After deinstitutionalization, the 2,000 community
mental health centers (CMHCs) that were supposed
to be built by 1980 had not materialized. By 1990,
only 1,300 programs provided various types of psychosocial
rehabilitation services. Persons with severe
and persistent mental illness were either ignored or
underserved by the CMHCs (International Association
of Psychosocial Rehabilitation Services, 1990).
This meant that many people needing services were,
and still are, in the general population with their
needs unmet.
Community support services programs were developed
to meet the needs of persons with mental
illness outside the walls of an institution. These programs
focus on rehabilitation, vocational needs, education,
and socialization, as well as management of
symptoms and medication. These services are funded
by states (or counties) and some private agencies.
Therefore the availability and quality of services
vary among different areas of the country. For example,
rural areas may have limited funds to provide
mental health services and smaller numbers of people
needing them. Large metropolitan areas, while having
larger budgets, also have thousands of people in need
of service. Rarely is there enough money to provide
all the services needed by the population. Chapter 4
provides a detailed discussion of community-based
programs.
Unfortunately the community-based system did
not accurately anticipate the extent of the needs of
people with severe and persistent mental illness.
Many clients do not have the skills needed to live independently
in the community, and teaching these
skills is often time-consuming and labor-intensive,
requiring a one-to-one staff-client ratio. In addition,
the nature of some mental illnesses makes learning
these skills more difficult. For example, a client who is
hallucinating, or “hearing voices,” can have difficulty
listening to or comprehending instructions. Other
clients experience drastic shifts in mood, being unable
to get out of bed one day, then unable to concentrate
or pay attention a few days later.
Despite the flaws in the system, community-based
programs have positive aspects that make them preferable for treating many people with mental illness.
Clients can remain in their communities, maintain
contact with family and friends, and enjoy personal
freedom that is not possible in an institution.
People in institutions often lose motivation and hope
as well as functional daily living skills such as shopping
and cooking. Therefore treatment in the community
is a trend that will continue.
