Better But Not Well
Mental Health Policy in the United States since 1950
Publication Year: 2006
Published by: The Johns Hopkins University Press
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America has always struggled to care for and support people who have mental illnesses. The challenges of addressing these disabling health conditions demand that we both show our compassion and use our ingenuity. When Jimmy was president during the 1970s, I served as honorary chairperson for a presidential commission to assess the mental heath needs of the nation and to develop...
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In the past ten years, discussions of mental health policy have routinely taken a dour view of the recent history of mental health care in the United States. President Bush’s 2003 New Freedom Commission report begins by calling mental health care in America “a system that had fallen into a state of disarray.” The...
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The mental health system today bears scant resemblance to that of the first half of the twentieth century. Albert Deutsch, after a decade of investigation, indicted mental health care in 1948 in The Shame of the States. Deutsch described how people with severe mental illness languished on the filthy back wards of public mental hospitals...
2 The Population with Mental Illness
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Mental illness is far more visible today than it was fifty years ago. People with severe mental illness, once housed in state institutions often located far from population centers, now live in the community. People who were once thought to have personality quirks or to be victims of harsh social circumstances are now described...
3 The Evolving Technology of Mental Health Care
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The past fifty years have been filled with technological innovations in health care. From the polio vaccine to water fluoridation, from new pharmaceuticals to joint replacement, the benefits of new technologies over the past half century have been staggering. The economist William Nordhaus estimates that during these...
4 Health Care Financing and Income Support
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Between 1950 and 2000 the financing and delivery of mental health care underwent structural changes as dramatic as those in the Eastern European nations after the Soviet Union’s disintegration. In a matter of twenty years, starting in the mid-1960s, mental health care moved largely from a centrally planned...
5 The Supply of Mental Health Services
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Public and private spending on mental health services and social services that improve the well-being of people with mental illness have expanded tremendously since 1950. An infusion of new funding, coupled with the renewed professional optimism about the potential of mental health treatment that, in part, prompted...
6 Policy Making in Mental Health: Integration, Mainstreaming, and Shifting Institutions
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In the 1950s and 1960s mental health policy making was the domain of governors and their state mental health program directors. Organized psychiatry wielded great influence and was deeply involved in consequential debates about the future of mental health care in the United States. Today, by contrast, state Medicaid directors, the...
7 Assessing the Well-being of People with Mental Illness
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Over the past five decades, Americans have witnessed vast improvements in living standards. Incomes have more than tripled (adjusting for inflation). The share of U.S. families living in poverty has fallen by half. The life expectancy of adults has increased seven years since 1950. Most Americans have benefited...
8 Looking Forward: Improving the Well-being of People with Mental Illness
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In 1963 President Kennedy set out a “to-do list” for improving the quality of mental health care in the United States and the lives of people with mental disorders: We must act to bestow the full benefits of our society to those who suffer from mental disabilities; to prevent occurrence of mental illness . . . wherever and whenever...
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Page Count: 208
Illustrations: 13 line illustrations
Publication Year: 2006