Division of Labor: Function Shifts and Realigned Responsibilities in the Evolving Mental Health Services System

  • Joseph P. Morrissey
  • Howard H. Goldman


The past several decades have witnessed tumultuous changes in the delivery of public mental health services in the United States. These changes resulted more from policy developments in the health and social welfare sectors than from the mental health services sector itself, notably the passage of Medicare and Medicaid legislation and expanded Social Security benefits. In the process, functions in the custody, treatment, and social control areas once served mostly by state mental hospitals were transferred to agencies outside the direct control of state mental health authorities. The resultant mental health services landscape expanded enormously but without central or coherent policy direction. Efforts to overcome the resulting fragmentation focused on a variety of clinical, management, and funding initiatives including renewed efforts to integrate primary care and behavioral health. Current evidence supports primary care integration for depression and other common mental disorders. However, specialty-based behavioral health services still appear optimal for persons with severe mental illness; whatever advances in psychiatric treatments might occur in future years, social welfare policies and supports will continue to shape their life chances and well-being.


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Copyright information

© The Author(s) 2020

Authors and Affiliations

  • Joseph P. Morrissey
    • 1
  • Howard H. Goldman
    • 2
  1. 1.Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.University of Maryland School of MedicineBaltimoreUSA

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