Caplanian mental health consultation: Historical background and current status.

Abstract

Abstract: This article traces the historical roots ofCaplanian mental health and lists nineaspects of the model that have proved valuable overtime. A relatively new development, mental healthcollaboration, is discussed with reference to theinternal consultant. The role of mental healthconsultation in primary prevention is brieflyreviewed, and it is argued that consulting psycholo-gists who conduct organization development woulddo well to consider explicitly the preventive aspectsof their work. The paper concludes with somethoughts regarding potential problems of workingthrough intermediary caregivers to achieve the goalsof primary prevention. IntroductionThe genesis of Caplanian consultationoccurred in Israel in 1949 when psychiatristGerald Caplan, overseeing a small staff ofsocial workers and psychologists, was giventhe responsibility to care for the mental heathneeds of 16,000 immigrant adolescents locatedat more than 100 residential institutions.Caplan soon realized that the usual practice ofproviding individual client referral/diagnosis/psychotherapy was not feasible, given thesubstantial number of referrals (about 1000)which were received during the first year, andIsrael's rough terrain and generally poor roadswhich made it difficult to transport referredclients to a central clinic location.These circumstances gave rise to analternative, indirect method of providingmental health services. Rather than meetclients at a clinic, Caplan and his staff traveledto the individual institutions and meet withreferred adolescents and with their caregiversto discuss the latter's perceptions of the clients.These collegial discussions often revealed acaregiver 's stereotyped, inaccurate perceptionof an adolescent that impeded the solution ofpresenting problems. Following sympatheticand objective discussion with the staff member,the caregiver (i.e., consultee) often returned tohis or her duties with a new perspective andbroader range of possibilities in working with theclient. In focusing efforts on improving thefunctioning of caregivers through this method, itwas believed that the mental health of many moreclients could be improved than was possiblethrough a direct service method.Although this practice was originally termedcounseling the counselors, it was renamedmental health consultation to reflect that thewelfare of the clients remained the ultimateprofessional concern, and the consultees were notundergoing psychotherapy. Caplan also discov-ered that meeting caregivers in their own institu-tions— originally borne of necessity—was anintegral part of the method. The consultees' worksettings provided much relevant information thatenabled clinical staff to see critical issues morereadily. Furthermore, consultees were much morelikely to speak candidly about their perceptions ofproblems while at work than at a clinic (Caplan CMeyers, Brent, Faherty, & Madferri, 1993; Oak-land, 1994), community psychology (Iscoe, 1993;

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