Magazine article Developments in Mental Health Law

Creating Community Housing for the Seriously Mentally Ill: Systems Issues

Magazine article Developments in Mental Health Law

Creating Community Housing for the Seriously Mentally Ill: Systems Issues

Article excerpt

Virginia's Department of Mental Health, Mental Retardation, and Substance Abuse Services (DMHMRSAS) and network of Community Services Boards (CSBs) are responsible for providing a comprehensive system of care for the seriously mentally ill. Although the DMHMRSAS has endorsed the community support systems model developed by the National Institute of Mental Health as the primary means for providing necessary services for this population, appropriate community-based supported and supervised housing services for the seriously mentally ill, which are key elements of this model, have so far proven difficult to provide on a sufficient and consistent basis in Virginia. This report will describe the origin of the community support systems model, discuss the housing service needs of the seriously mentally ill, and assert that one of the major problems limiting Virginia's ability to provide necessary housing services is the lack of sufficient fiscal and administrative integration of state and community components of our mental health system. Further, this lack of integration can and should be remedied by building upon our current system in a manner guided by the experiences of other states and data about how key administrative and clinical leaders in Virginia view the strengths and weaknesses of our system.

The Community Support Systems Model

The concept of community support systems (CSS) was developed by the National Institute of Mental Health to address perceived inadequacies in the implementation of community mental health centers (CMHCs). The importance of CSS as a concept, and not just a group of services, derives its evolution from knowledge about the nature of serious mental illnesses and their treatment that did not exist when community mental health centers were first conceived during the 1950s and then enabled by the Community Mental Health Centers Act of 1963.

The initial movement toward CMHCs can be traced to the experiences of many psychiatrists in the treatment of traumatic "war neurosis" during World War II and to prevention theory. Psychiatrists treating "war neurosis" learned that these conditions responded most favorably, and had the fewest long-term sequelae, when treatment was initiated promptly and as closely as possible to the site where a person was identified to be in need of treatment. According to Morrissey and Goldman (1984) "the community mental health movement was born out of this enthusiasm for brief treatment techniques, which avoided the removal of patients to faraway hospitals." Mental health planners hoped that early intervention in community settings would similarly prevent the development of chronicity in patients who would otherwise be admitted to state mental hospitals. Thus, CMHCs were conceptualized as serving a primary preventive function with regard to serious mental illness.

However, the initial mission and philosophical underpinning of CMHCs did not equally or adequately stress the long-term rehabilitation and support needs of chronically ill patients who were discharged from state mental hospitals. Thus, CMHCs across the United States were ill-prepared to address the hundreds of thousands of patients who were discharged from long-term state mental hospital care as deinstitutionalization progressed. The many problems of deinstitutionalization led to reviews of this process by both the General Accounting Office (1977) and the President's Commission on Mental Health (1978), which called for a national mental health policy to specifically address the needs and problems of the chronically mentally ill.

In addition to the growing concerns about the inadequacies of services delivered to patients who were "deinstitutionalized," impetus for improving community services for the seriously mentally ill came from progress during the 1970s in understanding the nature of serious mental illnesses as brain disorders. Research indicated that these disorders involved significant alterations in brain structure and functioning. …

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