The level of disability among severely mentally ill persons is a substantial and costly burden on society as well as a burden on family members and the affected individual. In the past decade, research findings have brought new hope that the disabling aspects of severe mental problems can be significantly reduced by early interventions that bring individuals under the care of professionals using effective treatment and rehabilitation methods. A major challenge for research in the 1990s will be to provide the information necessary to improve the existing systems of care by answering two questions:

The many ideas being discussed in the debate over health care reform, and the possibility that different states may implement different types of service systems opens the opportunity for research to test the relative adequacy of different approaches. As Grob (1994) points out, the history of the care and treatment of the mentally ill in America for almost four centuries offers a sobering example of a cyclical pattern that has alternated between enthusiastic optimism and fatalistic pessimism.... Each [new stage] was marked by unrealistic expectations and rhetorical claims that had little basis in fact. (p. 309–310)

The above techniques can help establish more accurately the state of knowledge applicable to improving services. These techniques can be expected to be used more as the United States struggles to make its health and mental health care systems more efficient.

The above descriptions of recent results from NIMH's services research program are only a small sample of the findings that continue to be produced from projects that NIMH has funded. Since the NIMH services research program has grown rapidly in the last three years, a larger volume of findings can be expected, and will be reported in future columns.

The National Institute of Mental Health (NIMH) emphasizes improved mental health and mental health services in rural areas through funding for research projects and research centers. NIMH also supports related activities including state planning, improvement of state data systems, protection of and advocacy for mentally ill individuals, disaster relief, professional training, and education concerning depression. Other important components include surveys, analyses, and public information, including support for a public hearing on rural mental health.

Community mental health centers (CMHCs) have been criticized for directing resources that should be used to treat the seriously mentally ill to the treatment of less impaired patients. Many of the latter group are assigned one of the DSM-III V codes for conditions that do not meet criteria for a mental disorder. This study compared patients with V-code conditions and those with diagnosed mental disorders on clinical, social, and economic variables. V-code patients were significantly less likely to have had prior care and to rely on third-party payments. They were significantly more likely to have been self-referred or referred by friends or family and to be white, well-educated, female, and married. CMHCs that treated fewer V-code patients reported proportionally more staff hours worked by physicians, indicating a greater medical orientation. The authors believe CMHCs should periodically evaluate whether, by serving patients with less serious conditions, they are diverting badly needed resources away from the seriously mentally ill.

Representative community mental health center (CMHC) survey data showed that psychiatrists differed from other CMHC providers of mental health services by serving the more seriously impaired patients who are admitted and readmitted to outpatient services. Psychiatrists also shared more outpatients with providers from other disciplines than providers in other disciplines shared with one another. The results are consistent with previous research on differences between disciplines and with the flight of psychiatrists from CMHCs but cast doubt on the hypothesis that psychiatrists see sicker patients than psychologists see because of differences in reimbursement between the two disciplines.

Back to table of contents Previous article Next article ArticleNo AccessCMHCs: Muted ImpactPaul R. AhrPaul R. AhrSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ps.39.3.318-aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "CMHCs: Muted Impact." Psychiatric Services, 39(3), pp. 318-a–319 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - Psychiatric Services $35.00 Add to cart PPV Articles - Psychiatric Services Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 39Issue 3 March 1988Pages 318-a-319 Metrics PDF download History Published online 1 April 2006 Published in print 1 March 1988

AbstractThe course of evaluation in mental health has been altered by the sociopolitical context of the 1970s and 1980s. Among the lessons learned are (1) the limitations of some evaluation technologies, (2) improvements that have occurred in others, and (3) the need for “echelon‐specific” evaluations. Insufficient recognition has been given to the need for both internal and external evaluation and replication.

To measure how much federally funded community mental health centers increased the quantity and range of mental health services, 63 catchment areas in which CMHCs began to receive federal funding in 1974-75 were matched individually with catchment areas that never received federal CMHC funding. The two groups of catchment areas were compared to determine average increases from 1973 to 1980 in amounts of services, mental health staff, expenditures, and accessibility and availability of services. Results showed that establishment of local CMHCs had a clear impact on the quantity and the availability and accessibility of services in the catchment area. The effect sizes resulting merely from the passage of time and from CMHC funding were compared.

Changes in funding, clientele, and services from 1971 to 1980 were examined cross sectionally and with cohorts for two types of CMHCs that differ in their structure for providing inpatient service. Inpatient provider CMHCs grew in revenues and shifted from reliance on federal funds to revenues from services and states. Inpatient-affiliated CMHCs fell in revenues (in constant dollars) and changed little in their proportional reliance on federal dollars. Inpatient provider CMHCs averaged more additions and episodes of care than inpatient-affiliated CMHCs. Inpatient-affiliated CMHCs grew more from 1971 to 1976, but from 1976 to 1980 inpatient provider CMHCs grew, while inpatient-affiliated CMHCs dropped or grew less. The relatively poor final showing of inpatient-affiliated CMHCs parallels findings with total revenues.

Surveys of the extent and types of participation of non-specialists in program evaluation indicate that consumers and typical citizens seldom have a role other than as subjects. Community mental health center boards and mental health associations often are reactors to evaluation by others and in appreciable numbers cooperate in or do independent evaluations.