Healthcare Delivery For Persons With Mental Illness

The Community Mental Health Act of 1963, was the first federal law that inspired community-based mental health care, and it ignited the transformation of the public mental health system (Young Minds Advocacy, 2016). Other names of the Act are Mental Retardation and Community Mental Health Centers Construction Act of 1963. It was the beginning of the Deinstitutionalized movement in mental health treatment options for children, youth, and adults (National Council for Behavioral Health (NCBH), 2015). States received money from grants, from the Community Mental Health Act for the construction of these mental health centers. Initially, the intention of the grant program was to provide 1500 mental health centers nationally (Young Minds

A Community health center can be defined as a center where high quality primary and preventive healthcare is provided regardless of the ability of the patient’s financial situation. There are some basic characteristics a community health center must possess to be fully functional. Some of which are:

These two men set out on a campaign with the theme “fix the broken promise” which referred to Ronald Regan’s promise to use the funding that came from the closing of many mental hospitals for the care of the discharged patients (Peck 2005). The campaign put together “pilot programs” like the programs that are offered today in the actual act (Peck 2005). There was an overwhelming positive reaction with a “56% reduction in hospital stays, a 72% reduction in jail stays, and a 65% increase in people with full-time jobs” (Peck 2005). With law enforcement on their side (having seen what these programs would do to decrease the mentally ill population), they gained a tremendous amount of supporters for their cause. Darrell Stein dedicated a year of his life for this cause and helped raise close to $4.6 million for the campaign (Peck 2009).

Overcrowding became a major problem during the 1940s. Public pressure to reduce the lengthy waiting lists for admission to state hospitals and to remove mentally ill individuals from local jails increased occupancy in already overcrowded hospitals. In 1943, the legislature converted the Confederate Home for Men into a hospital for mentally ill male geriatric patients in order to provide beds in the larger hospitals. In 100 years, the state system for caring for the mentally ill grew to nine state hospitals scattered about the state. Their population had, however, begun to decline as a result of new treatment techniques and changing social ideas about the role of state psychiatric hospitals in caring for afflicted individuals (Creson).

Problem Statement: The World Health Association defines ‘good’ health as: “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” However, in the United States, access to care and funding for mental health care are grossly neglected and underfunded in comparison to other aspects of health care.

The elimination and cut backs of public mental hospitals resulted in the building of Community Mental Health Centers. The serious mentally ill who were supposed to benefit by these developments were replaced by people who were well off and thought they were sick. Making the problem worse the serious mentally ill were unable to re-enter hospitals because of tighter admissions standards ( Contemporary World Issues 1990). Without hospitalization or the ability to support themselves they were forced to the streets.

In 1955, over 559,000 individuals resided in inpatient psychiatric hospitals. By 1995, however, the number had drastically diminished to 69,000, (National Health Policy Forum, 2000). This drastic reduction was largely due to the discovery of antipsychotic medications in the 1950s, and the deinstitutionalization movement of the 1960s, wherein several thousands of mentally ill individuals were released from psychiatric institutions to return to their communities for treatment. Mental health centers (MHCs) were conceptualized during deinstitutionalization to provide treatment to these newly-released mentally ill persons in their communities. Although efforts were well-intended, the MHCs failed to serve the

In 1965, there was a histrionic change in the method that mental health care was delivered in the United States. The focus went from State Mental Hospitals to outpatient settings for the treatment of mental health issues. With the passing of Medicaid, States were encouraged to move patients out of the hospital setting (Pan, 2013). This process failed miserably due to under funding and understaffing for the amout of patients that were released from the State Mental Hospitals. This resulted in patients, as well as their families, who were in dire need of mental health services. This population turned to either incarceration (jails and/or prisons) or emergency departments as a primary source of care for their loved ones.

Jails have been described as “de facto mental hospitals” because they have filled the void created when state psychiatric hospitals began closing in the early 1960s through a process known as deinstitutionalization. Supporters of deinstitutionalization thought the process would help individuals suffering from a mental illness live more self-reliantly while being treated by community mental health programs. However, the federal government did not provide the necessary funding to meet the mounting demand for these programs, leaving numerous untreated. Individuals with serious mental illnesses are often poor or homeless and are likely to have substance abuse problems. Therefore, when they are left untreated, they are more likely to commit minor crimes that have been the focus of law enforcement in recent years (H. Richard Lamb and Linda Weinberger).

This resulted in a process known as deinstitutionalization (Biasotti et. al. 2014). Webster’s Dictionary defines Deinstitutionalization as the release of institutionalized individuals from institutional care (as in a psychiatric hospital) to care in the community. “In 1963 President John F. Kennedy approved the Community Mental Health Act, which led to the establishment of comprehensive community mental health centers throughout the country. It helped people with mental illnesses who were “warehoused” in hospitals and institutions move back into their communities” (Community Mental Health Act).

Health care systems are organizations that are formed to meet the overall health needs of the population. Health care is regarded as one of the leading cause in promoting not only physical and mental health but the well-being of the population. Legislation is implemented requiring government to offer services to all members of its society. The role of health services and the organizations that provide aid is to focus on the health of an individual and to uphold their human rights. According to WHO (2013), a “well-functioning health care system requires a robust financing mechanism, a well-trained and adequately-paid workforce, reliable information on which to base decisions and policies, and well maintained facilities and logistics to deliver quality medicines and technologies (World Health Organization; 2013).

During the 1960’s the United States of America was undergoing a revolution. The Civil Rights movement was in full effect, as well as the community mental Health Act of 1963. The act ensured that individuals, who were locked away in institutions, would be released to outpatient facilities where they would continue their treatment. This was also the first time in history funds from the federal government would be used to provide services/treatment for the disabled (Ramsey

In the state of Georgia there are 227 federally qualified health centers and two centers that are of are of particular interest to me, The Center For Health & Rehabilitation in Atlanta and East Dekalb Health Center Lithonia. These centers qualify because they are public entities that serve the population where they are located. The Center For Health & Rehabilitation provides mental health services to mentally inmate released from the prison system and to those individual whose mental illness treatment began in prison. In contrast East DeKalb Health Center provides primary and preventative health care services in an underserved

Mental health facilities have evolved over the last several hundred years. In 1965 the Mental Health Act was put in place. (A. Penden) It funded community mental health centers throughout the United States. (A. Penden) These outpatient mental health facilities are great places for those who suffer with certain mental illnesses that do not have to be placed in inpatient facilities to be

Additionally, legislative actions were taken in the 1960s and 1970s that made it even more difficult to help those who needed it the most. The system for community mental care was vastly underfunded and many people did not have access to care. As of 1977, according to statistics from Officer.com, “there are 650 community health facilities serving 1.9 million mentally ill patients a year” (Deinstitutionalization). A major problem was that funding was given and then taken away, or diverted to other causes (Thomas). This increasingly paints a picture of the community mental health initiative as a rapidly sinking ship. At this point, not only were mentally ill people being discharged from inpatient treatment facilities with nowhere else to go, they could not even get the help that they needed if they were willing to seek treatment. For those unwilling, or unable, to seek treatment, the Lanterman-Petris-Short Act, and others like it, made forcing the issue even more difficult. To make matters worse, underfunding was also having a negative impact on the few remaining state hospitals. Because the jobs paid so