Int J Health Serv
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Historical Article
The transfer of care: U.S. mental health policy since World War II.
Recent criticism of mental health policy has raised many questions about the so-called "mental health revolution." Following World War II, the federal government and the growing mental health lobby planned the first nationally oriented system of psychiatric treatment, rehabilitation, and prevention. The rapidly expanding National Institute of Mental Health coordinated that policy, particularly through its Community Mental Health Centers program. Custodial state hospitals were depopulated and their patients "dumped" in nursing and boarding homes, which now constitute the largest arena for and most expensive form of psychaitric care. ⋯ They, and many others, are maintained on psychiatric drugs, another source of profit as well as a dangerous technology. Community mental health programs have maintained psychiatry's traditional class, race, and sex biases, and have incurred widespread intrusion into communities. This article shows that such problems are part of an interconnected system in which the driving forces are fiscal crisis, ideological justifications for dumping patients, attempts to pass responsibility from state governments to federal and local bodies, restrictions on government and insurance reimbursements, the free enterprise economics of the nursing home and drug industries, and the professionalist practices of the mental health field.
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By drawing on a wide range of material, a picture emerges of extensive abuse, discrimination, and exploitation of women and ethnic minorities at the hands of the American health industry. The numbers of minorities and women in professional schools and among the "elite" strata of the industry remain disproportionately low. As patients, they receive often inferior, insensitive treatment. Overall, there is a remarkable similarity in the situation of women and minorities, a condition which reflects the pervasiveness of racism and sexism in American institutions and ideologies.
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This paper analyzes four basic reasons for curtailing the number of foreign medical graduates (FMGs) entering the United States: the loss to less-developed countries, the possible lower quality of medical care delivered by FMGs, the inability of all U. S. citizens who desire to receive a medical education to do so, and the fear of a possible surplus of physicians in the U. ⋯ Based on the options proposed for reducing the number of FMGs, the conclusion is reached that the primary concern at present is an oversupply of U. S. physicians.