Privatization and the rise and fall of the public mental health safety net

Chronicles how the provision of clinical services for the mentally ill in the US has waxed & waned depending on political & economic factors. An underlying safety net has existed throughout the country's history, however, shaped by the level of treatment technology available at the time to the states. In 1963, the Community Mental Health Center Act established a formal commitment on the part of the federal government toward providing such a safety net, including five basic services: inpatient, emergency, partial hospitalization, outpatient, & consultation/education; these were extended in 1975 to cover services to children & the elderly, the deinstitutionalized, addicts needing treatment, the homeless, & those in the criminal justice system. Six principles required for the effective delivery of such services are delineated, & underfunding is identified as the greatest impediment to implementation. The birth of managed care & privatization options as a result of rising costs of services are discussed, & some potential negative consequences are identified; comparisons are made with the failure of the community mental health/deinstitutionalization movement. It is concluded that the mental health safety net must be maintained. 9 References. K. H. Stewart