Better But Not Well: Mental Health Policy in the United States since 1950

Foreword

f or e w or d 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 recommendations for meeting these needs. The result of that commission was the enactment of the Mental Health Systems Act of 1980. Unfortunately, the legislation was never funded by the next administration, although much of it was eventually implemented in practice. Twenty-five years later, President George W. Bush established the President’s New Freedom Commission on Mental Health. Regrettably, many of the problems noted in the 1970s remain, but there have been some exciting developments, especially the expectation of recovery now for people with mental illnesses. In considering how to better address the mental health needs of the American people, we must, from time to time, take stock of our successes and failures. In Better But Not Well, Professors Frank and Glied offer a broad-based and candid assessment of the evolution of mental health care in the United States and of how the well-being of people touched by mental health problems changed during the last half of the twentieth century. They highlight significant gains in our investments in mental health care, in scientific advances, and in new opportunities for people with mental illnesses to share in everyday life. Frank and Glied also offer a sober examination of some notable failures, including the inexcusable increases in homelessness and incarceration of people who have mental illnesses. Their analysis provides a new understanding of how economic, scientific, and legal forces combined to shape the way people with these disorders are cared for today. Fortunately, they use their assessment to define some new directions for mental health policy in the twenty-first century. x Foreword This kind of periodic examination of where mental health care in the United States stands is necessary because so much work remains to be done. For too long, mental illnesses have been shrouded in secrecy, shame, and hopelessness. We must continue to work toward eliminating the stigma surrounding them, abolishing barriers that exclude people with these illnesses from sharing in the benefits of American society, expanding scientific inquiry, and developing policies that serve to promote mental health and prevent mental illnesses. It is my goal to see mental illnesses attended to like all other diseases so that people with them can share fully in everyday life. Rosalynn Carter Chair The Carter Center Mental Health Task Force ...