Designing Community Treatment Systems for the Most Seriously Mentally Ill: A State Administrative Perspective

Abstract

State mental health authorities confront many challenges in the post‐deinstitutionalization era, especially in assuring appropriate treatment for the most seriously and persistently mentally ill. This paper identifies current problems in the community treatment system, which stem from lack of coordination between the deinstitutionalization process and development of the Community Mental Health Centers program, and from the effects of reimbursement mechanisms on client residential placement. Two New York State program initiatives, Intensive Case Management and Supported Housing, are described to illustrate state efforts to address these problems by reforming the community treatment system. There is an important state role in determining treatment priorities and in contributing to the evolution of models for community treatment.

A framework for evaluating systems thinking interventions: an experimental approach to mental health system change

“…In New York State, people with severe mental illness seeking vocational rehabilitation services are likely to encounter a fragmented delivery system that is unresponsive to their specific and often unique needs. The negative consequences of services fragmentation are well documented (Shern et al 1989;Talbott 1987) and often produce obstacles that limit, delay, or deny clients access to necessary services (Agranoff and Pattakos 1979). When clients successfully obtain services, fragmentation can disrupt care as clients are shifted from provider to provider.…”

Models of Community Care for Severe Mental Illness: A Review of Research on Case Management

“…In response to the growing need for community-based services for persons with severe mental illness, the National Institute of Mental Health established the Community Support Program (CSP) in 1977 (Turner and TenHoor 1978). The primary function of CSP was to improve the coordination of mental health services in the community, with special emphasis on enhancing the role of States, which had previously played a minimal role in the deinstitutionalization movement (Shern et al 1989). Further involvement of the States was ensured when a funding mechanism was established that provided block grants directly to States to improve their community-based mental health systems (Surles 1987).…”

A Comparison of Assertive Community Treatment and Intensive Case Management for Patients in Rural Areas

“…Intensive case management involves assertive outreach, assessment of consumer need, and negotiation and coordination of care. In one large-scale implementation started in 1992, the state of New York supported intensive case management with a capitated Medicaid financing strategy (19,20). Since then, intensive case management has been implemented at different sites across the United States, including an adaptation at the Department of Veterans Affairs (21), as well as in Europe (22) and Australia (23).…”