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Community care of the seriously mentally ill: Continuing problems and current issues

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Abstract

The crisis in community care for the seriously mentally ill (SMI) stems from organizational and financial difficulties as well as from deeply embedded structural factors. The analysis shows a preference for medicalizing and individualizing the problems of SMI rather than viewing them as structural social welfare issues. The author discusses problems of deinstitutionalization, homelessness, service provisions, financing, accounting and reporting, employment, bureaucratic skimming and burden to families and points out the ambivalent ideology and the inherent contradictions within the mental health service system. Finally, the centrality of social control and the maintenance of orderly social life in public, policy and program development is illuminated.

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Author notes

  1. Uri Aviram D.S.W. (Visiting Professor)

    Present address: Bob Shapell School of Social Work, Tel-Aviv University, Israel

Authors and Affiliations

  1. Institute for Health Health Care Policy and Aging Research, New Brunswick, NJ.

    Uri Aviram D.S.W. (Visiting Professor)

  2. School of Social Work, Rutgers University, New Brunswick, NJ.

    Uri Aviram D.S.W. (Visiting Professor)

Authors
  1. Uri Aviram D.S.W.
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Additional information

Research for this article was supported in part by the Brookdale Fellowship Program of the Jewish Communal Fund of New York City. The author would like to acknowledge with thanks the assistance provided by Dr. Jeffrey Solomon, former Executive Vice President of Altro, Health and Rehabilitation Service, New York, NY. The author thanks David Mechanic, Leona Bachrach, Phyllis Solomon and Shirley Smoyak for their comments on an earlier draft of the paper. Thanks are due also to Gerald Grob whose editorial suggestions improved the final version of this paper.

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Aviram, U. Community care of the seriously mentally ill: Continuing problems and current issues. Community Ment Health J 26, 69–88 (1990). https://doi.org/10.1007/BF00752677

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