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AbstractOnce defined as long‐term residents of psychiatric hospitals, the chronically mentally ill today are a heterogeneous population living in a variety of institutional and community settings.

Severe and persistent mental illnesses are among the most pressing health and social problems in contemporary America. Recent estimates suggest that more than three million people in the U.S. have disabling mental disorders. The direct and indirect costs of their care exceed 180 billion dollars nationwide each year. Effective treatments and services exist, but many such individuals do not have access to these services because of limitations in mental health and social policies.

Homelessness among persons with severe mental illness is a visible manifestation of deeply flawed public policies. This article critically assesses research to date on housing and related policies for the homeless mentally ill and recommends that future research target three strategic areas: (i) housing subsidies; (ii) landlord reluctance to rent to persons with mental illness, thereby solving one of their major problems in accessing housing; and (iii) appropriate housing and service mix for this heterogeneous population; that is, answering the longstanding threshold policy question of what housing and service mixes work best and for whom.

Severe and persistent mental illnesses are among the most pressing health and social problems in contemporary America. Recent estimates suggest that more than three million people in the U.S. have disabling mental disorders. The direct and indirect costs of their care exceed 180 billion dollars nationwide each year. Effective treatments and services exist, but many such individuals do not have access to these services because of limitations in mental health and social policies. For nearly two centuries Americans have grappled with the question of how to serve individuals with severe disorders. During the second half of the twentieth century, mental health policy advocates reacted against institutional care, claiming that community care and treatment would improve the lives of people with mental disorders. Once the exclusive province of state governments, the federal government moved into this policy arena after World War II. Policies ranged from those focused on mental disorders, to those that focused more broadly on health and social welfare. In this book, Gerald N. Grob and Howard H. Goldman trace how an ever-changing coalition of mental health experts, patients' rights activists, and politicians envisioned this community-based system of psychiatric services. The authors show how policies shifted emphasis from radical reform to incremental change. Many have benefited from this shift, but many are left without the care they require.

Three major cycles of reform in public mental health care in the United States—the moral treatment, mental hygiene, and community mental health movements—are described as a basis for assessing the shifting boundaries between the mental health, social welfare, and criminal justice systems. Historical forces that led to the transinstitutionalization of the mentally ill from almshouses to the state mental hospitals in the nineteenth and twentieth centuries have now been reversed in the aftermath of recent deinstitutionalization policies. Evidence is suggestive that the mentally ill are also being caught up in the criminal justice system, a circumstance reminiscent of pre-asylum conditions in the early nineteenth century. These trends shape the current mental health service delivery system and the agenda for policy-relevant research on issues involving the legal and mental health fields.

Three major cycles of reform in public mental health care in the US -- the moral treatment, mental hygiene, & community mental health movements -- are described as a basis for assessing the shifting boundaries between the mental health, social welfare, & criminal justice systems. Historical forces that led to the transinstitutionalization of the mentally ill from almshouses to the state mental hospitals in the nineteenth & twentieth centuries have now been reversed in the aftermath of recent deinstitutionalization policies. Evidence suggests that the mentally ill are also being caught up in the criminal justice system, a circumstance reminiscent of pre-asylum conditions in the early nineteenth century. These trends shape the current mental health service delivery system & the agenda for policy-relevant research on issues involving the legal & mental health fields. HA

Kelley and Stahelski's "triangle model" describes differences in the perceptions and behaviors of cooperative versus competitive personality types and has important implications for theories of social influence and conflict. However, the generality of the model has been seriously questioned, data exist that seem to contradict some of its basic predictions, and the findings can be "conceptualized in terms of an alternative information-processing approach. To test predictions of the triangle model against those derived from the alternative, 158 male and female subjects were classified as cooperators or noncooperators, paired with a cooperative or noncooperative partner, and participated in a mixed-motive game that had a cooperative or competitive payoff structure. The results largely supported the predictions of the triangle model and showed high general-izability across situational demands and subject's sex. Noncooperators expected others to be primarily competitive, misidentified cooperative opponents, and their other perceptions were unaffected by the situation or partner. Cooperators were more flexible in that they expected others to have diverse dispositions, based their inferences about the opponent on the opponent's behavior, and their other perceptions were affected by the situation and partner. Minor revisions of the triangle model were suggested to account for mutual behavioral assimilation in mixed-disposition pairs and other anomalous data.

This book contains updates of papers written by the Commission's subcommittees, including those related to housing and employment for the mentally ill as well as recommendations for change.This is an excellent resource for mental health rofessionals, policy makers and consumers and families alike.

Context: This article chronicles the political history of efforts by the U.S. Congress to enact a law requiring "parity" for mental health and addiction benefits and medical/surgical benefits in private health insurance. The goal of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity (MHPAE) Act of 2008 is to eliminate differences in insurance coverage for behavioral health. Mental health and addiction treatment advocates have long viewed parity as a means of increasing fairness in the insurance market, whereas employers and insurers have opposed it because of concerns about its cost. The passage of this law is viewed as a legislative success by both consumer and provider advocates and the employer and insurance groups that fought against it for decades.

1. Theory of Progress: Fundamental Reform or Incremental Change? -- 2. Division of Labor: Function Shifts and Realigned Responsibilities in the Evolving Mental Health Service System -- 3. Economic Perspectives on the Organization and Governance of Mental Health Care -- 4. What is the Meaning of Recovery? -- 5. Balancing Access to Medications and Psychosocial Treatments -- 6. Are There Enough Inpatient Psychiatric Beds? -- 7. Mandated Community Treatment in Services for Persons with Mental Illness -- 8. Shared Decision-Making and Self-Directed Care -- 9. Suicide Prevention: Rising Rates and New Evidence Shape Policy Options -- 10. How Should the U.S. Respond to the Opioid Addiction and Overdose Epidemic? -- 11. Early Intervention in Psychosis: From Science to Services -- 12. Policy Effects on Disparities in Mental Health Status and Mental Health Care -- 13. Mental Health Insurance Parity – How Full is the Glass? -- 14. Housing for People with Serious Mental Illness -- 15. What is the Role of Schools in the Treatment of Children's Mental Illness? -- 16. Policy Issues Regarding Employment for People with Serious Mental Illness -- 17. Adults with Serious Mental Illnesses Who Are Arrested and Incarcerated -- 18. Gun Violence Prevention and Mental Health Policy -- 19. Stigma as a Mental Health Policy Controversy: Positions, Options and Strategies for Change -- 20. How Shall We Promote Citizenship and Social Participation? -- 21. Evidence-Based Practices or Practice-Based Evidence: What is the Future? -- 22. New Financing Models in Behavioral Health: A Recipe for Efficiency or Under-provision? -- 23. Mental Health Disability, Employment and Income Support in the 21st Century

AbstractThe seriously mentally ill, homeless or not, require a broad range of housing, mental health, and social welfare supports. This chapter suggests how the framework of the federal Community Support Program for the chronically mentally ill can be adapted to assure comprehensive care for the homeless among them.