For the Public Good Highlights from the Institute of Medicine, 1970-1995 (1995) / Chapter Skim
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COMMENTARIES
COMMENTARIES
Pages 128-145
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From page 128... ...
The focus has been on treatment and prevention (even though prevention remains problematic) , whereas relatively little attention has been devoted to studies of the ways in which we provide care to people whose chronic illness leads to dependency.
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From page 129... ...
Health policy as it relates to the severely and chronically mentally ill, therefore, must be conceptualized within a framework that includes the traditional emphasis on prevention and treatment, but accepts as well the need for care. Indeed, severe mental disorders require the integration of health policy and social policy.
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From page 130... ...
More importantly, CMHCs served a different population. Most centers made little effort to provide coordinated aftercare services and continuing assistance to severely and persistently mentally ill persons.
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From page 131... ...
Equally significant, states during and after the 1970s accelerated the discharge of large numbers of severely and persistently mentally ill persons from public mental hospitals. The origins of "deinstitutionalization" a term that is both imprecise and misleading-are 131
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From page 132... ...
The elderly were among the first to be affected by new federal policies. Immediately following the passage of Medicaid in 1965, states began to shift the care of elderly persons with behavioral symptoms from mental hospitals to chronic care nursing facilities.
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From page 133... ...
In addition, public housing programs and food stamps added to the resources of mentally ill persons residing in the community. The expansion of federal entitlement programs hastened the discharge of large numbers of institutionalized patients during and after the 1970s.
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From page 134... ...
Data from the Vermont Longitudinal Research Project offered some dramatic evidence that people with severe mental illness who were provided with a range of comprehensive services could live in the community. A variety of other experiments have confirmed that individuals with severe mental disorders prefer and do better in community settings that dispense economic resources (particularly vocational rehabilitation)
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From page 135... ...
After 1970, however, a subgroup of the severely mentally ill-composed largely of young adults-was adversely affected by the changes in the mental health service system. Young chronically mentally ill persons were rarely confined for extended periods within mental hospitals.
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From page 136... ...
A superficial analysis of the mental health scene in the recent past can easily lead to depressing conclusions. The combined presence of large numbers of young adult chronic mentally ill individuals as well as larger numbers of homeless people undoubtedly reinforced feelings of public apprehension and professional impotence.
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From page 137... ...
severely and persistently mentally ill persons might require comprehensive assistance and services for much of their adult lives. In sum, the challenge was to create a system that provided all of the elements incorporated into traditional mental hospitals, but without the liabilities that accompanied protracted institutionaTization.
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From page 138... ...
In an effort to improve services to the chronically mentally ill population, the Robert Wood Johnson Foundation the nation's largest foundation concerned with health-created the Program on Chronic Mental Iliness in 1985. Under this program, nine cities were given resources to create a central mental health authority to deliver services to chronically mentally ill persons.
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From page 139... ...
We must also confront the evidence that serious mental disorders are often exacerbated by other social problems of a nonmedical nature-poverty, racism, and substance abuse. Although psychiatric therapies can alleviate symptoms and permit people to live in the community, there is no magic bullet that will cure all cases of serious mental illnesses.
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From page 140... ...
Indeed, to posit an absolute standard of cure leads to a paralyzing ~ncapaci~ to act despite evidence that programs that integrate mental health services, entitlements, housing, and social supports often nainimi~e the need for prolonged hospitalization and foster a better quality of life. The challenge to the TOM in the mental health field in the next quarter of a century is to broaden its traditional (and legitimated concerns with ~ea~nent and prevention by recognizing that senous and chronic mental disorders (in the absence of curative ~eabnents)
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From page 141... ...
Biobehavioral Sciences and Health: The Institute of Medicine's Enduring Leadership by David A Hamburg, M.D.
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From page 142... ...
to make objective, science-based analyses of policy options, taking into account the social and economic realities faced in implementing proposals; (3) to provide a broadly based, long-term view when analyzing policy questions; and (4)
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From page 143... ...
Now a new generation of investigators is based firmly on the ground of first-rate scientific training, abundant research accomplishments, rich clinical experience, and interdisciplinary cooperation. They have constructed a valuable guide to the mysterious territory of human behavioral biology.
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From page 144... ...
Moreover, advanced technologies such as computerized axial tomography, positron emission tomography, computer-assisted electroencephalography, magnetic resonance imaging, and spectroscopy have opened new windows on the brain and behavior and provide powerful tools for studying brain Unction in living animals and intact people. Yet there are more hurdles to be overcome the inherent complexity of the subject matter, old conceptual rigidities like the mind-body dichotomy, proper ethical limitations on experimental control in human research, ancient prejudices against objective inquiries into human behavior, dogmatic social ideologies, and institutional inertia that retards any kind of major change.
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From page 145... ...
We are now entering an era during which we wall evaluate the extent to which scientific methods can be brought to bear on the entire range of factors that affect and determine health and delineate well-tested diagnostic, therapeutic, and preventive interventions. This requires excellent basic science at every level of biological organization, a dynamic interplay between basic and applied science, a widening of horizons to include new or neglected lines of inquiry, and an enduring commitment to the scientific study of human behavior.
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