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

  • Joseph P. Morrissey
  • Howard H. Goldman
Chapter

Abstract

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.

References

  1. 1.
    Grob, G. N. (1991). From asylum to community: Mental health policy in modern America. Princeton, NJ: Princeton University Press.Google Scholar
  2. 2.
    Morrissey, J. P. (1982). Deinstitutionalizing the mentally ill: Structure, processes, and new directions. In W. Gove (Ed.), Deviance and mental illness. Beverly Hills, CA: Sage.Google Scholar
  3. 3.
    Morrissey, J. P., & Goldman, H. H. (1986). Care and treatment of the mentally ill in the United States: Historical developments and reforms. Annals American Academy of Political and Social Science, 484, 12–27.Google Scholar
  4. 4.
    Mechanic, D., & Rochefort, D. (1990). Deinstitutionalization: An appraisal of reform. Annual Review of Sociology, 16, 301–327.Google Scholar
  5. 5.
    Goldman, H. H., Adams, N. H., & Taube, C. A. (1983). Deinstitutionalization: The data demythologized. Hospital & Community Psychiatry, 34(2), 129–134.Google Scholar
  6. 6.
    Frank, R. G., & Glied, S. (2006). Better but not well: Mental health policy in the United States since 1950. Baltimore: Johns Hopkins University Press.Google Scholar
  7. 7.
    Frank, R. G., Goldman, H. H., & Hogan, M. (2003). Medicaid and mental health: Be careful what you ask for. Health Affairs (Millwood), 22(1), 101–113.Google Scholar
  8. 8.
    Donohue, J. D., & Frank, R. G. (1990). Medicaid behavioral health carve-outs: A new generation of privatization decisions. Harvard Review of Psychiatry, 8, 231–241.Google Scholar
  9. 9.
    Goldman, H. H. (2002). Perspectives: Parity—prelude to a fifth cycle of reform. Journal of Mental Health Policy and Economics, 5(3), 109–113.Google Scholar
  10. 10.
    Goldman, H. H., Taube, C. A., Regier, D. A., & Witkin, M. (1983). The multiple functions of the state mental hospital. American Journal of Psychiatry, 140(3), 296–300.  https://doi.org/10.1176/ajp.140.3.296.Google Scholar
  11. 11.
    Bachrach, L. L. (1978). A conceptual approach to deinstitutionalization. Hospital & Community Psychiatry, 29(9), 573–578.Google Scholar
  12. 12.
    Grob, G. N. (1983). Mental illness and American society, 1875–1940. Princeton, NJ: Princeton University Press.Google Scholar
  13. 13.
    Dain, N. (1980). The chronic mental patient in nineteenth century America. Psychiatric Annals, 10(9), 11–22.Google Scholar
  14. 14.
    Rothman, D. J. (1980). Conscience and convenience: The asylum and its alternatives in progressive America (1st ed.). Boston: Little, Brown.Google Scholar
  15. 15.
    Witkin, M., Atay, J. E., Mandersheid, R. W., DeLozier, J., Male, A., & Gillespe, R. (1998). Highlights of organized mental health services in 1994 and 1955. In R. W. Mandersheid & M. J. Henderson (Eds.), Mental Health, United States, 1998 (Chap. 14, pp. 142–187). Washington, DC: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, Department of Health and Human Services, U.S. Government Printing Office.Google Scholar
  16. 16.
    Bucher, R., & Schatzman, L. (1962). The logic of the state mental hospital. Social Problems, 9(4), 337–349.Google Scholar
  17. 17.
    Grinker, R. R., & Spiegel, J. P. (1945). Men under stress. Philadelphia: Blakiston.Google Scholar
  18. 18.
    Joint Commission on Mental Illness and Health. (1961). Action for mental health. New York: Basic Books.Google Scholar
  19. 19.
    Foley, H., & Sharfstein, S. (1983). Madness and government: Who will care for the mentally ill? Washington, DC: American Psychiatric Press.Google Scholar
  20. 20.
    Grob, G. N. (2004). Deinstitutionalization of the mentally ill: Policy triumph or tragedy? New England Journal of Medicine, 101(12), 19–30.Google Scholar
  21. 21.
    Grob, G. N., & Goldman, H. H. (2006). The dilemma of federal mental health policy: Radical change or incremental reform? New Brunswick, NJ: Rutgers University Press.Google Scholar
  22. 22.
    Hafner, H. (1987). Do we still need beds for psychiatric patients? An analysis of changing patterns of mental health care. Acta Psychiatrica Scandinavica, 75(2), 113–126.Google Scholar
  23. 23.
    Aviram, U., & Segal, S. (1973). Exclusion of the mentally ill: Reflections on an old problem in a new context. Archives of General Psychiatry, 29(1), 126–131.  https://doi.org/10.1001/archpsyc.1973.04200010095016.
  24. 24.
    Warren, C. (1981). New forms of social control: The myth of deinstitutionalization. American Behavioral Scientist, 6, 724–740.Google Scholar
  25. 25.
    Schmidt, L., Reinhardt, A. M., Kane, R. L., & Olsen, D. M. (1977). The mentally ill in nursing homes: New backwards in the community. Archives of General Psychiatry, 34(6), 687–691.  https://doi.org/10.1001/archpsyc.1977.01770180073006.Google Scholar
  26. 26.
    Lamb, H. R. (1979). The new asylums in the community. Archives of General Psychiatry, 36(2), 129–134.Google Scholar
  27. 27.
    Segal, S. P., & Aviram, U. (1978). The mentally ill in community-based sheltered care: A study of community care and social integration. New York: Wiley.Google Scholar
  28. 28.
    Sadish, W., & Bootzkin, R. (1981). Nursing homes and chronic mental patients. Schizophrenia Bulletin, 7, 488–498.Google Scholar
  29. 29.
    Lutterman, T., Shaw, R., Fisher, W., & Manderscheid, R. (2017). Trend in psychiatric inpatient capacity, United States and each state, 1970 to 2014. Alexandria, VA: National Association of State Mental Health Program Directors Research Institute.Google Scholar
  30. 30.
    Regier, D. A., Goldberg, I. D., & Taube, C. A. (1978). The de facto mental health services system: A public health perspective. Archives of General Psychiatry, 35(6), 685–693.  https://doi.org/10.1001/archpsyc.1978.01770300027002.Google Scholar
  31. 31.
    Mechanic, D., McAlpine, D. D., & Olfson, M. (1998). Changing patterns of psychiatric inpatient care in the United States, 1988–1994. Archives of General Psychiatry, 55, 785–791.Google Scholar
  32. 32.
    Lamb, H. R., & Weinberger, L. E. (1998). Persons with severe mental illness in jails and prisons: A review. Psychiatric Services, 49(4), 483–492.  https://doi.org/10.1176/ps.49.4.483.Google Scholar
  33. 33.
    Lamb, H. R., & Weinberger, L. E. (2005). The shift of psychiatric inpatient care from hospitals to jails and prisons. Journal of American Academy of Psychiatry and Law, 33(4), 529–534.Google Scholar
  34. 34.
    Wik, A., Hollen, V., & Fisher, W. H. (2017). Forensic patients in state hospitals, 1999–2016. Alexandria, VA: National Association of State Mental Health Program Directors Research Institute.Google Scholar
  35. 35.
    Mechanic, D. (1991). Strategies for integrating public mental health services. Hospital & Community Psychiatry, 42(8), 797–801.Google Scholar
  36. 36.
    Stein, L. I., & Santos, A. B. (1998). Assertive community treatment of persons with severe mental illness (1st ed.). New York: W. W. Norton.Google Scholar
  37. 37.
    Dieterich, M., Irving, C. B., Park, B., & Marshall, M. (2010). Intensive case management for severe mental illness. Cochrane Database of Systematic Reviews, (10), CD007906.  https://doi.org/10.1002/14651858.cd007906.pub2.
  38. 38.
    Bond, G. R., Drake, R., Mueser, K., & Latimer, E. (2001). Assertive community treatment: Critical ingredients and impact on patients. Disease Management and Health Outcomes, 9(3), 141–159.Google Scholar
  39. 39.
    Drake, R. E., Essock, S. M., Shaner, A., Carey, R. B., Minkoff, K., Kola, L., … Rickards, L. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services, 52(4), 469–476.  https://doi.org/10.1176/appi.ps.52.4.469.
  40. 40.
    Latimer, E. (2005). Economic considerations associated with assertive community treatment and supported employment for people with severe mental illness. Journal of Psychiatry and Neurosciences, 30(5), 355–359.Google Scholar
  41. 41.
    Cusack, K. J., Morrissey, J. P., Cuddeback, G. S., Prins, A., & Williams, D. M. (2010). Criminal justice involvement, behavioral health service use, and costs of forensic assertive community treatment: A randomized trial. Community Mental Health Journal, 46(4), 356–363.  https://doi.org/10.1007/s10597-010-9299-z.Google Scholar
  42. 42.
    Lamberti, J. S., Weisman, R. L., Cerulli, C., Williams, G. C., Jacobowitz, D. B., Mueser, K. T., … Caine, E. D. (2017). A randomized controlled trial of the Rochester forensic assertive community treatment model. Psychiatric Services, 68(10), 1016–1024.  https://doi.org/10.1176/appi.ps.201600329.
  43. 43.
    Meyer, P. S., & Morrissey, J. P. (2007). A comparison of assertive community treatment and intensive case management for patients in rural areas. Psychiatric Services, 58(1), 121–127.  https://doi.org/10.1176/ps.2007.58.1.121.Google Scholar
  44. 44.
    Teague, G. B., Bond, G. R., & Drake, R. E. (1998). Program fidelity in assertive community treatment: Development and use of a measure. American Journal of Orthopsychiatry, 68(2), 216–232.Google Scholar
  45. 45.
    Goldman, H. H., Ganju, V., Drake, R. E., Gorman, P., Hogan, M., Hyde, P. S., & Morgan, O. (2001). Policy implications for implementing evidence-based practices. Psychiatric Services, 52(12), 1591–1597.  https://doi.org/10.1176/appi.ps.52.12.1591.
  46. 46.
    Anthony, W. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabilitation Journal, 16, 11–23.Google Scholar
  47. 47.
    Salyers, M. P., & Tsemberis, S. (2007). Act and recovery: Integrating evidence-based practice and recovery orientation on assertive community treatment teams. Community Mental Health Journal, 43(6), 619–641.  https://doi.org/10.1007/s10597-007-9088-5.Google Scholar
  48. 48.
    Morrissey, J. P., Domino, M. E., & Cuddeback, G. S. (2013). Assessing the effectiveness of recovery-oriented act in reducing state psychiatric hospital use. Psychiatric Services, 64(4), 303–311.  https://doi.org/10.1176/appi.ps.201200095.Google Scholar
  49. 49.
    Shore, M. F., & Cohen, M. D. (1990). The Robert Wood Johnson Foundation program on chronic mental illness: An overview. Hospital & Community Psychiatry, 41(11), 1212–1216.Google Scholar
  50. 50.
    Goldman, H. H., Morrissey, J. P., & Ridgely, M. S. (1990). Form and function of mental health authorities at Robert Wood Johnson Foundation program sites: Preliminary observations. Hospital & Community Psychiatry, 41(11), 1222–1230.Google Scholar
  51. 51.
    Goldman, H. H., Lehman, A. F., Morrissey, J. P., Newman, S. J., Frank, R. G., & Steinwachs, D. M. (1990). Design for the national evaluation of the Robert Wood Johnson Foundation program on chronic mental illness. Hospital & Community Psychiatry, 41(11), 1217–1221.Google Scholar
  52. 52.
    Lehman, A. F., Postrado, L. T., Roth, D., McNary, S. W., & Goldman, H. H. (1994). Continuity of care and client outcomes in the Robert Wood Johnson Foundation program on chronic mental illness. Milbank Quarterly, 72(1), 105–122.Google Scholar
  53. 53.
    Morrissey, J. P., Calloway, M., Bartko, W. T., Ridgely, M. S., Goldman, H. H., & Paulson, R. I. (1994). Local mental health authorities and service system change: Evidence from the Robert Wood Johnson program on chronic mental illness. Milbank Quarterly, 72(1), 49–80.Google Scholar
  54. 54.
    Newman, S., Reschovsky, J., Kaneda, K., & Hendrick, A. (1994). The effects of independent living on persons with chronic mental illness: An assessment of the section 8 certificate program. Milbank Quarterly, 72(1), 171–198.Google Scholar
  55. 55.
    Bickman, L., Lambert, E. W., Andrade, A. R., & Penaloza, R. V. (2000). The Fort Bragg continuum of care for children and adolescents: Mental health outcomes over 5 years. Journal of Consulting and Clinical Psychology, 68(4), 710–716.Google Scholar
  56. 56.
    Randolph, F., Blasinsky, M., Morrissey, J. P., Rosenheck, R. A., Cocozza, J., Goldman, H. H., & Team, A. N. E. (2002). Overview of the access program. Access to community care and effective services and supports. Psychiatric Services, 53(8), 945–948.  https://doi.org/10.1176/appi.ps.53.8.945.
  57. 57.
    Rosenheck, R., Morrissey, J., Lam, J., Calloway, M., Johnsen, M., & Goldman, H. (1998). Service system integration, access to services, and housing outcomes in a program for homeless persons with severe mental illness. Psychiatric Services, 88(11), 1610–1615.Google Scholar
  58. 58.
    Rothbard, A. B., Min, S. Y., Kuno, E., & Wong, Y. L. (2004). Long-term effectiveness of the access program in linking community mental health services to homeless persons with serious mental illness. Journal of Behavioral Health Services Research, 31(4), 441–449.Google Scholar
  59. 59.
    Rosenheck, R., Lam, J., Morrissey, J., Calloway, M., Johnsen, M., & Goldman, H. (2002). Service systems integration and outcomes for mentally ill homeless persons in the access program. Psychiatric Services, 53(8), 958–966.Google Scholar
  60. 60.
    Drake, R. E., Torrey, W. C., & McHugo, G. J. (2003). Strategies for implementing evidence-based practices in routine mental health settings. Evidence-Based Mental Health, 6(1), 6–7.Google Scholar
  61. 61.
    Paley, W. D. (1993). Overview of the HMO movement. Psychiatric Quarterly, 64(1), 5–12.Google Scholar
  62. 62.
    Hoy, E. W., Curtis, R. E., & Rice, T. (1991). Change and growth in managed care. Health Affairs (Millwood), 10(4), 18–36.Google Scholar
  63. 63.
    Frank, R. G., & Garfield, R. L. (2007). Managed behavioral health care carve-outs: Past performance and future prospects. Annual Review of Public Health, 28, 303–320.  https://doi.org/10.1146/annurev.publhealth.28.021406.144029.Google Scholar
  64. 64.
    Frank, R. G., & Lave, J. (2003). Economics. In S. Feldman (Ed.), Managed behavioral health services (Vol. 6, pp. 146–165). Springfield, IL: Charles C. Thomas Publisher.Google Scholar
  65. 65.
    National Institute of Medicine. (2006). Improving the quality of health care for mental and substance-use conditions. Washington, DC: National Academy.Google Scholar
  66. 66.
    Burns, B. J., Scott, J. E., Burke, J. D., & Kessler, L. G. (1983). Mental health training of primary care residents: A review of recent literature (1974–1981). General Hospital Psychiatry, 5(3), 157–169.Google Scholar
  67. 67.
    Wagner, E., Austin, B., & Von Korff, M. (1996). Organizing care for patients with chronic illness. Milbank Quarterly, 74, 511–544.Google Scholar
  68. 68.
    Wagner, E. H. (1998). Chronic disease management: What will it take to improve care for chronic illness? Effective Clinical Practice, 1(1), 2–4.Google Scholar
  69. 69.
    Unutzer, J., & Park, M. (2012). Strategies to improve the management of depression in primary care. Primary Care, 39(2), 415–431.  https://doi.org/10.1016/j.pop.2012.03.010.Google Scholar
  70. 70.
    Unutzer, J., Katon, W., Callahan, C. M., Williams, J. W., Hunkeler, E., Harpole, L., … & IMPACT Investigators. (2002). Collaborative care management of late-life depression in the primary care setting: A randomized controlled trial. Journal of the American Medical Association, 288(22), 2836–2845.Google Scholar
  71. 71.
    Goodrich, D. E., Kilbourne, A. M., Nord, K. M., & Bauer, M. S. (2013). Mental health collaborative care and its role in primary care settings. Current Psychiatry Reports, 15(8), 383.  https://doi.org/10.1007/s11920-013-0383-2.Google Scholar
  72. 72.
    Rittenhouse, D. R., & Shortell, S. M. (2009). The patient-centered medical home: Will it stand the test of health reform? Journal of the American Medical Association, 301(19), 2038–2040.  https://doi.org/10.1001/jama.2009.691.Google Scholar
  73. 73.
    Druss, B. G., Zhao, L., Von Esenwein, S., Morrato, E. H., & Marcus, S. C. (2011). Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative U.S. survey. Medical Care, 49(6), 599–604.  https://doi.org/10.1097/mlr.0b013e31820bf86e.
  74. 74.
    Meltzer, H. Y. (2001). Treatment of suicide in schizophrenia. Annals of the New York Academy of Sciences, 932(1), 44–60.  https://doi.org/10.1111/j.1749-6632.2001.tb05797.x.Google Scholar
  75. 75.
    Palmer, B. A., Pankratz, V. S., & Bistwick, J. M. (2005). The lifetime risk of suicide in schizophrenia: A reexamination. Archives of General Psychiatry, 62(3), 247–253.Google Scholar
  76. 76.
    Colton, C., & Manderscheid, R. (2006). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease, 3(2), 1–14.Google Scholar
  77. 77.
    Domino, M. E., Wells, R., & Morrissey, J. P. (2015). Serving persons with severe mental illness in primary care-based medical homes. Psychiatric Services, 66(5), 477–483.Google Scholar
  78. 78.
    Domino, M. E., Kilany, M., Wells, R., & Morrissey, J. P. (2017). Through the looking glass: Estimating effects of medical homes for people with severe mental illness. Health Services Research, 52(5), 1858–1880.  https://doi.org/10.1111/1475-6773.12585.Google Scholar
  79. 79.
    Lichstein, J. C., Domino, M. E., Beadles, C. A., Ellis, A. R., Farley, J. F., Morrissey, J. P., … Jackson, C. T. (2014). Use of medical homes by patients with comorbid physical and severe mental illness. Medical Care, 52(Suppl. 3), S85–S91.  https://doi.org/10.1097/mlr.0000000000000025.
  80. 80.
    Domino, M. E., Jackson, C., Beadles, C. A., Lichstein, J. C., Ellis, A. R., Farley, J. F., … DuBard, C. A. (2016). Do primary care medical homes facilitate care transitions after psychiatric discharge for patients with multiple chronic conditions? General Hospital Psychiatry, 39, 59–65.  https://doi.org/10.1016/j.genhosppsych.2015.11.002.
  81. 81.
    Oleisuk, W. J., Farley, J. F., Domino, M. E., Ellis, A. R., & Morrissey, J. P. (2017). Do medical homes offer improved diabetes care for Medicaid enrollees with co-occurring schizophrenia? Journal of Health Care for the Poor and Underserved, 68(11), 1197–1200.  https://doi.org/10.1353/hpu.2017.0094.Google Scholar
  82. 82.
    Grove, L. R., Olesiuk, W. J., Ellis, A. R., Lichstein, J. C., DuBard, C. A., Farley, J. F., … Domino, M. E. (2017). Evaluating the potential for primary care to serve as a mental health home for people with schizophrenia. General Hospital Psychiatry, 47, 14–19.  https://doi.org/10.1016/j.genhosppsych.2017.03.002.
  83. 83.
    Alakeson, V., Frank, R. G., & Katz, R. E. (2010). Specialty care medical homes for people with severe, persistent mental disorders. Health Affairs (Millwood), 29(5), 867–873.  https://doi.org/10.1377/hlthaff.2010.0080.Google Scholar
  84. 84.
    Scharf, D. M., Eberhart, N. K., Schmidt, N., Vaughan, C. A., Dutta, T., Pincus, H. A., & Burnam, M. A. (2013). Integrating primary care into community behavioral health settings: Programs and early implementation experiences. Psychiatric Services, 64(7), 660–665.  https://doi.org/10.1176/appi.ps.201200269.
  85. 85.
    Krupski, A., West, I. I., Scharf, D. M., Hopfenbeck, J., Andrus, G., Joesch, J. M., & Snowden, M. (2016). Integrating primary care into community mental health centers: Impact on utilization and costs of health care. Psychiatric Services, 67(11), 1233–1239.  https://doi.org/10.1176/appi.ps.201500424.
  86. 86.
    Druss, B. G., von Esenwein, S. A., Glick, G. E., Deubler, E., Lally, C., Ward, M. C., & Rask, K. J. (2017). Randomized trial of an integrated behavioral health home: The health outcomes management and evaluation (home) study. American Journal of Psychiatry, 174(3), 246–255.  https://doi.org/10.1176/appi.ajp.2016.16050507.
  87. 87.
    Kathol, R. G., deGray, F., & Rollman, B. L. (2014). Value-based financially sustainable behavioral health components in patient-centered medical homes. Annals of Family Medicine, 12(2), 172–175.  https://doi.org/10.1370/afm.1619.Google Scholar

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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