Service delivery in Juneau.

Abstract

of services for the chronic mentally ill who live in Juneau. First, there are the widely recognized problems that seem to plague service delivery throughout the United States. Juneau provides no exception to such issues as the absence of a consistent and predictable policy concerning entitlements for chronic patients. Along with other communities throughout the United States, Juneau suffers from inadequate funding, bureaucratic slowdowns, attitudes both within the mental health community and the community at large that stigmatize the chronic mentally ill, and a widespread lack of understanding of the nature of chronic mental illness and the disabilities that attend it. Second, although these problems are hardly unique to Juneau, they are exacerbated there as in the rest of Alaska (2,3) by other kinds of issues more specifically associated with service delivery in remote or rural areas. Nonmetropolitan areas in the United States are typically burdened by a variety of service difficulties precipitated both by nonsocial factors such as topography and climate and by a multitude of demographic, socioeconomic, cultural, and attitudinal circumstances (4). These service difficulties are manifested in a tax base that is insufficient to support an adequate array of psychiatric and supportive services to chronically dependent individuals, in a general failure to recruit and retain essential professional personnel, and in the confounding of service delivery by a host of unrelated political issues