Community Mental Health Centers

Community mental health centers (CMHCs) are designed for those with mental health concerns but inadequate resources to pay for services. They vary regarding the range of services provided. Some centers offer individual and group psychotherapy and medication management, while others include partial hospitalization programs; psychological, personality, forensic, and intellectual evaluations; emergency/crisis treatment; and consultation/education programs. Most CMHCs determine clients’ fees from a “sliding scale,” meaning that the fee is based upon the person’s income level and ability to pay. Fees can be as low as $5 or $10 per session. The costs of providing services are funded by federal, state, and local grants. As of 2011, fifteen community mental health centers in Arkansas serve more than 141,000 individuals throughout the state.

Development
Several pieces of federal legislation paved the way for the emergence of CMHCs. The Barden-Lafollete Act of 1943 mandated that people with severe mental illness (SMI) receive federal and state rehabilitation services. Shortly thereafter, the National Mental Health Act of 1946 established the National Institute of Mental Health (NIMH), an organization whose intent was to apply the public health approach to mental health. This act allowed the federal government to provide grants supporting state outpatient treatment and to create new centers. Perhaps the most influential piece of legislation, the Community Mental Health Center Act of 1963, was concurrent with the civil rights movement and resulted from public activism for individuals with SMI. Court rulings and laws emerged that made involuntary hospitalization more difficult and enforced higher-quality care in psychiatric hospitals. Thus, hospital administrators were encouraged to reduce their inpatient population, and the total number of inpatients decreased eighty-two percent from 1955 to 1988.

This act moved the focus for individuals with SMI from state mental hospitals to community-based treatment or “least restrictive environments” and allowed for federally matched state grants to help create new centers. Developed in 1978, the NIMH Community Support Program (CSP) gave states additional federal assistance to provide more comprehensive services. Another key piece of legislation leading to more comprehensive services was the State Mental Health Planning Act of 1986, which allowed CMHCs to receive reimbursement from Medicare and Medicaid. In Arkansas, Act 243 of 1987 revised laws relating to voluntary admissions and involuntary commitments of mentally ill persons, and Act 944 of 1989 made an appropriation for personnel services and operating expenses. These acts led to an increase in responsibilities for the care and treatment of individuals with severe mental illness.

Community mental health programs are following the national trend toward a managed care delivery method. This is accomplished either by reducing the total number of people using services, or limiting the number of sessions available to individuals.

CMHCs in Arkansas
Some of the CMHCs in Arkansas offer unique programs. Identified as operating in a high-risk area, Community Counseling Services, Inc., in Hot Springs (Garland County) was awarded a grant to provide services to those with problem gambling behavior. Community Support Services at The Stride House, located in Benton (Saline County), offers a psychosocial rehabilitation program for mentally ill adults, with services provided on site and at clients’ homes. Delta Counseling Associates, Inc., offers alcohol safety education classes to those who have been charged with a DWI. Counseling Services of Eastern Arkansas and Mid-South Health Systems, Inc., have treatment foster care programs designed to provide supportive foster homes for emotionally and behaviorally disturbed children and adolescents or prepare them for independent living. Families participate in ongoing specialized training in order to offer a licensed placement home.

In 2009, the Arkansas Foundation for Medical Care (AFMC) conducted a survey to evaluate clients’ satisfaction with services provided to them by CMHCs. The major areas of interest were satisfaction with access, outcomes, participation in treatment planning, social connectedness, improved functioning, and overall satisfaction with services. Sixty-one percent of adult responders and fifty-three percent of children rated their overall satisfaction with services received as an eight or higher (on a scale of one to ten). The area with the lowest satisfaction rate for adults was social connectedness. For children, the area with the lowest satisfaction rate was outcomes. These results were sent to a benchmarking database, where Arkansas’s results will be presented with other states’ to display national consumer satisfaction with public mental health services.

The Mental Health Council of Arkansas (MHCA) is a non-profit organization governed by a board of directors representing each of the CMHCs. The purpose of MHCA is to ensure that high-quality community-based mental and behavioral healthcare in Arkansas is accessible and affordable. Its members include more than fifty psychiatrists and 2,000 healthcare professionals. MHCA hosts an annual conference/institute in Hot Springs, where mental health professionals can earn continuing education credits and network with other professionals.

For additional information:
Accordino, Michael P., Dione F. Porter, and Torrey Morse. “Deinstitutionalization of Persons with Severe Mental Illness: Context and Consequences.” Journal of Rehabilitation 67 (April–June 2001): 16–21.

“Arkansas Community Mental Health Centers Contact Information.” Arkansas Department of Education. http://arkedu.state.ar.us/commemos/attachments/CMHC_Contact_List.pdf  (accessed February 2, 2022).

Mechanic, D. and D. A. Rochefort. “A Policy of Inclusion for the Mentally Ill.” Health Affairs 11.1 (1992): 128–150.

Mental Health Council of Arkansas. http://www.mhca.org (accessed February 2, 2022).

Monk, Ginny. “Centers Tap into Telemedicine.” Arkansas Democrat-Gazette, November 26, 2017, pp. 1A, 13A.

Stromquist, Kat. “Mental Health Center to Close after 50 Years.” Arkansas Democrat-Gazette, August 28, 2019, pp. 1A, 3A.

Ashley Chason
Little Rock, Arkansas

Hillary R. Hunt
Little Rock, Arkansas