Community care of the seriously mentally ill: Continuing problems and current issues

Abstract

The crisis in community care for the seriously mentally ill (SMI) stems from organizational and financial difficulties as well as from deeply embedded structural factors. The analysis shows a preference for medicalizing and individualizing the problems of SMI rather than viewing them as structural social welfare issues. The author discusses problems of deinstitutionalization, homelessness, service provisions, financing, accounting and reporting, employment, bureaucratic skimming and burden to families and points out the ambivalent ideology and the inherent contradictions within the mental health service system. Finally, the centrality of social control and the maintenance of orderly social life in public policy and program development is illuminated.

On the move: Incarceration, race, and residential mobility

“…Financial struggles following incarceration (Lyons and Pettit, 2011;Western, 2002) put ex-inmates at a further disadvantage in the private housing market (Petersilia, 2003). Marginalized and disadvantaged sub-groups are known to have higher-than-expected rates of mobility (Aviram, 1990;Dear and Wolch, 1987;Rossi, 1989). Economically marginal groups are also more vulnerable to push factors such as rent increases, evictions, and building closures (Fischer, 2002;Lee, 1978).…”

Health care reform and rural mental health: Severe mental illness

“…The current rural mental health service system is described as fragmented, costly, and ineffective (Aviram, 1990;Bachrach, 1983;Carter, 1986;Human & Wasem, 1991;Leighton, 1990). Poverty, limited economic opportunities, inadequate transportation, communications infrastructure, and housing, limit the ability of rural mental health service systems to provide comprehensive services.…”

Homeless Shelter Users in the Postdeinstitutionalization Era

“…These findings suggest that homeless populations would benefit from the implementation of innovative programs designed to meet their special mental health needs-particularly programs designed to engage them in appropriate mental health service networks. The literature shows that the most assertive and potentially beneficial programs will: 1) be located in nontraditional settings such as shelters and other locations where homeless people congregate; 2) strive to successfully engage potentially fearful or hostile clients who have shunned mainstream service networks; 3) resolve immediate housing and survival needs; 4) link homeless persons with mental illness to existing community mental health delivery networks; 5) overcome clients' rootlessness and mobility by providing intensive follow-up across shelters and even across geographically defined catchment areas; and 6) where pos-"Control sample n = 66; for case group I. n = 106; for case group 2. n 0 66 sible and appropriate, reunite them with families who may have been searching for their lost relatives (8)(9)(10)(11)(12)14,(24)(25).…”