The mental health gatekeeper role: a paradigm for conceptual pretest. Proposal for a preliminary test of potential effectiveness.

Two of the major themes in the community psychiatry movement have been the employment of new and different types of persons in service roles and the maintenance of clients in the community, whenever possible, with avoidance of institutionalisation. A logical outcome of the combination of these two themes has been an increasing interest in the role of persons with fixed social roles within the community as gatekeepers for actual direct service or appropriate referrals into the mental health service system. Police, clergy and bartenders are among the social roles that have received serious consideration and, in some cases, actual use as points of entry and actual service. Careful analysis of the likely requirements of the gatekeeper role will show, however, that many existing social roles that appear fertile ground for the mental health gatekeeper function are in fact lacking in certain features necessary to such a role. This paper presents five criteria considered important or essential to any conclusion that a given role should be seriously considered for the gatekeeper function. These criteria may serve for a shortcut prior to the investment of money and time and may thus have false and expensive steps in our enthusiastic but often hasty search for innovation.