The Community Mental Health Act of 1963

Before the Community Mental Health Act (CMHA) of 1963 was signed into law, many Americans suffering from mental retardation were sent to asylums. President of Jon F. Kennedy of United States referred it as ‘custodial isolation,’ to mean that most of them had little chance for any constructive activity (CMHA, 1963). When CMHA was mended into law, it proposed the establishment of community mental health care to restore useful life and improve community standards. Although the program was not sustainable in the long-run, it provided short-term treatment to mentally sick individuals in the community. Local health amenities continued to be more useful option regarding accessibility and cost to taxpayer than government-owned facilities. The assignment explains the CMHA of 1963, the underlying social problems, its social-political history, policy goals, and it's economic, administrative, and social-political viability.

Description of the policy 

Community Mental Health Act was signed into law by President of US John F. Kennedy in the year 1963 that led to the creation of community mental health centres throughout the nation to support people with mental illness moved back into their societies (CMHA, 1963). The policy was expected to work by providing a more psychotherapy service that was easily feasible for persons with mental ailment at the communal level. It led to the transfer of resources from big institutions towards community-based mental health care facilities.

The resources and programs that were offered by the policy were grants to nations for the creation of community mental health centers and amenities designed to enhance prevention, diagnosis, and treatment of mental health. The people that were covered by the policy were youth, children, and persons living with mental disorders living in the community. Each center was to provide five essentials services, namely: consultation, inpatient services, emergency response services, and outpatient services (Kemp, 2007).

The growing inhuman conditions of many psychiatric health facilities prompted the creation of other treatment alternatives (Jon. et al., 2019). Large institutions housed thousands of people with a mental health condition for an extended period that outnumbered the health trained staff. The CMHA offered grants to states to establish local psychiatric facilities under the suggestion of National Institute of Mental Health (NIMH). The institution conducted survey on the adequacy of mental health and proposed the construction of community-based mental health centres as an alternative to institutionalization.

Community-based health facilities are operated and funded by a combination of national and devolved government as well as non- governmental and private organizations. These mental health services receive funding from sources such as state and county government, federal programs such as grants, Medicare, private insurance, self-pay, Medicaid, and years later Supplemental Security Income (SSI), provided short-term and direct monetary support to persons suffering from mental-ailments living in the society (Gallagher, 2017) .

Underlying Social Problems 

Social problems emerge as issues of communicative disorders that require something to be done. (Kemp, 2007). Social problems are conditions that are not allowed in the society because of perceptions as problems that require response and solution from the organizations. Social issues demand public reactions. The social problems addressed by the policy included mental disability, poverty and poor state of government mental health institutions and the prisons.

Mental disorder is caused by homelessness, substance abuse, discrimination to mention a few. People suffering from mental disorders were not given the opportunity to interact with others in the community. According to (Kofman, 2012) the mentally challenged were isolated from the rest of the world which makes it difficult to adapt with the society. When the government failed to fund the community-based healthcare facilities, it became challenge for the facilities to accommodate the large number of mentally ill who later returned while others were left in the streets.

Another social problem the policy addressed was poverty. Poverty is state of being in possession of resources or income that cannot meet your needs. One of the policy goals of the CMHA was to provide political support and promote community among the poor in US. The Act highlights that President Kennedy election into office included the coalition of poor voter of the Democratic Party (Kofman, 2012). The program was meant to enhance distribution of resources to reduce income disparities.

Additionally, the poor state public of mental health facilities and prisons contributed largely mental disorders which is regarded as social problems. Patients received less concern and poor treatment that even worsened psychological disorders. (Murphy, Rigg, 2014) To address social problems, the Community Mental Health Centres were constructed to provide counselling services and rehabilitation.

Social-Political History of the Policy 

In the year 1961, President John F. Kennedy assured of funding Community Mental Health Centres (CMHCs) and emptying large institutions before signing into law the CMHA in the year 1963; that led to the construction of CMHCs (Lewis, 2013). The Program was meant to bring changes in government mental health systems by transferring resources from government organizations to community-based mental health treating facilities. Unluckily, the creation of CMHCs took place slowly for many decades that streets and jails warehoused individuals who have a mental illness ( Torrey, 2013).

Community Mental Health Centres (CMHCs) had insufficient resources to support individuals living with mental disorders for many years (Hudson, 2018). It initially received funding from federal grants to states, although long-term quality health care programs for people with severe psychological sickness. It is not a personal choice to have mental disorders, although the law perceives so. Society ought to take responsibility for the well-being of its citizens instead of marginalizing the issue.

The role of government in every country is to provide support to its people and equal distribution of resources to moderate disparities. The formation of the CMHA of 1963, let to the inception of financing of mental health programs as well as medical services and later inspiration to ‘recover’ ( Michael, Angela, Christine, & Lilia 2019). The Act advocates for macroeconomic and social justice at different levels. Economic justice is addressed from the cost point of view, while social judgments included the right to self-determination and competence in the legislation.

Services offered to people living with mental disorders and addiction were diversified and became clear that individuals with addiction disorders need addiction treatment to function at an optimal level. It was labelled as ‘behavioral healthcare.’

Policy Goals 

The policy goals were just, legal and democratic because it aimed at improving the lives of the mentally retarded and the poor in the society. CMHA was legally signed into law in order to address the above policies (CMKHA, 1963). The goals were just since the Act addressed macro-economic justice and social justice. It is economically just because it led to reduction of cost of accessing medical treatment in short term and socially just it advocated for freedom of mental patients through construction of CMHCs to allow them assimilate with the society. Furthermore, it is democratic in that it considered the needs of the poor which formed part of the coalition which let to election of President Kennedy.

The overall aim of the program was to reduce the number of patients in public mental health care by half. The Community Mental Health Act's general purpose was to cut the number of patients suffering from psychological health in state hospitals under protective care by 50 percent in 10-20 years in the United States of America (Hogan, 2002). The policy was enacted to achieve two goals namely: Deinstitutionalize state institutions and offer political and promote community support among the poor.

The most significant goal was deinstitutionalization which means the transfer of mental patients under custodial care to community mental health facilities. To achieve the goal, CMHA focused on three initiatives: First, to provide financial support to construct community Mental Health Centres (CMHCs) to provide comprehensive healthcare service for the mentally ill (Kennedy, 1963). The second was the construction of inpatient, outpatient, and rehabilitation treatment and counseling clinics at the community level and thirdly to have Congress extends funds train counselors of mental disorders and initiate funds meant for particular research institutions in human development.

Another policy was to promote community and provide political support to the poor citizens in the US. According to (Kofman, 2012) illustrates that election of president Kennedy under Democratic Party into offices was a coalition of poor voters from US. To reduce income disparities and promote economic development, CMHA proposed development of mental health programs in the rural area.

Political Feasibility 

Following World War II, the US federal government formed the National Institute of Mental Health (NIMH) to expound on its role in psychological health care and later implemented Community Mental Health Centres (CMHCs) (Hogan 2002). The CMHA prompted deinstitutionalization movement and accelerated continued mental health and civil rights advocacy. The movement advocated for community rehabilitation programs and to least restive movements.

President Kennedy’s administration had mistrust in the government and any state opposition in performing federal plans during the civil rights movement. His administration had categorically stated that no national funds were channelled to government mental organizations because it would lead to violation of Democratic Congress intent’ (Kofman, 2012).

The NIMH supported the policy to fund five essential services that were selected by Dr.Yolles, who is staff at the institute. (Torrey, 2013) Dr.Yolles further encouraged newly formed centres to concentrate their funds on social issues as a way of preventing mental disorders. Also, the NIMH was among the source of federal funding. Also, the House of Congress supported the policy because it was advocating for more funds to be allocated to the CMHCs (Kemp, 2007).

The agencies in support of the policy laid policies that allowed for continuation of the community health systems even after the CMHA of 1963 failed to restructures the CMHCs. For instance Congress passed CMHA of 1980 to continue funding and support the remaining CMHCs. Conservatives opposed the act because they believed that the policy was the expansion of state welfare, which might leave the federal government with the cost of operations to bear. The policy affected National Institute of Health, Community Mental Health Centres and U.S department of Justice.

Economic Feasibility 

The minimum level of funding required to successfully implement the policy was $116 million which was geared to supporting and facilitating grant programs (“FY 2018 Funding for Mental Health – NAMI”, 2018). The policy was not well-funded and did not offer long-term financial support to the community mental health facilities and housing. The public failed to allocate equitably financial resources to mental health systems, although it initially mandated to provide funding for the construction of the CMHCs. In the long-run, the plan was not able to withstand itself since finance was cut-off by the two levels of government. President Kennedy’s hopes have not been realized as both public and community health systems are in adverse conditions (Lewis, 2013). The procedures needed to develop the CMHCs were not an issue; the problem was inadequate funding and evaluation of socio-economic benefits of the program to the target group.

In the long-term, the program did not achieve its overall mandate because it failed to address how to structure the community-based medical care. To mean that families have to carry the burden of taking care of individuals suffering from the disorder, making life more expensive. Mental health care facilities should be open and accessible to friends and family members to visit their loved ones. It makes the patient feel attached to the community and feel part of them. Proper restructuring and financial support will enhance active community mental health programs that are economically viable and accessible to those who require it.

The mandate of the CMHA could be realized if the government, not-for-profit institutions, and private sector offer full financial support while monitoring if the program has addressed social issues faced by individuals living with mental disorders. Furthermore, the two levels of government must restructure the CMHCs to accommodate persons living with the condition and as well provide long-term treatment.

Administrative Feasibility 

The policy was broad enough in order to accomplish its stated goals. The program was able to provide a remedy to address overcrowded and poor conditions of the state mental hospitals ( Lewis, 2013). The act accomplished its goal of deinstitutionalizing state institutions and deny state government of control over community mental health care. The benefits of the policy were not able to reach the target group. This is because in the long run, the policy did not achieve the said objectives because it lacked enough funding and proper restructuring of the local mental health facilities (Dyck,2018). Inadequate services and financial support available in the community, made many individuals suffering from mental ill-health to remain in society and their homes. (Kofman, 2012) Claims that shutting down of institutions without expanding funding for community-based health care imposed more hardships to individuals and families. The program created employment for non-target groups in the economy, such as counseling teachers who received training and had no achieved professional qualifications but for a short period as some facilities were shut down due to insufficient finance.

A successful implementation would have only caused a few social problems. On the other hand, the society would have benefited by having an improved state of health and wellness and overall peace among the larger population. The failed implementation of the policy led to social problems that from mental sickness. The implementation of the policy could have resulted in several challenges for the society through higher taxes. With huge amounts of money being channeled towards the program, this could mean that the tax payer experienced increase in taxes. Additionally, the funds that could have been channeled towards business opportunities and significant expenditure would mean reduction of opportunities.

Summary 

In general, the problem that was analyzed by the policy was the issue of mental health. The CMHA was implemented to facilitate provision of assistance to individuals suffering from mental health. From the analysis, the deinstitutionalization movement showed that Community Mental Health Centres (CMHCs) have more difficulties in providing lasting treatment for severe mental illness than what state mental hospitals can do. Alternatively, the government should build more psychiatric medical facilities at the county and community level with enough staffing instead of creating many state hospitals with poor conditions. One of the suggestions for hospitals is to create facilities that focus in recovering and rehabilitating patients in the community. It will help people suffering from severe illness and are homeless or lack family support because it allows family and friends to access the amenities easily. It will also help reduces violations of human rights and make the surrounding similar to that of general medical facilities. All being well, there will exist an operative community mental well-being systems to provide worth and economical medical attention.

Reference

Accordino, M. P., Porter, D. F. & Morse, T. (2001). Deinstitutionalization of Persons with Severe Mental Illness: Context and Consequences.  Journal of Rehabilitation. 

Community Mental Health Act of 1963, Pub. L. No. 88-164, § 406, 761 Stat. 77 (1963) Retrieved September 23, 2016. 

Dyck, E. (2018). Bitter Pills: The Impact of Medicare on Mental Health.  Health Economics Policy and Law (Issue 3-4), 263. 

FY 2018 Funding for Mental Health – NAMI. (2018). Retrieved from https://www.nami.org/getattachment/Get-Involved/NAMI-National-Convention/Convention-Program-Schedule/Hill-Day-2017/FINAL-Hill-Day-17-Leave-Behind-Appropriations.pdf 

Gallagher, M. (2017). From mental patient to service user : deinstitutionalisation and the emergence of the Mental Health Service User Movement in Scotland, 1971-2006. 

Hogan, M. F. (2002). President’s New Freedom Commission on Mental Health. Retrieved November 03, 2016. 

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Michael Olson, Angela Ammon, Christine Page, & Lilia Larkin. (2019). Building integrated teams to address mental and behavioral health needs in rural primary care: 

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