‘How Do You Pay Your Rent?’ Social Policies And The President’s Mental Health Commission

Commentary: The counter-reformation that failed? A commentary on the mixed legacy of supported housing

The articles in this special section rejoin a conversation about the terms and conditions of social participation that was suspended some time ago. While welcoming the move, this commentary raises some questions about the vehicle. The formidable achievements of supported housing notwithstanding, it still functions as an abeyance mechanism ensuring its occupants a kind of sheltered livelihood. Arguably, then, the larger social questions gathered under the encompassing terms of social inclusion and citizenship will not be fully addressed, and may be occluded, either by declaring supported housing a forward operating base of recovery or by rewriting its original remit as an undeclared experiment in reintegration. To extend its promise will mean first confronting the purposes served by supported housing, by design or default, in its present configuration.

The patient as a policy factor: a historical case study of the consumer/survivor movement in mental health

This paper analyzes the history of the modern consumer/survivor movement and its impact on the policy-making climate in the mental health field. The growing attentiveness to consumers' perspectives is presented largely as a consequence, not a cause, of radical restructurings of the mental health system. Consumers' perspectives have entered policy discourse in the wake of policy failures and have flourished in a climate of perpetual crisis and tight budgets. Precisely because it has been such a contested arena for so long, the mental health field has produced some innovative responses to demands for patient empowerment.

Making progress in mental health policy in conservative times: one step at a time

Progress in mental health services has been made incrementally in a sequence of policy steps. In recent years, in spite of political conservatism, progressive changes have advanced new principles of service delivery. Reports from the surgeon general and the President's New Freedom Commission on Mental Health advanced these principles, including recovery and evidence-based practices. Both of these high-level reports were influenced by the findings of the Schizophrenia Patient Outcomes Research Team (PORT). The Schizophrenia PORT established the effectiveness of mental health treatments and supports, which provided a scientific foundation for the optimistic focus on recovery and its expectation of improved outcomes for individuals with severe mental disorders. The PORT study also established the gap between treatment recommendations and actual services. Concern about this gap has motivated efforts to transform services by implementing evidence-based practices. Advances in broad mental health and social policy, coupled with continued advances in science, have the potential to improve the care of individuals who experience severe mental disorders, such as schizophrenia.

Behavioral health problems, ex-offender reentry policies, and the "Second Chance Act"

The federal "Second Chance Act of 2005" calls for expanding reentry services for people leaving prison, yet existing policies restrict access to needed services for those with criminal records. We examined the interaction between individual-level characteristics and policy-level restrictions related to criminal conviction, and the likely effects on access to resources upon reentry, using a sample of prisoners with Axis I mental disorders (n=3073). We identified multiple challenges related to convictions, including restricted access to housing, public assistance, and other resources. Invisible punishments embedded within existing policies were inconsistent with the call for second chances. Without modification of federal and state policies, the ability of reentry services to foster behavioral health and community reintegration is limited.

Overview Of Publicly Funded Managed Behavioral Health Care

Using MEDLINE and other Internet sources, the authors perform a systematic review of published literature. A total of 109 articles and reports are identified and reviewed that address the development, implementation, outcomes, and trends related to Managed behavioral health care (MBHC). MBHC remains a work in progress. States have implemented their MBHC programs in a number of ways, making interstate comparisons challenging. While managed behavioral health care can lower costs and increase access, ongoing concerns about MBHC include potential incentives to under-treat those with more severe conditions due to the nature of risk-based contracting, the tendency to focus on acute care, difficulties assuring quality and outcomes consistently across regions, and a potential cost-shift to other public agencies or systems. Success factors for MBHC programs appear to include stakeholder involvement in program and policy development, effective contract development and management, and rate adequacy.