Mental Health Services in the 21st Century: The Economics and Practice Challenges on the Road to Recovery


  • W. Patrick Sullivan



Mental Health, Medicaid, Managed Care, Mental Health Policy


Since the program was initiated in 1963, little has been stable in Community Mental Health. Not only has this important quasi-public utility fought for survival, but the primary models and philosophies that shape the mission and delivery of services have undergone cycles of reform. There is much to be optimistic about in the mental health treatment arena, particularly in services focused on those with most challenging and debilitating conditions. However, all is not well. As states began to deemphasize institutional care and incrementally build a community infrastructure to care for those most in need, savvy administrators relied less on internal fiscal resources, and more on programs such as Medicaid to accomplish their agendas. Faced with budgetary cries in general, and in the Medicaid program specifically, many states are increasingly forced to consider processes to restrict eligibility, place limits on benefit packages, and cut rates to service providers. Indeed the worlds of economics, policy, and practice are on a collision course. This article explores some of the challenges of providing mental health care in the 21st century, and the continuing quest to address fiscal realities while offering high quality services.