Dimensions of State Mental Health Policy

Dimensions of State Mental Health Policy

Dimensions of State Mental Health Policy

Dimensions of State Mental Health Policy

Synopsis

This volume introduces students to the emerging field of state mental health policy, its history, current policies, organizational models, and required programming knowledge. Focusing on current issues and trends, it also provides administrative and policy practitioners with a previously unavailable source of new program designs and initiatives. Five chapters on program development identify key principles of programming and describe model programs in primary prevention, clinical treatment, and psychiatric rehabilitation. Contributors include leading scholars and practitioners, several having served as state commissioners of mental health.

Excerpt

In the United States, mental health policy, and particularly the care of persons with serious mental illness, traditionally has been a local and state responsibility. With growth and urbanization in the late nineteenth and twentieth centuries, states and localities built institutions for the care and custody of the seriously mentally ill. As these systems grew, staffing and maintenance became significant components of state budgets. By 1955, there were almost 559,000 residents of state and county institutions and over 800,000 yearly inpatient episodes.

In the 1960s, the nation implemented a broad public health and community care ideology based on a variety of unconfirmed premises about the nature of mental illness, the potentials of prevention, and the advantages of care in the community. the development and support of community mental health centers (CMHCs) was to be the major vehicle for implementation. the federal program in its efforts to develop a national network of CMHCs bypassed state mental health authorities and dealt directly with local community institutions. National policy makers became the advocates and Instruments for a radically new conception of public responsibility in managing mental illness. the states continued with their traditional responsibilities of maintaining mental hospitals. the new CMHCs contributed little to the care of the severely mentally ill once they returned to the community. Instead they focused their efforts on new types of clients.

The new community ideology and the expansion of the boundaries of care for mental illness were facilitated by other trends. the growth of health insurance and increased coverage for mental illness provided more opportunities for care and for development of new treatment settings. Most dramatic was the expansion of psychiatric treatment in general hospitals in both specialized psychiatric units and in beds scattered throughout medical and other units. Also, in the late 1960s, Medicare stimulated the rapid expansion of nursing home beds, and the Medicaid program provided strong incentives to states to shift patients from mental institutions completely funded by the states to nursing home beds where funding would be shared.

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