Impact of recent federal legislation: community mental health services.

Abstract

IN 1963, state mental health directors became involved with the first of several federal programs, introduced at short intervals, designed to initiate a new mental health era in the United States. Each federal program, and I will touch on some but not all, has had considerable impact on state services. Perhaps the impetus came from the monumental work that began with the Mental Health Study Act of 1955, making possible the Joint Commission Monograph Series concluding with Action For Mental Health, The Final Report of the Joint Commission on Mental Illness and Health.1 Many impassioned pleas were made in this report, but major themes seemed to be the need for more funds, manpower, and research focused on the largest segment of the clinical population, those who reside in our nation's state hospitals. The report seemed to stimulate an interest in mental health issues at multiple levels, i.e., the Congress, state legislatures, state mental health program directors and, perhaps most important, the consumer. Shortly thereafter, an NIMH grant program, now referred to as Comprehensive Mental Health Planning, resulted in fairly large grants to the states for a truly concerted effort to study, over a period of two years, state mental health needs with the goal of producing a well organized plan designed to remedy problems and meet needs. For the first time, agency representatives and individuals with many different viewpoints had a mandate to meet together because of a common interest in mental health. In Missouri alone, 500 individuals and representatives from 36 agencies toiled in this great undertaking.2 Similar activities were going on in other states. During the course of Comprehensive Mental Health Planning, two new NIMH programs were launched with the express purpose of uplifting the overall quality of state hospital programs. They were the Hospital Improvement Project (HIP) and Inservice Training (IST). The former grant made possible the development of a program leading to direct and improved benefits to hospitalized patients; the latter was designed to provide a program of inservice training for nursing and attendant personnel. State hospitals, and particu-