A Living Document: Mental Health, United States Evolves Alongside the Field

By Manderscheid, Ronald W. | Behavioral Healthcare Executive, May 2007 | Go to article overview

A Living Document: Mental Health, United States Evolves Alongside the Field


Manderscheid, Ronald W., Behavioral Healthcare Executive


In March, the Substance Abuse and Mental Health Services Administration (SAMHSA) published Mental Health, United States, 2004. Since I have been associated with this publication for more than 20 years at the National Institute of Mental Health (NIMH) and the Center for Mental Health Services (CMHS), I thought it important to provide a short historical perspective, together with some comments on the major policy directions reflected through this publication and likely future policy directions.

Origins

When MH, US was first developed by NIMH in 1983, it consisted solely of statistical tables thought to be of use to the mental health field. For the most part, these tables were taken directly from the surveys conducted at that time by the NIMH Division of Biometry and Epidemiology. (Additional tables from these NIMH surveys were published recurrently in Health, United States, a publication of the National Center for Health Statistics, and in the Statistical Abstract of the United States.) In response to this and subsequent editions of MH, US, NIMH was told repeatedly that the tables were useful, but that some interpretation should be provided. Hence, textual material was added to draw attention to particular findings and to put the findings into a factual context.

As interpretations and context were added, readers also began to suggest to NIMH and later CMHS that the policy implications of the findings should be explored and that work outside NIMH/CMHS also should be added. These changes were made in the 1990s, and MH, US is the only national policy document in the mental health field published recurrently.

Major Policy Directions

Perhaps the best way to characterize the major policy shifts reflected through the various editions of MH, US is to say that the field has moved from an exterior view, like looking at a store window from the street, to an interior view, in which we are behind the store window examining what's on display. For example, in the 1980s great concern was expressed about counting the number of adults with chronic mental illness, changes in the number of beds in state mental hospitals, increases in the total number of episodes of care in community programs--all exterior views. By contrast, now we are principally concerned with consumer and family empowerment and recovery, as well as delivering effective care, whether in specialty or primary care settings--both views from the inside. …

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