Community Care & the Mental Health Act

The National Mental Health Act, signed in 1946, signaled the beginning of a mental health reform plan that applies federal resources to state-based programming. The act authorized the use of federal funds for mental health services, launched a science-based approach to mental health services and led to a national focus on the needs of the mentally ill. The act led to subsequent research and legislation that promoted community care over institutionalization.

History

• Prior to the Mental Health Act, the mentally ill faced stigma and institutionalization. Community-based services were few and provided mostly by private or nonprofit organizations. Mental health care reformers re-evaluated the use of institutionalization for any but the most severely ill and in 1963, as a direct result of the Mental Health Act and the studies that followed, Congress passed the Mental Retardation Facilities and Community Mental Health Centers Construction Act (P.L. 88-164).

Significance

• The Mental Retardation Facilities and Community Mental Health Centers Construction Act authorized funding to help states transition to more effective and humane methods of care, including construction of community care centers. Community care, a research-based practice of providing comprehensive mental health services at community centers, contributes to community inclusion, independence and improved functioning for the developmentally disabled and the mentally ill. Federally funded community mental health centers were required to provide services such as diagnosis, treatment, education and sheltered workshops.

Benefits

• In 1965, the Mental Retardation Facilities and Community Mental Health Centers Construction Act was amended to authorize the use of federal funds for mental health services. The act provided funds for the construction of community mental health centers throughout the country and provided grants to federally-funded centers for payment of salaries. Federally-funded centers were required to provide outpatient and inpatient care, partial hospitalization, 24-hour emergency care and education and other supports for community caretakers.

Effects

• In spite of setbacks, such as the 1981 legislation limiting the federal role to technical assistance and block grants, the national mental health care reform effort that began with the 1946 Mental Health Act continues its focus on community care as the most effective method of service delivery for the mentally ill and their families. Mental health reformers continue to promote community care as the preferred alternative to institutionalization.

Legacy

• Mental health reform efforts experienced yet another renewal of effort with the 2002 New Freedom Commission on Mental Health, charged with revitalizing the development of community care programs. The 2005 Federal Action Agenda required federally-funded community health centers to coordinate mental health care with community mental health care centers by providing diagnostic, treatment and referral services.