Community Mental Health

Definition

Definition

Community mental health is a decentralized pattern of mental health or other services for people with mental illnesses. Community-based care is designed to supplement and decrease the need for more costly inpatient mental health care delivered in hospitals. Community mental health care may be more accessible and responsive to local needs because it is based in a variety of community settings rather than aggregating and isolating patients and patient care in central hospitals. Community mental health assessment, which has grown into a science called psychiatric epidemiology, is a field of research measuring rates of mental disorder upon which mental health care systems can be developed and evaluated.

Community mental health centers

In the United States, an increase in community mental health care delivery began in the 1960s when President John F. Kennedy signed the 1963 Community Mental Health Centers (CMHC) Act (Public Law #88-164). Growing community mental health capacities were intended to complement and mirror trends toward fewer hospital stays and shorter visits for mental illness. This restructuring of mental health service delivery has occurred in the context of evolving fiscal responsibilities, however. The goals and practices of community mental health have been complicated and revised by economic and political changes.

The National Institute of Mental Health (NIMH) initially developed a CMHC program in the 1960s. CMHCs were designed to provide comprehensive services for people with mental illness, locate these services closer to home, and provide an umbrella of integrated services for a catchment area of 125,000-250,000 people. CMHCs were designed to provide prevention, early treatment, and continuity of care in communities, promoting social integration of people with mental health needs.

Competing public interests

At the outset, CMHCs were providing outpatient care to people with less severe, episodic, or acute mental health problems. In the 1980s, more people with serious mental illness began using CMHCs, due in part to deinstitutionalization, and following the redirection and capping of federal funds for local mental health care. With growing awareness of the homeless mentally ill, state-funded CMHCs faced new challenges, and their work became fragmented according to catchment areas of responsibility, leaving some urban centers overburdened, while others maintained locally funded operations, limiting responsibility for their area only.

The growth of local community mental health centers was an example of competing governmental interests and authorities. Growing numbers of CMHCs were mandated federally and to be funded by local communities, bypassing state control. This growth in outpatient capacity was later used to complement decreases in inpatient hospital care, or deinstitutionalization, which reduced the costs of diminishing and state-funded mental hospitals.

Policies to improve public mental health care

Community mental health centers were the first of several programmatic attempts to improve mental health care in the latter part of the twentieth century. A second was when the federal government recommended Community Support Programs (CSPs) in 1977-1978 in response to problems associated with deinstitutionalization. CSPs focused on providing direct care and rehabilitation for the chronically mentally ill. However federal support for mental health care and CMHCs in particular was reduced in 1980-1981, with the repeal of the Mental Health Systems Act and the federal budgeting actions that cut funding and provided it instead through block grants to states.

A third initiative has been to expand the national capacity for children’s mental health care under the Child and Adolescent Service System Program (CASSP), beginning in the 1980s. Principles for this system of care included a continuum of services, including mental health. The expansion of mental health classification systems and the Diagnostic and Statistical

KEY TERMS

Catchment —In mental health, a term that refers to a particular geographical area served by a particular mental health agency.

Psychiatric epidemiology —A field of research for establishing the incidence, distribution or prevalence, and control of mental disorders in a population, including the sum of the factors controlling the presence of mental disorders.

Manual of Mental Disorders, or DSM, has helped identify and treat a growing number of children and youth. A fourth initiative was a joint effort by the Robert Wood Johnson Foundation and the department of Housing and Urban Development. Their Program on Chronic Mental Illness (PCMI) promoted the integration of regional mental health authorities in nine cities. Coordinated local mental health systems run by local mental health authorities remain an important goal of mental health policy. As this program ended, another program, Access to Community Care and Effective Services and Supports (ACCESS) began in 1993, ending in 1998. This nine-state demonstration project targeted homeless populations with mental illness.

Finally, many private and public health systems have moved towards managed mental health care, which has become also known as behavioral health care. This form of cost containment is a constellation of organizational reforms, financing systems, and regulatory techniques. Managed care, which began its expansion throughout health care in the 1990s, provided mental health care policy new challenges. While federal health policy and medical assistance provide reimbursement for mental health care and for people with mental illness, the regulation of these systems has grown increasingly complex.

The United States Department of Health and Human Services has developed the Comprehensive Community Mental Health Services Program for Children and Their Families with the goal of improving the delivery of mental health services to families with children and adolescents who have serious emotional disturbances. According to their information, as many as two-thirds of children and adolescents in the United States do not receive the mental health services they need. This fraction in absolute numbers translates to as many as 6.3 million children. The program is designed to bring together various child-ren’s mental health programs into a single plan or system of care, led by the family. Grants from this program, which was first authorized in 1992, target improvements and expansions of such systems.

Resources

BOOKS

Aneshensel, Carol, and Jo Phelan, eds. Handbook of the Sociology of Mental Health. New York: Kluwer Academic, 1999.

Scheid, Teresa, and Allan Horwitz, eds. Handbook for the Study of Mental Health. New York: Cambridge University Press, 1999.

PERIODICALS

Grob, Gerald. “Government and Mental Health Policy: A Structural Analysis.” Milbank Quarterly 72.3 (1994): 471–500.

Rothbard, Aileen B., So-Young Min, Eri Kino, and Yin-Ling Irene Wong. “Long-Term Effectiveness of the ACCESS Program Linking Community Mental Health Services to Homeless Persons with Serious Mental Illness.” The Journal of Behavioral Health and Services and Research 31 (2004): 441–49.

ORGANIZATIONS

American Psychiatric Association. 1400 K Street NW, Washington, DC 20005. <http://www.psych.org>.

American Sociological Association. 1307 New York Ave., Washington, DC 20005-4701. <http://www.asanet.org>.

National Institute of Mental Health. 6001 Executive Boulevard, Rm. 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513. <http://www.nimh.nih.gov>. This agency also maintains a Web site with information about how to locate community mental health services locally. It is available at: <http://www.nimh.nih.gov/healthinformation/gettinghelp.cfm>.

Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Mental Health Services (CMHS), Department of Health and Human Services. 5600 Fishers Lane, Rockville MD 20857. <http://www.samhsa.org>.

Michael Polgar, PhD
Emily Jane Willingham, PhD