title: Mental health services then and now.
abstract: Over the past twenty-five years, psychiatric services have shifted from hospital to community. Managed care reinforces this trend. Mental illness is better understood and less stigmatized, and services are more commonly used. But many in need do not receive care consistent with evidence-based standards, or at all. Challenges are greatest for people with serious and persistent mental illnesses who depend on generic health and welfare programs and integrated services. Evidence-based rehabilitative care is often unavailable. Failures in community care lead to arrest; jail diversion and treatment are required. Despite progress, implementing an effective, patient-centered care system remains a formidable challenge.
authors.affiliation: nstitute for Health, Health Care Policy, and Aging Research, State University of New Jersey, New Brunswick, USA. mechanic@rci.rutgers.edu
authors.forename: David
authors.initials: D
authors.lastname: Mechanic
mesh_terms: D003156:Community Mental Health Services / Q000639:trends*; D003688:Deinstitutionalization; D019033:Delivery of Health Care, Integrated; D019317:Evidence-Based Medicine; D006301:Health Services Needs and Demand; D006801:Humans; D018802:Patient-Centered Care; D014481:United States