Community mental health Health Article

Definition

Community mental health is a decentralized pattern of mental health, mental health care, or other services for people with mental illnesses. Community-based care is designed to supplement and decrease the need for more costly inpatient mental health care delivered in hospitals. Community mental health care may be more accessible and responsive to local needs because it is based in a variety of community settings rather than aggregating and isolating patients and patient care in central hospitals. Community mental health assessment, which has grown into a science called psychiatric epidemiology, is a field of research measuring rates of mental disorder upon which mental health care systems can be developed and evaluated.

Community mental health centers

In the United States, a modern increase in community mental health care delivery began in the 1960s when President John F. Kennedy signed the 1963 Community Mental Health Centers (CMHC) Act (Public Law #88-164). Growing community mental health capacities were intended to complement and mirror trends toward fewer hospital stays and shorter visits for mental illness (see Deinstitutionalization). This restructuring of mental health service delivery has occurred in the context of evolving fiscal responsibilities, however. The goals and practices of community mental health have been complicated and revised by economic and political changes.

The National Institute of Mental Health (NIMH) initially developed a CMHC program in the 1960s. CMHCs were designed to provide comprehensive services for people with mental illness, locate these services closer to home, and provide an umbrella of integrated services for a catchment area of 125,000-250,000 people. CMHCs were designed to provide prevention, early treatment, and continuity of care in communities, promoting social integration of people with mental health needs.

Competing public interests

At the outset, CMHCs were providing outpatient care to people with less severe, episodic, or acute mental health problems. In the 1980s, more people with serious mental illness began using CMHCs, due in part to deinstitutionalization, and following the redirection and capping of federal funds for local mental health care. With growing awareness of the homeless mentally ill, state-funded CMHCs faced new challenges, and their work became fragmented according to catchment areas of responsibility, leaving some urban centers overburdened, while others maintained locally funded operations, limiting responsibility for their area only.

The growth of local community mental health centers was an example of competing governmental interests and authorities. Growing numbers of CMHCs were mandated federally and to be funded by local communities, bypassing state control. This growth in outpatient capacity was later used to complement decreases in inpatient hospital care, or deinstitutionalization, which reduced the costs of diminishing and state-funded mental hospitals.