Reinventing Mental Health Service Delivery: One Nonprofit's Experience

Article excerpt

INTRODUCTION

During the 1980s, nonprofit agencies experienced a $30 billion decrease in federal funding. In the early 1990s, the federal budget package eliminated more than $492 billion in federal spending over five years--much of it in health and social programs (Harrison, 1991). This reduction in federal funds directed at social service organizations necessitated the need for nonprofit managers to seek sources of external support in order to survive (Downs, 1967) and to develop strategic plans which would guide them through the remaining decade. This change in funding patterns and sources is relevant for community nonprofits dependent upon government support (Salamon, 1993). The need to stay fiscally viable necessitates that organizations reevaluate their internal culture and structures so there is continued improvement in productivity, reduced costs, and better quality (Stupek, 1993).

This case study illustrates some of the unanticipated consequences of a community-based nonprofit agency serving mentally ill adults that attempted to confront these challenges. Part of the organization's strategy was to develop a market-driven public relations campaign to inform the St. Louis community about its programs and services. The process of developing and implementing the public relations program had an unanticipated effect on the agency's organizational design and personnel/human resource management (HRM) strategies.

BACKGROUND

Places for People, Inc. (PFP) is a private, nonprofit organization located in St. Louis, Missouri. It has an annual budget of 1.5 million dollars. PFP has been in existence for more than 21 years providing residential, vocational, recreational, and psychosocial services for approximately 300 clients. Its target population consists of adults with severe and persistent mental illness who reside in St. Louis City and County.

Places for People was founded in 1971 on the premise that all individuals, regardless of disability, have the right to live as independently as possible. This includes the right to live in the housing of their choice and the opportunity to choose which programs or services will work best for them in obtaining their personal goals. To accomplish this purpose, the agency provides a variety of mental health services including supported community living, psychosocial rehabilitation, and a group home for adults with severe psychiatric disabilities.

PFP staff work with the client from the point of initial screening and admission through the process of choosing and setting up an apartment. Staff members also provide follow-up services which may include case management, financial management, medication monitoring, assistance with daily living skills, substance abuse education, supported employment, vocational training, 24-hour crisis intervention, and advocacy.

Another service that clients may select is the psychosocial rehabilitation center, known as the "club" established in 1975. Clients are considered "members" and are expected to contribute their talents as part of membership responsibility. Staff and members work together as a team to do shopping and to prepare meals for 80 people on a daily basis. Members may answer phones, participate in building maintenance or perform clerical work. There is also a member council that supervises the daily operations of the club including a thrift store and snack bar.

The West Pine Group Home, established in 1981, is a transitional, residential facility. On-site staff provide 24-hour supervision and assistance to 12 residents who are preparing for independent living in the community.

PFP has an interdisciplinary, professional staff of 50 employees with Bachelor's and Master's degrees represented by the fields of Business, Education, Counseling, Law, Nursing, Public Administration, Psychology, and Social Work. PFP is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) and is a recognized leader in the mental health field (McAdoo, 1992). …