Hospital & community psychiatry
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Hosp Community Psychiatry · May 1990
Economic barriers to widespread implementation of model programs for the seriously mentally ill.
Although deinstitutionalization has been linked with an increase in the number of mentally ill people who are homeless or in jails, several demonstration programs started during the past 30 years have shown that community-based services for the seriously mentally ill can be both humane and cost-effective. Four such programs, none of which has been widely implemented or has significantly influenced service delivery systems, are described. ⋯ The economic disincentives of the present system include lack of coordination of services at the state and local level and federal policies that favor hospitalization, restrict payment for outpatient and rehabilitation services, and discourage mentally ill persons from working. The author suggests that public services for the mentally ill are unlikely to improve significantly until such disincentives are addressed.