Community Mental Health Journal, Vol. 39, No. 5, October 2003 ( 2003)

Introduction to the Special Issue ofCommunity Mental Health Journal

Commemorating the 40thAnniversary of The Community

Mental Health Centers Act of 1963

David Pollack, M.D.Jacqueline Maus Feldman, M.D.

We are pleased to introduce this special issue of Community MentalHealth Journal commemorating the 40th anniversary of the CommunityMental Health Centers Act of 1963. That event was a turning point inthe history of mental health policy and services in the United States.It resulted from and fostered sustained proactive thinking and planningfor the mental health needs throughout this country. Up until then,most care was provided in long-term institutions, in spite of the factthat Clifford Beers and others had urged the development of communitybased care in less restrictive environments more than 50 years earlier.This anniversary provides us an opportunity to mark time and reviewhow far we have come, and to honor those dedicated to enhancingservices. It also allows us to identify how much more work we have leftto do.

This watershed event in 1963 spawned the modern community mentalhealth movement. It led eventually to much more organized and compre-hensive care delivery systems, increased attention to prevention andearlier intervention, recognition of the psychosocial rehabilitative andrecovery needs of our patients, the importance of working more effec-tively with families, and the value of integrating care for mental health,chemical dependency and primary care conditions. These service system

David Pollack, M.D., is the Medical Director for the Office of Mental Health and Addiction Servicesfor the Oregon Department of Human Services and Professor of Psychiatry and Associate Directorof the Public Psychiatry Training Program at Oregon Health and Science University.

Jacqueline Maus Feldman, M.D., is Patrick H. Linton Professor, Department of Psychiatry andBehavioral Neurobiology, University of Alabama at Birmingham, and President of The AmericanAssociation of Community Psychiatrists.

Address correspondence to David Pollack, M.D., e-mail: david.pollack@state.or.us.

377 2003 Human Sciences Press, Inc.

Community Mental Health Journal378

developments parallel the more prominent advances in brain science,psychiatric diagnosis, and the development of increasingly more effec-tive and safer biological treatments.

Emerging during this exciting period of expanded knowledge andsystem development have been three important factors: training pro-grams for community based mental health professionals, professionalorganizations attuned to the needs of those clinicians and their patients,and the advocacy/consumer movement. Training programs, such as thePublic Psychiatry Training Program at Oregon Health and Science Uni-versity, which is celebrating its 30th anniversary this year, have helpedto provide committed and skilled clinicians to work in the public sector.The American Association of Community Psychiatrists, which is ap-proaching its 20th year anniversary, exemplifies groups of activist clini-cians and administrators, who have helped to stimulate further growthand improvement in this very challenging system. No anniversary ofthe community mental health movement would be complete withouthonoring the important and growing influence of the family advocacyand consumer movements; the consumer movement and family advo-cacy, which have pushed the rest of us to be more sensitive and respon-sive in the work that we do.

The articles in this issue cover much of the progress we have madein the past 40 years. We ar particularly pleased to present the articleby Dr. Jackie Goldstein regarding the program at Geel, Belgium, per-haps the world’s oldest mental health program dating to the middle-ages. Geel gave the world the example it needed to appreciate thatpersons with mental illness can be helped and can play a productiverole in society. The fact that this program with such a long history stillexists gives us hope in these difficult times. Drs. Cutler, McFarland,and Bevilacqua’s historical account of mental health care since 1963 isa detailed narrative of the complex and rapid evolution of a movementwith ups and downs, triumphs and failures. The authors have beenfirst hand witnesses and participants in this evolution; especially Dr.Bevilacqua who was Mental Health Commissioner in three differentstates over three decades. The paper by Drs. Pumariega and Winterson the history of children’s mental health is an equally comprehensivereview of child guidance and child mental health work from the early1990s, to the CASSP initiative of the 80’s, and to current evidencebased notions of culturally competent systems of care for children. Drs.Drake and Goldman have produced a wonderful review of communitymental health treatment and rehabilitation for persons with severe andpersistent mental illness. Finally, Dr. Cohen et al., have together given

David Pollack, M.D., and Jacqueline Maus Feldman, M.D. 379

us a glimpse into the future of community and public mental healthsystems and services. We believe the reader will be saddened and buoyedby what he/she reads here. Anyone in the field should find this helpful ingetting one’s bearing in this ever changing world of American communitymental health.

We know a lot more than we did 40 years ago. In fact, we know a lotof what we need to in order to provide very good care to most of thepeople for whom we are clinically responsible. Unfortunately, stigma,the vagaries of economic cycles, state and federal budget inadequacies,the absence of meaningful national health insurance reform, and thelack of parity for mental health have prevented many of our programsfrom achieving the outcomes that should be possible. Let us hope thatthe next period of work will lead us to a place where our knowledgeand skills can be more effectively used to implement quality care forour communities.