Community Mental Health Policy in America: Lessons Learned

After 1945 the prevailing consensus that persons with serious mental disorders should be treated in public hospitals began to dissolve. It was replaced by a faith in the efficacy of community care and treatment. Yet for a variety of reasons the new community care system fell far short of its initial promise. Advocates failed to understand that the problems of persons with serious and persistent disabilities were different from those people with mild and moderate disorders. The belief that residence in the community would promote adjustment and integration was illusory and did not take into account the extent of social isolation, exposure to victimization, inducement to substance abuse, homelessness, and criminalization of persons with mental disorders. Effective community care for those previously kept in hospitals must make up for the range of functions that hospitalization was intended to provide, from housing and supervision to treatment and rehabilitation.