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PubMed1976

Community mental health center legislation: flight of the phoenix.

The author describes the history and implications of recent legislation affecting community mental health centers. New legislative requirements will result in centers seeing typically underserved populations (children, the elderly, and drug and alcohol abusers) as part of 7 new essential services. The impact of new grant mechanisms and the role of the National Institute of Mental Health in assisting and evaluating centers are examined. The author concludes that as a result of legislative and other trends in mental health care, psychiatrists will be seeing sicker patients for shorter periods, role confusion in the mental health professions will lessen, and centers will be forced to devote much time and effort to financial concerns and appropriate allocation of manpower.

Community Mental Health Services↗
PubMed1978

Will community mental health survive in the 1980s?

There are now 675 funded community mental health centers (CMHCs), covering almost half the country. Many of these programs were funded in the social optimism of the 1960s and now face a crisis of purpose and funding. Additional requirements imposed by the 1975 amendments to the CMHC act are not matched by additional fiscal resources. Programs are graduating from the federal grant to find that other sources of funds, especially third-party insurance funds, are not replacing the lost federal dollars. There is evidence that CMHCs are changing from clinical/medical programs to social programs; the numbers of persons seeking care who have diagnosable mental illness and of psychiatrists and nurses relative to other staff are decreasing. The issue is whether CMHCs as a national program are headed for extinction or whether there will be new vitality for this program into the 1980s.

Community Mental Health Services↗
PubMed1978

Issues critical to the survival of community mental health.

The author delineates some of the critical issues that face community mental health, with the opportunity for either growth and further development or regression into a decentralized type of custodial care. These issues include clarifying boundaries and priorities, caring for chronically ill deinstitutionalized patients, providing differentiated care, collaborating with the community, relating to the rest of psychiatry and medicine, defining the community psychiatrist's role, maintaining psychiatric manpower, undertaking evaluation research, and achieving stable funding. Psychiatry's response to these issues will help determine the resolution of this crisis and the future viability and direction of community mental health.

Chronic Disease↗
PubMed1976

The federal mental health program: past, present, and future.

Dr. Brown traces the history of America's federal mental health program from its beginning in the early 1900s. NIMH, the institute he currently directs, was established in 1946 for the treatment and prevention of mental and emotional illnesses through research,training, and services. It is now one of the institutes of the Alcohol, Drug Abuse, and Mental Health Administration of the Department of Health, Education, and Welfare. Dr. Brown describes its continuous progress toward providing high-quality mental health care to the entire population, and discusses priorities for the future that include continuation of research on schizophrenia and depression and research that will benefit children and the elderly.

Community Mental Health Services↗
PubMed1977

Creating a mental health consultation package for community agencies.

The author designed a consultation package for a community mental health center consultant to present to the relevant agencies and organizations in the community. The consultation package is designed to create a series of regularly scheduled voluntary group meetings that center on the discussion of a case or a particular topic. The package also includes a written agreement, an evaluation procedure, and a six- to eight-month free trial period. The steps for establishing a new consultative relationship and developing a consultation network are also outlined. By using those steps and the package, the author and his colleagues have successfully established consultation services with schools, with the welfare, probation, and police departments, and with organizations of physicians, nurses, and clergy.

Attitude of Health Personnel↗
PubMed1977

Community mental health services in Alabama after Wyatt.

The author believes that the growth of the community mental health system in Alabama has suffered as a result of the Wyatt decision. The state has a limited number of dollars to invest in mental health, and the Wyatt court order requires that the state allocate a large portion of its resources to upgrade its institutional system. That demand on resources has interfered with the development of community services, and it comes at a time when many patients are being released from institutions and need such services. Because the centers must care for increasing numbers of released patients, other important preventive services, such as consultation and education, are receiving less attention than they should.

Alabama↗
PubMed1979

Proposition 13: experience in one community mental health center.

The impact of Proposition 13 on one community mental health center in California is described. Although the center has had no layoffs as a result of its passage, the measure has had a serious effect on staff morale, which was already at a low point because of pre-existing budgetary constrictions that led to staff reductions despite increased demands for services. It has also generated several changes in treatment programs designed to reduce overhead costs and make more efficient use of staff time. The author emphasizes that because of the supplemental funds made available by the state from its surplus during fiscal year 1978-79, the full impact of Proposition 13 on local service programs is still to be felt.

California↗
PubMed1987

The impact of federally funded CMHCs on local mental health service systems. Community Mental Health Centers.

To measure how much federally funded community mental health centers increased the quantity and range of mental health services, 63 catchment areas in which CMHCs began to receive federal funding in 1974-75 were matched individually with catchment areas that never received federal CMHC funding. The two groups of catchment areas were compared to determine average increases from 1973 to 1980 in amounts of services, mental health staff, expenditures, and accessibility and availability of services. Results showed that establishment of local CMHCs had a clear impact on the quantity and the availability and accessibility of services in the catchment area. The effect sizes resulting merely from the passage of time and from CMHC funding were compared.

Catchment Area, Health↗
PubMed1989

Substance abuse among the chronic mentally ill.

Substance abuse was examined in a group of 187 chronic mentally ill patients living in the community. According to ratings by aftercare clinicians, approximately onethird of the sample abused alcohol, street drugs, or both during the six months before evaluation. Patients who were dually diagnosed with substance abuse and mental illness differed from those with mental illness alone in several respects: they were younger and more often male; were less able to manage their lives in the community in terms of maintaining regular meals, adequate finances, stable housing, and regular activities; showed greater hostility, suicidality, and speech disorganization; and had poorer medication compliance. In addition, they were nearly twice as likely to be rehospitalized during one-year follow-up. Substance abuse, appeared to add the problems of disruptive, disinhibited, noncompliant behaviors to chronic mental illness.

Adult↗
PubMed1991

Strategies for integrating public mental health services.

Practical solutions to the issues troubling public mental health systems must be developed within the constraints of existing political structures. A key enabling factor is the inclusion of a broad range of reimbursable mental health benefits within health insurance. However, services cannot be improved without the development of viable frameworks for organizing effective service delivery; such strategies include assertive community treatment, capitation approaches, strong local mental health authorities, and reimbursement structures that achieve key objectives. The author discusses examples of the four strategies and argues for their better integration.

Capitation Fee↗