Community Mental Health Act of 1963

Community Mental Health Act of 1963

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Community Mental Health Act of 1963

 

  1. What is the formal name of the social policy and what is its official purpose, according to the agency responsible for its administration?

The social policy was the Community Mental Health Act of 1963 that was initiated by John F Kennedy; it was a large-scale transfer of mentally ill patients from psychiatric institutions to community mental health centers. It was the first direct intervention strategy by the federal government in the national healthcare. The mandate has since shifted to local and state governments who have failed in surviving the social policy.

It was characterized by three primary elements. Firstly, the institutionalized patients were brought closer to the community. Secondly, the community health infrastructure was to be expanded to accommodate the expected influx of patients and to increase the capacity of the facilities provide adequate care, support and treatment for these individuals. Thirdly, there was a deliberate evasion of the traditional institutionalization owing to their deplorable conditions. The social policy aspired to integrate this disenfranchised group into the mainstream community (Yeager, Cutler, Svendsen, & Sills, 2013). It hoped to facilitate their potential to realize they right to interact and coexist harmoniously with their fellow citizens. Though it had its pitfalls, it effects the act were enduring in the US equally transcending the national boundary. It currently informs the mental health policies of majority of the world’s countries. For example, the psychiatry reform movement in Europe and deinstitutionalization in India


  1. Provide a historical context to explain why this social policy was introduced and, if it has been modified since then, summarize how it has changed over that time period, emphasizing current provisions.

The policy was birthed following the charismatic president JF Kennedy’s revelation on the need to enhance care of the mentally ill in society. This came after he had a family tragedy along the same lines. Due to lack of efficient medicine to treat mental illnesses, her sister was lobotomized, psychosurgery, with dire repercussions. Subsequently, she would have been condemned to institutionalization for the rest of her life. Her family took her to a nursing home following their belief in personalized care. Her verbal communication regressed to mumbling as she stared to the walls of their house (Sisti, Segal, & Emanuel, 2015). The said personal misfortune helped Kennedy to have the resolve to champion for the rights of these disadvantaged. JFK posited that rather than isolate these members of the population, the community should step up and be at the forefront in help to facilitate a semblance of normalcy. To him, the community had an innate curative property that would help the said mentally retarded have less pronounced symptoms even attain full recoveries. He said that it was not only a health issue but it was a problem intertwined into the socioeconomic fabric. The urgency of the said problem could not allow it to be ignored or postponed a solution had to provided. The mandate was thrust into the public domain. Kennedy during his term promulgated the Maternal and Child Health and Retardation Planning Amendment to the social security, a milestone towards his vocal objectives to salvage the neglected populace.

In support of this venture, he gave funding to the states to build corresponding infrastructure that would accommodate and care for mentally retarded individuals. However, the pre-existing state mental hospitals that formally institutionalized these disenfranchised groups en masse were denied funding. The JFK administration believed that these hospitals were bound to utilize the funds in contravention of the set parameters. Furthermore, it was the administration intent to end the dark era of institutional confinement.  JFK had sought his presidential bid under the slogan of fighting for the marginalized groups through direct federal intervention with the objective of poverty eradication. Mental health was in accord with his campaign rhetoric. The President’s interagency task Force on mental health was established by JFK in 19621. Headed by NIH leadership working in concert with the premier economists from both the Council of economic advisors and the Bureau of the budget they decided to give the funds for the mental ill directly to communities. There was an inherent distrust by the administration towards the state governments during this Civil War Era. The reason being they had been numerous instances of resistance to implement federal welfare programs and contravention o other laws with impunity.

To reaffirm his commitment on the journey embarked on, JFK signed into law the seminal policy on mental health of the decade. This was the mental retardation facilities and Community Mental Health Centers Construction Act of 1963(CMHCA). JFK was assassinated a month afterwards. Attached to his last legislative act was the message that relayed what he hoped the act would achieve. The message highlighted the large number of the mentally sick individuals and the corresponding costs incurred when caring for them. Similarly, he pointed out the brutal experiences these people were subjected to in state hospitals due to neglect and their violation of fundamental human rights.  Concomitantly he shared his optimism on the discovery of effective therapeutic techniques and medicine. He stressed the importance of the community in managing the individual’s conditions from becoming severe. Health practices were advised to treat their patients as humans first. He proposed prevention as an equal strategy to treatment.

  1. What does the social policy provide? Identify and describe the benefits of the social policy (i.e., cash grants, vouchers, concrete goods, etc.), funding sources, administrative structure and other details that trace the policy’s components from its source to the hands of its recipients.

The CMHCA championed a more individual centered and community oriented approach towards mental health care. It harnessed both the competencies of the public health and proven medical models. The act’s implementation began by the issuance a national mandate on the deinstitutionalization. Among the envisioned benefits of the act was the establishment of 2000 community centers nationwide sealing the fate of the failed institutionalization model. The hospitals would be freed up to take up different health cases (Short, Thomas, Luebbers, Mullen, & Ogloff, 2013).  It follows that it suggested the reduction of the mentally ill who were in asylums and other long-term custodial hospitalization by a half. The act facilitated the release of federal funds to states to undertake the construction of the proposed community mental health facilities. The size of the resource allocation was proportional to a particular state’s need and populace density. Upon completion, an amount was set aside to cater for the remuneration of staff.

The law was instrumental in softening the public stance on mental retardation. The populace felt that these illnesses were curable lessening the isolation of the said disenfranchised group. The shaping of public opinion is a benefit that is often overlooked. Another reason for the change in attitude was the publication of findings that showed there is an increased prevalence of mental illnesses in the mainstream culture. This meant everyone was susceptible to the condition. The said above action had an enduring effect that transcended the decline of the Act. These landmark changes ran concurrent with the introduction of Medicare and Medicaid that all aspired to provide healthcare to the diseased but financially disadvantaged. The services were more diverse, there were out patient as well as the traditional inpatient services and proposed follow up efforts to synchronize the two medical strategies. The five core elements of the act was access of outpatient and the traditional inpatient services, doctor consultation typical to normal medical practices, partial hospitalization, and a provision for emergency intervention.

  1. Who is directly affected by this social policy? Be specific and identify recipient populations, including demographic and socioeconomic characteristics of each subgroup.

Unlike its more institutionalized predecessor the community mental health centers served a wider array of patients. The previous target demographic was limited to patients who had chronic mental illnesses. This enhanced method would accomodate individuals with a milder version of a mental illness that prior was seen as not severe enough to warrant hospitalization. These decentralized and more heterogeneous facilities, strived to serve the ill in the community who could not cater for the expenses of their own (Rosenberg & Rosenberg, 2013). With reduction in funding, there was a redirection of resources to the original target group, priority populations. This population constituted of emotionally unstable children or adolescents with chronic disturbances or life threatening social disabilities demanding prolonged intervention and adults with severe mental illnesses, intense psychosis episodes. Still the administrations of the community centers cross subsidized the services of those without the priority categories using the available funds. This was aimed to maintain the affordability aspect of that was synonymous with them during the height of the mental illness initiative. Even the distinction between care provision and treatment was corrupted. Though overtly professing care as they guiding principle they concentrated provision of therapeutic treatment. The human and social needs of the patient that constitute care were often overlooked.
5. Assess the effectiveness of this social policy (using academic, peer-reviewed journal articles as well as other sources). If evidence-based policy research has been conducted, make sure to include it here.

The Acts strategy of decentralizing health services and its accompanying deinstitutionalizing policies in the long term proved to be impulsive and unsustainable. It was ideal on paper but had several shortcomings in practice. The coerced abandonment of existing infrastructure in the state hospitals in favor of building new community facilities lacked foresight. In retrospect, JFK’s decision to isolate the state and all their facilities was an emotional one. Though the individualized focus proposed by the commission was ground breaking, it overlooked the population that would require long-term institutionalization. With a change of administration in the said facilities, their usefulness in accommodating the mentally ill would have been restored.

Furthermore, the effectiveness of the social policy was depended on the funding the socioeconomic undertaking would collect. Under President Ronald Reagan all the major welfare legislation enacted within 18 years to his assumption of office were rescinded. This regression was marked by the enactment of the Omnibus Budget Reconciliation Act of 1981. The federal government was no longer involved in the direct finances of the community health centers. The power to allocate resources to health facilities was reverted to the respective states. As the states were neither the brainchild of the project nor stakeholders of the social revolution, they gave other welfare projects precedence over the centers (Procter, Baker, Grocke, & Ferguson, 2013). The federal government would occasionally give block grants to the state government but they did not interfere with their mandate to chose who or which institution was worthy of their funding. Without the state resources, the mentally ill were condemned to the streets with more horrid conditions than the worst state hospital could offer. Correspondingly, the underpaid staff in these community mental health centers moved to work in the private sector.  Having emotionally unstable individuals on the streets unsupervised led to an increase in violent episodes. Subsequently the rise in assaults pointed to these former patients leading them to jail. The US incarceration system acts as a surrogate psychiatry hospital with severely psychotic residents. Those patients who lacked relatives or caring friends to placed with became victims of the social ostracism the act initially aiming to avoid. The failure of the policy can also be attributed to the involved psychiatrists who did not evaluate the credibility of the program in its entirety leaving it at the mercy of politicians. They appeared to be blinded by wishful thinking thus did not enact an alternative strategy. Their ideological standpoint upon which the entire program was founded was not backed up empirical evidence.
6. Identify and assess how this policy affected economic and social justice considerations for the recipient population(s) and other stakeholders in the US.

The priority population that left the psychiatric institutions to come to the community often was condemned to homelessness after the diversion of the federal funds to other projects. Majority had no alternative shelter whereas the rest were neglected by their familial relations, they avoided the costly responsibility. The mental state of the patients made recalling the relations a challenge. Unless the relatives initiated the interaction the individual’s fate was sealed.  After the collapse of the community health centers, majority of the health practitioners became jobless. Apart from shelter the patients lacked all other basic needs (Gilmore & Sillince, 2014).  The social exclusion frustrated any effort by the said mentally ill persons to escape poverty. Some acting out of desperation engaged in criminal undertakings ending up in prison. The increase in severity of the disease without lack of treatment to neutralize it led to death of many patients. The reduced funds by the state working in concert with an increase in inflation led to stagnation on ongoing construction projects. The rise of mentally unstable inmates transferred the cost owed to halted funding back to the federal government. The stigma that accompanies mental illnesses condemned the socially awkward individuals to isolation. Without a support system, any semblance of sanity attempted by the said individuals could not be achieved. Nonetheless, the policy had initiated a crucial debate in the public domain. The subsequent administration had invested substantial economic resources on researching mind with insightful findings.
7. Discuss what the social work profession’s ethical mandates suggest should be done to improve this social policy.

In order to establish the ethical mandates of the profession in relation to the mental health care one must first identify the underlying values of the same. The perspective of the stakeholders of the policy on the issue is equally important. Maintenance of proportionality dictates the justification of the choices made. There has to be a balance between values violated and those promoted with a commensurate reason for the former (Dear & Wolch, 2014). Ethical compliance implies a respectful relationship between the client and caregiver that translates to effectiveness in both quarters.  Among the greatest dilemmas presented by the repercussions of the social policy is the facilitating the mentally ill to utilize opportunities available to them amidst social exclusion. De-institutionalization has failed in placing the patients on an equal level with rest of society.  The community tolerates rather than embraces these special members.

The family relations have a moral mandate to look after their kin taking up to 80% of the cost of care. The dilemma occurs when the needs of the latter inhibit the former from satisfying their own. There is also lack of controls to prevent the invalid from being institutionalized within the family. Professionals doubt their mandate to facilitate transition from the health facilities into the mainstream community (Drake, 2013). The reluctance can be attributed to their knowledge of the impediments awaiting them in their bid to integrate themselves, ranging from emotional and financial constraints to barriers enacted by the community. The patient’s autonomy is not practical as the choices of community care are limited and the professionals often override it to protect the individual. Similarly, the patient may be reluctant to embrace independence due to complacency. He may be forced into the society before he is mentally prepared for the practical challenges he will face. Conversely, the mentally ill person may want to enter society before he is stable enough to interact with people. The professional will have to use coercion to make him stay. The conundrum demands that the health or social practitioner to choose between protecting society from a potentially dangerous individual or infringe of the person’s liberty; equilibrium has to be struck between freedom and inviolability (Mowbray, Grazier, & Holter, 2014). Though the fundamental values that define social interactions are equal, at special occasions others take precedence over the rest.  The deinstitutionalization process aimed to stop involuntary admission. However, it is still a common practice, the end justifying the means. Operating in a system with insufficient funds the conflict between ethical mandates and economical interests is pronounced.

Professionalism dictates provision of highest quality treatment for their individual patients on the other hand the needs of equally deserving patients have to be put into consideration.  A compromise of quality standards in this instance is understandable. Furthermore, the practitioner has to consider the financial remuneration as it is his livelihood. Upholding the highest ethical standards becomes a challenge when there are insufficient resources (Csipke et al, 2014). Otherwise, a person will have endured personal sacrifices to uphold them. Another dilemma arises in the provision of accommodation of people with mental illnesses. Provision of care in the community entails ensuring the individual has access to the basic needs of life key among them shelter. The residents have a right to peaceful conditions devoid of interruptions associated with violent episodes the patients may experience. In the same line, the neighbors have a mandate to respect the confidentiality and privacy of people with mental challenges. The community that ought to facilitate the integration of said patients often isolates peoples with social handicap. Communities are vocal on the injustice of putting mentally ill persons behind bars yet they sabotage efforts to construct halfway houses for the same victims of impartiality in their neighborhoods. It is an innate paradox that patients that show recovery are the only ones that benefit from care innovations and that community mental health facilities lack provisions to cope with chronic patients.

  1. Identify how this policy can be modified to improve its impact and better reach the goals of the social work profession.

Adoption of evidence-based practices is essential to prevent repeating the previous mistake of adopting an unsustainable social policy. Though delegating the management of the mental health institution to states is ideal, the government should push the congress to enact laws that clearly demarcate the criteria for admission into the said facilities to avoid bias (Adair et al, 2014). Moreover, where the government has seen that a particular state is negligent they may seek alternative partners. There are efficient non-governmental organizations with a proven record of organization skills as pertaining to dealing with dynamics present in disenfranchised groups. The said organizations have their separate revenue streams to fund their projects all they require is unrestricted aces to said patients.

During the age of the brain, the government involvement in research resulted in profound discoveries in the scientific world. The federal government can aspire to replicate the same feat and use the resultant proceeds to increase grants to help resurrect the community mental health centers (Corrigan & Gelb, 2014). The concept was benign and can be effective if properly implemented. As it has been established that genetics can predict the vulnerability of individuals, family based treatments that concentrate on prevention rather than waiting for the illness to advance are recommended. The policy can be revived to help in relocating mentally ill individuals from jails to supervised accommodations. The government can utilize the America’s Law Enforcement and Mental Heath Act (H.R. 2594), to establish mental health courts to divert nonviolent mentally ill offenders from going to prison. In these areas there bound to be taught coping and other work skills that will return them to optimal functionality. Majority of the afflicted do not suffer one disease only as such the treatment centre should ensure that the various treatments are synchronized with other medication the patient is using.

Finishing social exclusion is achievable by enacting public awareness campaigns meant to educate the masses about the plight of the mentally retarded eventually reduce stigma. The conversation can be spread through the entertainment industry leveraging on artists abilities to shape values. This will facilitate early treatment, as people will not fear discrimination. Increasing the quality of mental health correlates to the availability of professional health care providers. The job conditions should be made more attractive to prevent poaching by the private sector. A legislation that will equate the comprehensiveness of health insurance covers of mental illness with other physical illnesses ought to be proposed. The current federal mental health parity law posits that an individual can get coverage without a health plan. The judicial system can give rulings that protect the rights of mentally ill patients (Adair et al, 2014). Consequently, the set precedence will prevent a person seeking treatment from being terminated while he is still capable of fulfilling his job requirements. Assertive community treatment will prevent the straining the limited resources of the functioning mental hospitals by high rates of readmission. The said treatment consists of an interdisciplinary team constituting of a psychiatrist, a social worker, a psychologist, a nurse and a case manager who concert the efforts and resources in following up with patients recovery. They establish close and consistent relationships with the said individual providing him with an effective support system when he is in need and backing away when the patient improves to prevent excessive dependency.

 

References

Adair, C. E., McDougall, G. M., Beckie, A., Joyce, A., Mitton, C., Wild, C. T., … & Costigan, N. (2014). History and measurement of continuity of care in mental health services and evidence of its role in outcomes. Psychiatric Services.

Corrigan, P., & Gelb, B. (2014). Three programs that use mass approaches to challenge the stigma of mental illness. Psychiatric Services.

Csipke, E., Flach, C., McCrone, P., Rose, D., Tilley, J., Wykes, T., & Craig, T. (2014). Inpatient care 50 years after the process of deinstitutionalisation. Social psychiatry and psychiatric epidemiology, 49(4), 665-671.

Dear, M. J., & Wolch, J. R. (2014). Landscapes of despair: From deinstitutionalization to homelessness. Princeton University Press.

Drake, G. (2013). The ethical and methodological challenges of social work research with participants who fear retribution: To ‘do no harm’. Qualitative Social Work, 1473325012473499.

Gilmore, S., & Sillince, J. (2014). Institutional theory and change: the deinstitutionalisation of sports science at Club X. Journal of Organizational Change Management, 27(2), 314-330.

Mowbray, C. T., Grazier, K. L., & Holter, M. (2014). Managed behavioral health care in the public sector: Will it become the third shame of the states?. Psychiatric Services.

Procter, N., Baker, A., Grocke, K., & Ferguson, M. (2013). Introduction to mental health and mental illness: Human connectedness and the collaborative consumer narrative (Doctoral dissertation, Cambridge University Press).

Rosenberg, J., & Rosenberg, S. (Eds.). (2013). Community mental health: Challenges for the 21st century. Routledge.

Short, T. B., Thomas, S., Luebbers, S., Mullen, P., & Ogloff, J. R. (2013). A case-linkage study of crime victimisation in schizophrenia-spectrum disorders over a period of deinstitutionalisation. BMC psychiatry, 13(1), 66.

Sisti, D. A., Segal, A. G., & Emanuel, E. J. (2015). Improving long-term psychiatric care: bring back the asylum. JAMA, 313(3), 243-244.

Yeager, K., Cutler, D., Svendsen, D., & Sills, G. M. (Eds.). (2013). Modern community mental health: An interdisciplinary approach. Oxford University Press.

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