Toward a national mental health policy

In an address to a 1991 symposium on community psychiatry in Albany, NY, the recent history of public mental health programs is traced, noting a severe disintegration of these services during the 1980s. Personal experience as administrator of the Philadelphia (Pa) Office of Mental Health & Mental Retardation is drawn on to chronicle decline in the number of community mental health centers affiliated with hospitals, animosity between city & state, charges of racism, & a serious increase in the use of psychiatric emergency rooms. In the 1990s the mental health system has retreated from a comprehensive system of care to one that is complex, fragmented, & incomplete. Recommendations are made to establish national policy for those at greatest risk, increase coordination between general hospitals & state psychiatric hospitals, & support innovative case management & financing systems. Although the impact of insurers, employers, increased monitoring of services by state & federal bodies has resulted in reducing or rationing access to care, some benefits are cited: greater acceptance of responsibility by mental health professionals, & a renewed interest in working in public & community mental health & a national mental health agenda. S. Dilts