The Needs of the Chronically Mentally Ill: The Perspective of a Director of a Large Urban Mental Health Program

Abstract

The chronically mentally ill have been with us since the beginning of recorded history. Their care has continuously shifted from institutional to community settings and back again. Over time we have seen many innovative humane and even successful methods of providing care and rehabilitation; but the provision of services to the chronically ill is, by definition, a continuous responsibility that is frequently expensive and always frustrating. Had we discovered a cure for chronic mental illnesses, we would not need to write these papers and I and my staff would be engaged in pursuits other than that of public mental health. I make this point because the care of the chronically mentally ill has been and continues to be primarily the responsibility of government, principally state governments, and, in some states, local government.