation to the philosophy that he is primarily accountable directly to the client rather than to the agency. This difference encourages a more personal commitment and an individualized contract between student worker and client. The worker becomes the client's advocate in a system that has many alternative means of helping the client. There are, of course, hazards in freedom. The lack of external restraints places greater importance on the student's own judgment. H e must, with the help of his field instructor and other resource persons, carefully evaluate the client's needs on several levels and make clinically sound decisions regarding which of the broad range of responses available to him he will use. He must take the responsibility of responding genuinely to the client rather than merely playing a structured agency role, as is possible in a highly structured traditional setting. If serious defects in judgment or ability for autonomous functioning exist in the student, it is far better that they be exposed or corrected during his training experience than that they remain undetected because of an excessively structured, overprotective field placement setting. Many students leave the classroom expecting to step into a ready-made role in their field agency. When placed in the community mental health center, the student may spend his first weeks searching for a prescribed role that does not exist. A few supervisory conferences focused not on what he should do, but rather on what are the likely outcomes of numerous possible courses of action, several of which might be expected to be quite positive, can free the student to start spontaneously using his own judgment and begin truly maturing as a professional person. UNCLEAR STAFF ROLES In the new community mental health center staff roles are likely to be quite unclear, often with antagonisms among various groups. Social workers who for decades have been community oriented (at least in theory) may feel somewhat gratified that their efforts at serving both individuals and the community are now being legitimized by the entry of psychiatry and allied professions into community practice. The same social workers may also be resentful that'their profession's seniority in this area is not sufficiently acknowledged. Unfortunately too many social workers have been followers rather than leaders in the move toward community mental health practice. Although outstanding contributions to community mental health have been made by psychiatrists, many practicing psychiatrists have been oriented by
30
Community Mental Health Journal
training and experience to o n e - t o - o n e or small group, analytically based clinical psychotherapy. O n finding himself in the c o m m u n i t y mental health center, such a psychiatrist m a y find his expertise of limited relevance to the b r o a d e r goals of c o m m u n i t y psychiatry. C o n d i t i o n e d to expect a leadership role, he m a y be embarrassed, defensive, and antagonistic t o w a r d other staff persons from w h o m he can learn and to w h o m he m a y feel he has to prove himself. H e m a y charge off in some r a n d o m direction, asserting the authority of his position and h o p i n g to find his bearings along the way, or attempt to recreate in the c o m m u n i t y mental health center a clinical setting in w h i c h he can practice traditional psychiatry. Or he m a y accept the fact that he, like m a n y of the staff, is n e w in this e n d e a v o r and has a lot to learn from his co-workers, patients, and the c o m m u n i t y . His reception of students will d e p e n d largely on his view of his role in the center. Perhaps the greatest confusion in the c o m m u n i t y mental health center exists a r o u n d the issue of the role of the i n d i g e n o u s paraprofessional worker. In various settings the i n d i g e n o u s w o r k e r m a y be so limited in what he is allowed to do that he is little more than an office boy, or so elevated that he may be encouraged to attempt i n - d e p t h p s y c h o t h e r a p y with little professional supervision. Sometimes his position in a single agency swings from one extreme to another. Appropriate task specification for the i n d i g e n o u s paraprofessional worker remains one of the major n e e d s in the d e v e l o p m e n t of efficient and effective c o m m u n i t y mental health services. In the m e a n t i m e the i n d i g e n o u s worker is angry at having b e e n lured into the system with promises of learning h o w to be an effective mental health worker and finding status in his career. Usually he has either b e n d e n i e d meaningful work and its a c c o m p a n y i n g status w i t h i n the center or has b e e n allowed to u n d e r t a k e tasks for w h i c h he was given little training or supervision and w h i c h he recognizes as being inappropriate for him. He is often r e m i n d e d of the lack of credentials that makes him the most vulnerable m e m b e r of the staff. He is a threat to the formally trained staff w h o fear that he depreciates their worth, and h e is a threat to his c o m m u n i t y n e i g h b o r s w h o fear that he is being co-opted b y the "establishment." In addition to the division and dissension b y profession, the staff is likely to be d i v i d e d b y ideology over such issues as the ratio of effort to be put into preventive programs to that put into treatment, the degree of c o m m u n i t y control of the center to be allowed, or which treatment model is most relevant to the setting. There are a n u m b e r of respects in which the staff ferment can be very constructive for the student. He sees the staff not as a collection of ]professional roles w h i c h incidentally have persons in them, but as individuals, each with a u n i q u e experiential background, interacting u n d e r the pressures of heavy workloads, ill-defined tasks and functions, and with minimal guidance from the precedent of their o w n experience or that of others. The student has the rare o p p o r t u n i t y to learn experientially about agencies in their b e g i n n i n g phase, about organizational dynamics, and about systems that do not yet have the " b u g s " w o r k e d out. He can experience the n e e d in some areas for structure that is lacking and see the slow d e v e l o p m e n t of bureaucratic characteristics in the agency. In traditional field work agencies the same processes m a y be occurring, but m u c h more slowly and subtly, so that the student m a y only see
Ted R. Watkins
31
the rather smooth operation of an agency that is efficient, t h o u g h not necessarily effective or relevant. In the traditional field setting there is likely to be the implication that the problems to be dealt w i t h and the n e e d for change lie exclusively outside the agency. In the c o m m u n i t y mental health center in the developmental stage, the distinction b e t w e e n inside and outside the agency is less clear. For example, p o w e r struggles a m o n g staff are not so different from p o w e r struggles in client families or p o w e r struggles in the c o m m u n i t y in w h i c h the client has b e e n victimized. In some instances the similarities are entirely too great, as w i t h the black i n d i g e n o u s w o r k e r in the ghetto c o m m u nity mental health center w h o s e whole history of b e i n g discriminated against, b e i n g given promises b y the p o w e r s in the system, and still b e i n g allowed to m o v e only to the first rung of the ladder of success is repeated in the c o m m u nity mental health center. The mature student will be able to learn as m u c h about personality dynamics, interpersonal and c o m m u n i t y relationships, and m e t h o d s of intervention from b e i n g a part of the staff in such a fluid setting as he will from dealing with his clients. STAFF REACTION TO STUDENTS It is to be expected that a staff w h i c h is already in turmoil over its o w n structure will be highly reactive to the entrance of students into the system. W h e r e there is interprofessional rivalry, social work students will be resented b y mental health professionals of other disciplines w h o will feel that the ranks of the staff social workers are b e i n g reinforced b y the students. The fact that the students are likely to be u n e n c u m b e r e d b y a significant i n v e s t m e n t in traditional agency practice gives t h e m an advantage over some more experienced workers in adjusting to an innovative c o m m u n i t y mental health center setting; this m a y sometimes arouse alarm and a n t a g o n i s m in the senior social work staff, w h o m a y complain that the school is not teaching the students "real" (that is, traditional) clinical social work. The i n d i g e n o u s workers are likely to be the most t h r e a t e n e d b y social work students, although sometimes simultaneously the most supportive. There is often some competition regarding w h i c h group, students or i n d i g e n o u s workers, will be relegated to the b o t t o m of the totem pole in agency status. The i n d i g e n o u s workers m a y have v e r y little concept of the i n p u t the students have received from their education, and m a y see t h e m as some sort of " v o l u n teers" w h o are being given credit toward a professional degree for d o i n g essentially the same kind of work the i n d i g e n o u s workers have b e e n d o i n g for a long time. They may resent b e i n g expected to help these n e o p h y t e s surpass t h e m in status and pay in the mental health field. If left u n c h a n g e d , such resentments can result in severely effective sabotaging of the students' efforts. O n the other h a n d m a n y i n d i g e n o u s workers, originally hired because of their positive personal qualities (as o p p o s e d to professional credentials), t e n d to be w a r m and helpful toward the students, identifying with their role as new, junior m e m b e r s of the c o m m u n i t y mental health center team. POSITIVE CONTRIBUTIONS OF STUDENTS The c o m m u n i t y mental health center setting not only offers a u n i q u e field experience for students, but benefits in some u n e x p e c t e d ways from the hosting of a student unit. The students entering the center can, in the
32
Community Mental Health Journal
process of defining their role, reduce staff antagonisms. Being neither fully professionals nor untrained, they need not be identified with either the professional staff or the indigenous group to the detrement of their ability to form positive relationships with the other. They can become a link between the professionally trained and indigenous staff groups. They have in common with the indigenous staff a position at the bottom of the agency's power structure and the fact that they are still learning basics in the mental health field. The indigenous staff tend to identify with the students. It is possible to offer joint learning experiences, such as case consultations or seminars, in which the students can learn a great deal about the community and the agency from the perspective of the front-line indigenous workers while the indigenous workers are exposed to the theoretical expertise of the students. Such contacts have been known to inspire lesser-trained staff members, impressed by the students' academic knowledge, to return to school for professional training or to pressure agencies for more intensive in-service training. Maximizing the positive aspects of the ambivalence of the indigenous staff is no easy task and can be a major step for students in the learning of relationship skills. Relationships with the professional staff also need to be cultivated by students, who should tap every available resource for learning in the agency. Most professionals will be eager to help students who are willing to bring out the teacher in them. Through this relationship the students can articulate their learning needs in a way that not only helps the professionals help them, but also allows carry-over into the teaching role of the professional to the nonprofessional staff member. It is easier for a student to reveal his lack of understanding than it is for a regular staff member, so the students may at times need to speak for themselves and the lesser-trained staff w hen asking for clarification of learning. The student is likely to have been exposed, through the classroom and its required reading, to a broad spectrum of the most current trends in behavioral science theory and service delivery. Typically, persons employed in busy agencies such as community mental health centers find themselves getting increasingly behind in their knowledge of developing trends. Students, if given the opportunity, can provide valuable theoretical input, both through verbal expression of their learning and through demonstration in their work with clients. Through their knowledge of the area of expertise of their faculty, and through their association with classmates placed in other settings, students can keep the agency informed of resources that might be available to it for consultation or research. The students themselves, because of their half-in half-out status in the agency can make some most helpful and astute observations of what is occurring in the agency, if allowed to do so. The most conspicuous advantage to the placement of students in community mental health center settings is the orientation of a new generation of professionals to the concepts and practice of community mental health. With an early incorporation of community mental health concepts (which current practitioners did not have), they will be able to make great strides toward the achievement of community mental health ideals.
ABSTRACT: The comprehensive community mental health center, as a new organization, has many characteristics that make it a unique setting for the training of social workers. The organization's struggles for identity create a fluidity that requires the development of flexibility greatly needed in the mental health professions. Students can make valuable contributions to the functioning of the center if allowed to become fully involved in its activities. A generation gap may exist between senior staff, trained in traditional settings, and new staff and students whose orientations are more relevant to community practice.
During the early 1960s the Final Report of the Joint Commission on Mental Illness and Health, President K e n n e d y ' s challenge to find "a bold n e w a p p r o a c h " in mental health services, and the e n a c t m e n t of the C o m m u n i t y Mental Health Centers Act of 1963, occurring in rapid succession, signaled the b e g i n n i n g of a m o v e m e n t t o w a r d the d e v e l o p m e n t of a more effective model for the delivery of mental health services. The years following the legislation of 1963 have b e e n m a r k e d b y near frantic activity b y states and local c o m m u n i t i e s in efforts to put the " c o m m u n i t y mental health center" concept into practice. That there has b e e n m u c h m o v e m e n t is evident in the increase in the n u m b e r of n e w programs and facilities available for the prevention and treatment of mental illness and mental retardation. Progress, h o w ever, in terms of effectiveness and efficiency of the services is considerably less evident. Nevertheless the c o m p r e h e n s i v e c o m m u n i t y mental health center is n o w generally seen as the most p r o m i s i n g m o d e l for the delivery of mental health services. HISTORICAL BACKGROUND The c o m m u n i t y mental health m o v e m e n t has faced n u m e r ous difficulties in putting into practice relatively u n t r i e d concepts. There has b e e n b r o a d (though not universal) acceptance b y mental health professionals of the goals of (a) continuity of care, (b) a full range of services readily available to the service seeker in his o w n c o m m u n i t y , (c) greater e m p h a s i s on p r i m a r y and secondary p r e v e n t i o n of mental disability, and (d) the g e a r i n g of service to the peculiar needs of the various groups w i t h i n the catchment area, including the disadvantaged, w h o in the past have not fit into the patient role in a
* Mr. Watkins is Assistant Professor of Social Work at the Graduate School of Social Work, University of Texas at Arlington, Arlington, Texas 76010. Community Mental Health Journal, Vol. 11(1), 1975
27
28
Community Mental Health Journal
manner complementary to our traditional treatment models. Acceptance of these goals has not necessarily been accompanied by the ability to achieve them. The lag between the specification of goals and the kn'owledge of how to achieve them has resulted in the expenditures of large amounts of money and efforts that have, to this point, perhaps brought as much frustration as success. Mental health professionals typically have been trained to function in wellestablished, structured agencies or in private practice, but not in new, innovative, loosely structured organizations that are still defining their purposes and groping for realistic means to accomplish idealistic ends. Community mental health centers in their early years have been characterized by extreme fluidity of structure. Most centers have come into existence rather suddenly, either as entirely new organizations or as mixed bags of preexisting specialized agencies, each with its own identity, goals, and tradition of means for accomplishing these goals. Before maximally effective service can begin in either the completely new center or the composite of preexisting specialized agencies, a basic identity crisis must be worked through, which includes clearly defining the role the agency will fill in the community, specifying goals, and deciding on appropriate steps toward the accomplishment of these goals. This complicated process of establishing identity is made more difficult by the fact that the whole ideology of community mental health has only recently gained full recognition in professional circles and is as yet meaningfully incorporated by only a few. A situation exists in which " n e w " organizations staffed by " n e w " persons (that is, inexperienced in the "community" mental health field) are attempting to administer " n e w " (innovative) programs, based on a new body of theory. While struggling with the identity crisis, finding what it is and where it is going, an agency will undergo many changes, typically including rapid growth as new programs are funded; changes in focus as the basic goals of the organization are redefined; shifts in formal and informal staff power structure as each staff member finds his place in the organization's pecking order; and day-to-day shifts in the individual staff member's role as he collides with others w h o s e functional territory overlaps his own. These instabilities within the new community mental health centers are testing the adaptive abilities of the professionals working in them. The fluidity of structure involving these several factors offers many challenges to social work students placed in corn munity mental health centers for their field practicum. In past years, graduate schools of social work often tried to limit their clinical field placement settings to agencies that were stable in terms of agency function, staff composition and relationships, and methods of service delivery, so that the student would have a maximally consistent environment in which to add an experiential component to his academic learning about clients, formal agency structure, social work practice, and himself in relation to these factors. Field placement in the community mental health center in the 1970s does not offer stability or consistency. The student finds himself not in a controlled laboratory setting, but in a tempest of activity in which change is one of the most conspicuous characteristics. This fluidity has advantages and disadvantages for the student.
Ted R. Watkins
29
MINIMAL PROCEDURAL RESTRAINTS The looseness of structure and paucity of rigid rules and procedures give the student the freedom to use himself and his skills in the manner that seems to be best for the client in the specifiC circumstances of the moment. The student can thus focus on the client and his needs, taking the most expedient route to helping the client with a m i n i m u m of concern about whether this is the usual or routine procedure for the agency. Bureaucratic restraints seldom impinge on the helping process in the community mental health center. The result is not only that the student has a less constricted learning experience; he also develops an orientation to the philosophy that he is primarily accountable directly to the client rather than to the agency. This difference encourages a more personal commitment and an individualized contract between student worker and client. The worker becomes the client's advocate in a system that has many alternative means of helping the client. There are, of course, hazards in freedom. The lack of external restraints places greater importance on the student's own judgment. H e must, with the help of his field instructor and other resource persons, carefully evaluate the client's needs on several levels and make clinically sound decisions regarding which of the broad range of responses available to him he will use. He must take the responsibility of responding genuinely to the client rather than merely playing a structured agency role, as is possible in a highly structured traditional setting. If serious defects in judgment or ability for autonomous functioning exist in the student, it is far better that they be exposed or corrected during his training experience than that they remain undetected because of an excessively structured, overprotective field placement setting. Many students leave the classroom expecting to step into a ready-made role in their field agency. When placed in the community mental health center, the student may spend his first weeks searching for a prescribed role that does not exist. A few supervisory conferences focused not on what he should do, but rather on what are the likely outcomes of numerous possible courses of action, several of which might be expected to be quite positive, can free the student to start spontaneously using his own judgment and begin truly maturing as a professional person. UNCLEAR STAFF ROLES In the new community mental health center staff roles are likely to be quite unclear, often with antagonisms among various groups. Social workers who for decades have been community oriented (at least in theory) may feel somewhat gratified that their efforts at serving both individuals and the community are now being legitimized by the entry of psychiatry and allied professions into community practice. The same social workers may also be resentful that'their profession's seniority in this area is not sufficiently acknowledged. Unfortunately too many social workers have been followers rather than leaders in the move toward community mental health practice. Although outstanding contributions to community mental health have been made by psychiatrists, many practicing psychiatrists have been oriented by
30
Community Mental Health Journal
training and experience to o n e - t o - o n e or small group, analytically based clinical psychotherapy. O n finding himself in the c o m m u n i t y mental health center, such a psychiatrist m a y find his expertise of limited relevance to the b r o a d e r goals of c o m m u n i t y psychiatry. C o n d i t i o n e d to expect a leadership role, he m a y be embarrassed, defensive, and antagonistic t o w a r d other staff persons from w h o m he can learn and to w h o m he m a y feel he has to prove himself. H e m a y charge off in some r a n d o m direction, asserting the authority of his position and h o p i n g to find his bearings along the way, or attempt to recreate in the c o m m u n i t y mental health center a clinical setting in w h i c h he can practice traditional psychiatry. Or he m a y accept the fact that he, like m a n y of the staff, is n e w in this e n d e a v o r and has a lot to learn from his co-workers, patients, and the c o m m u n i t y . His reception of students will d e p e n d largely on his view of his role in the center. Perhaps the greatest confusion in the c o m m u n i t y mental health center exists a r o u n d the issue of the role of the i n d i g e n o u s paraprofessional worker. In various settings the i n d i g e n o u s w o r k e r m a y be so limited in what he is allowed to do that he is little more than an office boy, or so elevated that he may be encouraged to attempt i n - d e p t h p s y c h o t h e r a p y with little professional supervision. Sometimes his position in a single agency swings from one extreme to another. Appropriate task specification for the i n d i g e n o u s paraprofessional worker remains one of the major n e e d s in the d e v e l o p m e n t of efficient and effective c o m m u n i t y mental health services. In the m e a n t i m e the i n d i g e n o u s worker is angry at having b e e n lured into the system with promises of learning h o w to be an effective mental health worker and finding status in his career. Usually he has either b e n d e n i e d meaningful work and its a c c o m p a n y i n g status w i t h i n the center or has b e e n allowed to u n d e r t a k e tasks for w h i c h he was given little training or supervision and w h i c h he recognizes as being inappropriate for him. He is often r e m i n d e d of the lack of credentials that makes him the most vulnerable m e m b e r of the staff. He is a threat to the formally trained staff w h o fear that he depreciates their worth, and h e is a threat to his c o m m u n i t y n e i g h b o r s w h o fear that he is being co-opted b y the "establishment." In addition to the division and dissension b y profession, the staff is likely to be d i v i d e d b y ideology over such issues as the ratio of effort to be put into preventive programs to that put into treatment, the degree of c o m m u n i t y control of the center to be allowed, or which treatment model is most relevant to the setting. There are a n u m b e r of respects in which the staff ferment can be very constructive for the student. He sees the staff not as a collection of ]professional roles w h i c h incidentally have persons in them, but as individuals, each with a u n i q u e experiential background, interacting u n d e r the pressures of heavy workloads, ill-defined tasks and functions, and with minimal guidance from the precedent of their o w n experience or that of others. The student has the rare o p p o r t u n i t y to learn experientially about agencies in their b e g i n n i n g phase, about organizational dynamics, and about systems that do not yet have the " b u g s " w o r k e d out. He can experience the n e e d in some areas for structure that is lacking and see the slow d e v e l o p m e n t of bureaucratic characteristics in the agency. In traditional field work agencies the same processes m a y be occurring, but m u c h more slowly and subtly, so that the student m a y only see
Ted R. Watkins
31
the rather smooth operation of an agency that is efficient, t h o u g h not necessarily effective or relevant. In the traditional field setting there is likely to be the implication that the problems to be dealt w i t h and the n e e d for change lie exclusively outside the agency. In the c o m m u n i t y mental health center in the developmental stage, the distinction b e t w e e n inside and outside the agency is less clear. For example, p o w e r struggles a m o n g staff are not so different from p o w e r struggles in client families or p o w e r struggles in the c o m m u n i t y in w h i c h the client has b e e n victimized. In some instances the similarities are entirely too great, as w i t h the black i n d i g e n o u s w o r k e r in the ghetto c o m m u nity mental health center w h o s e whole history of b e i n g discriminated against, b e i n g given promises b y the p o w e r s in the system, and still b e i n g allowed to m o v e only to the first rung of the ladder of success is repeated in the c o m m u nity mental health center. The mature student will be able to learn as m u c h about personality dynamics, interpersonal and c o m m u n i t y relationships, and m e t h o d s of intervention from b e i n g a part of the staff in such a fluid setting as he will from dealing with his clients. STAFF REACTION TO STUDENTS It is to be expected that a staff w h i c h is already in turmoil over its o w n structure will be highly reactive to the entrance of students into the system. W h e r e there is interprofessional rivalry, social work students will be resented b y mental health professionals of other disciplines w h o will feel that the ranks of the staff social workers are b e i n g reinforced b y the students. The fact that the students are likely to be u n e n c u m b e r e d b y a significant i n v e s t m e n t in traditional agency practice gives t h e m an advantage over some more experienced workers in adjusting to an innovative c o m m u n i t y mental health center setting; this m a y sometimes arouse alarm and a n t a g o n i s m in the senior social work staff, w h o m a y complain that the school is not teaching the students "real" (that is, traditional) clinical social work. The i n d i g e n o u s workers are likely to be the most t h r e a t e n e d b y social work students, although sometimes simultaneously the most supportive. There is often some competition regarding w h i c h group, students or i n d i g e n o u s workers, will be relegated to the b o t t o m of the totem pole in agency status. The i n d i g e n o u s workers m a y have v e r y little concept of the i n p u t the students have received from their education, and m a y see t h e m as some sort of " v o l u n teers" w h o are being given credit toward a professional degree for d o i n g essentially the same kind of work the i n d i g e n o u s workers have b e e n d o i n g for a long time. They may resent b e i n g expected to help these n e o p h y t e s surpass t h e m in status and pay in the mental health field. If left u n c h a n g e d , such resentments can result in severely effective sabotaging of the students' efforts. O n the other h a n d m a n y i n d i g e n o u s workers, originally hired because of their positive personal qualities (as o p p o s e d to professional credentials), t e n d to be w a r m and helpful toward the students, identifying with their role as new, junior m e m b e r s of the c o m m u n i t y mental health center team. POSITIVE CONTRIBUTIONS OF STUDENTS The c o m m u n i t y mental health center setting not only offers a u n i q u e field experience for students, but benefits in some u n e x p e c t e d ways from the hosting of a student unit. The students entering the center can, in the
32
Community Mental Health Journal
process of defining their role, reduce staff antagonisms. Being neither fully professionals nor untrained, they need not be identified with either the professional staff or the indigenous group to the detrement of their ability to form positive relationships with the other. They can become a link between the professionally trained and indigenous staff groups. They have in common with the indigenous staff a position at the bottom of the agency's power structure and the fact that they are still learning basics in the mental health field. The indigenous staff tend to identify with the students. It is possible to offer joint learning experiences, such as case consultations or seminars, in which the students can learn a great deal about the community and the agency from the perspective of the front-line indigenous workers while the indigenous workers are exposed to the theoretical expertise of the students. Such contacts have been known to inspire lesser-trained staff members, impressed by the students' academic knowledge, to return to school for professional training or to pressure agencies for more intensive in-service training. Maximizing the positive aspects of the ambivalence of the indigenous staff is no easy task and can be a major step for students in the learning of relationship skills. Relationships with the professional staff also need to be cultivated by students, who should tap every available resource for learning in the agency. Most professionals will be eager to help students who are willing to bring out the teacher in them. Through this relationship the students can articulate their learning needs in a way that not only helps the professionals help them, but also allows carry-over into the teaching role of the professional to the nonprofessional staff member. It is easier for a student to reveal his lack of understanding than it is for a regular staff member, so the students may at times need to speak for themselves and the lesser-trained staff w hen asking for clarification of learning. The student is likely to have been exposed, through the classroom and its required reading, to a broad spectrum of the most current trends in behavioral science theory and service delivery. Typically, persons employed in busy agencies such as community mental health centers find themselves getting increasingly behind in their knowledge of developing trends. Students, if given the opportunity, can provide valuable theoretical input, both through verbal expression of their learning and through demonstration in their work with clients. Through their knowledge of the area of expertise of their faculty, and through their association with classmates placed in other settings, students can keep the agency informed of resources that might be available to it for consultation or research. The students themselves, because of their half-in half-out status in the agency can make some most helpful and astute observations of what is occurring in the agency, if allowed to do so. The most conspicuous advantage to the placement of students in community mental health center settings is the orientation of a new generation of professionals to the concepts and practice of community mental health. With an early incorporation of community mental health concepts (which current practitioners did not have), they will be able to make great strides toward the achievement of community mental health ideals.
