Advances and New Directions

By Silvano Arieti; H. Keith H. Brodie | Go to book overview

CHAPTER 35

THE DELIVERY OF
MENTAL HEALTH SERVICES *

Darrel A. Regier

Carl A. Taube

MENTAL HEALTH services in the United States are provided by a diverse group of professional personnel and facilities with little coordination or centralized governmental planning. As a result, a combination of public and private, general medical and specialty mental health, multispecialty group and solo practice settings constitute what has previously been described as the "de facto U.S. mental

health services system." 24 Major changes in this service delivery system have been the result of multiple economic forces, socio‐ cultural pressures, and therapeutic innovations, as well as governmental policy decisions.

This chapter will describe the principal characteristics of the current mental health services system and the evolutionary trends that have emerged over the past twenty‐ five years. By starting with a brief review of epidemiological data on the prevalence of mental disorders, it is possible to provide some perspective on the scope of the mental health problems that the service system is designed to address. The major sites for mental health service delivery will be identified, as will the trends that have emerged in the service delivery system since 1955. Finally, the characteristics and distribution of professional personnel involved in providing specialty mental health services will be briefly discussed.

____________________
*
Sections of this chapter are taken in part from two previous publications: D. A. Regier, I. D., Goldberg and C. A. Taube "The De Facto U.S. Mental Health Services System," Archives of General Psychiatry, 35 (1978): 685-693, and C. A. Taube, D. A. Regier, and A. H. Rosenfeld "Mental Disorders" in Health United States— 1978, DHEW publication No. (PHS) 78-1232, Hyattsville, Md., 1978. All statistical data have been updated to reflect the most recent available information from the National Institute of Mental Health and the National Center for Health Statistics surveys. The assistance of Michael J. Witkin, Statistician, Survey and Reports Branch, Division of Biometry and Epidemiology, NIMH, in updating these data is gratefully acknowledged.

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