Significant changes in mental health: 1972?1992

Abstract

In September 1974, I first entered the field of mental health. My previous experience was in education and disabilities at a university. I was recruited by the State of North Carolina to work on and eventually to direct a state mental health study commiss iona commission that is still active today. The commission's charge was to review and support changes in state law and management, as well as to plan model community mental health programs in an effort to promote the development of comprehensive community based services. Over the next 18 years, I accepted other assignments in Vermont, Pennsylvania and New York-always toward this same g o a l enhancement of community based services, especially to high-risk groups and those with more severe forms of mental illnesses. The first national meeting I attended as a state official was with the National Association of State Mental Health Program Directors in the fall of 1974. At that time, a majority of the state directors were psychiatrists. Non-physician commissioners tended to have had long tenure in state service and were generally clinically trained and administratively self-educated. While most states were beginning to develop plans to promote community mental health centers (CMHCs), the vast majority of state expenditures was still devoted to state hospitals. Generally, the role of the state was to manage state operations and to be cooperative in promoting entrepreneurial efforts to acquire federal