the seriously mentally ill in the public sector, and the expansion of other services for less disturbed populations, such as some adolescents and the elderly, in the private sector.
During the last decade the nation has made major strides in identifying and responding to the repercussions of a precipitous process of depopulating public mental hospitals and the privatization of services. Much of this response has been unleashed by the devolution of authority to the states. This newfound leadership in state mental health authorities has often acted in concert with the burgeoning advocacy movement to target the seriously mentally ill and to provide many of the neglected services such as rehabilitation, assisted housing, social clubs, and case management, among others.
The targeting of the seriously mentally ill, however, has had a downside, as it has complicated problems of interorganizational coordination required for the many clients with multiple disabilities. It has also meant a movement away from primary prevention and early intervention in those areas where such strategies have proven effective, such as those involving children. While the new priority given to the seriously mentally ill promises to redress many of the problems of the deinstitutionalization of public mental hospitals, the ideal of a balanced service remains elusive. It is, therefore, critical that governmental mental health authorities continue to upgrade their abilities to rationally plan comprehensive services.
There is growing support in the United States for a universal health insurance plan, perhaps one similar to that of Canada's. With the expansion of both private insurance and Medicaid and Medicare, such a prospect is becoming increasingly likely. A key task for mental health advocates and policy makers is to plan for the mental health component of such a system. It would need to be carefully crafted so as to preserve the planning, monitoring, licensing, and other oversight functions of the state mental health authorities, which would operate within a clearly articulated national mental health policy promulgated by the federal government.