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Promise, Progress, and Pain
The purpose of the
study is to show the enormous power of the federal government to
influence social movements.
This is demonstrated by the extraordinarly skillful use of
information by senior officials in the National Institute of
Mental Health and the Department of Health, Education and
Welfare regarding the potential in the 1960s of new medications
and community mental health centers.
They sold the idea that through the combination of
medications and community mental health centers, adequate care
would be available for virtually all mentally ill persons
although there was not clear evidence to support that view.
The study reveals defects in federal and state government action
related to services for people with serious mental illness along
with government flaws concerning financing the community mental
health centers, and inadequate planning and evaluation of the
centers program. The
paper deals with those issues in some detail.
But the study also covers the mental health movement’s important
achievements. As one
interviewee for the case study commented, “The community mental
health movement is a plus in my opinion.
I do think, however, that after the AIDS epidemic, the
biggest public health problem we have in this country is the
individuals who are mentally ill in jail and on the streets.
That is, in part, maybe in large part, a side effect of
the progress we’ve made.
But if we had stayed in the culture and mode of the 30s,
40s, and 50s, we would have 2000 mental hospitals in this
country with two million beds.
That would have been unconscionable.”
Another interviewee commented, “The community care movement was
probably the most important and dramatic thing that occurred in
the history of treatment of mental illness.
So for all of the problems associated with it, we
shouldn’t lose sight of how much the shake up, with all its
attendant manifestations, really meant to the place we are today
… still not good, but so much better than what had existed
before.”
Most social movements don’t achieve all of their initial goals
and the mental health movement was no exception.
Even with its flaws, however, it accomplished major
social change in the mental health arena, while leaving
important unfinished business.
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