1. History of Mental Health 1840’s-Dorthea Dix championed need for mental health institutions on a federal level By the 1920’s, State Hospitals were warehousing individuals who utilized them due to lack of social programs

2. Mental Health Reform Early 1900’s, Mental Health Reform was started Critical of State Hospitals run by the state governments WWII-Focused attention on Mental Health Issues, due to 1 out of 4 draftees being rejected from duty because of mental health or neurological issues Mental Health Act of 1946-established the National Institute of Mental Health that focused on modernizing treatment approaches to psychiatric care

3. Community Health Centers Acts of 1963 & 1965 Act of 1963-Appropriated funds only for construction of Community Health Centers Act of 1965-Staffing-Governmental proposals to institute federal programs for the aged and the poor Focused on mental health prevention-a concept that was borrowed from the Public Health concept of prevention

4. Deinstitutionalization Nixon Administration impounded funds for mental health programs Reagan Administration collapsed all mental health funding to block grants Between 1970-73, 14 state hospitals had closed, with Reagan promising to close all by 1980 Judicial decisions impacted treatment- increased civil rights of patients, while requiring the states to provide treatment States provided narrow interpretation of Donaldson decision Illusory legal decisions for the mentally ill-enhancing human rights and freedoms without any corresponding improvement in services to be provided

5. Revolving Door High incidence of readmissions to the state hospitals and less money for treatment-medication management Hospital related deaths Mental health clients increase involvement to petty crime By 2000, reforms change judicial policy and establish specialized courts to deal with mentally ill, non-violent offenders

6. Community Mental Health Centers under siege Chronically, mentally ill population that were discharged from state hospitals prove to be a burden for the service providers CMHC’s receive cut in federal funding Reagan provides block grants to states, but with a 21% cut Reliance on government assistance programs Reorganization-increase of case loads and target of chronic mentally ill treatment

7. Preventative Committment Out-patient programs have lack of follow thru by chronically mentally ill patients, but continue with increased hospitalization Utilizes preventative commitment as a treatment modality to prevent decompensation of the chronically, mentally ill Statue provides for mentally ill people who are unable to voluntarily comply with treatment and need treatment to prevent decompensation to be a danger to self, others, or a grave disability

8. Mental Health Service Delivery SAMSHA-Substance Abuse and Mental Health Services Administration-oversees block grants Block grants administered since 1981 New Approaches to treatment delivery- Capitation Method Predetermined amount of money to be provided per client that insist on a wide range of services to be delivered

9. Integrated Mental Health Concept Categorical grants-Medicaid, Supplemental Security Income, Food Stamp Program. Local funding would be allocated to a common fund Non-Profit Planning Committee-Would oversee planning and coordination, monitor performance, and evolve innovative programs High-usage clients would be targeted for provision of less costly services in order to generate surpluses for less intensive programs

10. Parity for Mental Health Care 1996-Established parity form mental health treatment Employers with more than 50 employees who offer any mental health coverage, must include mental health coverage comparable to physical health coverage In 2000, survey found a resulting decrease in employee benefits

11. Substance Abuse High cost to society has provided much focus in social policy Increase in block grants to fund programs Public intolerance has escalated due to highway fatalities, HIV transmission between IV drug users, and Fetal Alcohol Syndrome and drug abuse affects among newborn infants Drug-Free Schools Act of 1990-Provided $500 million for drug abuse prevention Focus of treatment is mainly directed at intervention strategies and rehabilitation since there are not any major prevention initiatives