Monday, November 4, 2013

50 Years After: Will We Realize JFK’s Vision for Mental Health Care?

APA President Jeffrey Lieberman, M.D., is using the Psychiatric News Alert as a forum to reach APA members and other readers. Please send your comments to

In October 1963, a half century ago, President John F. Kennedy signed the landmark Community Mental Health Act (CMHA) into law. “The time has come for a bold new approach,” he’d declared in urging congressional action. “If we apply our medical knowledge and social insights fully, all but a small portion of the mentally ill can eventually achieve a wholesome and constructive social adjustment.”
While the intent was noble, the vision was never realized.

The CMHA was intended to set the foundation for contemporary mental health policy, one premised on the establishment of community-based care as an alternative to institutionalization. Yet its vision—for persons with mental illness as well as for the country—was doomed almost from the start.

In 1963, U.S. public psychiatric hospitals had more than 500,000 beds. In these institutions, some patients had been held for years. When states began to discharge patients from these hospitals in accordance with the new policy of deinstitutionalization, local communities had neither the expertise nor infrastructure to care for the influx of patients suddenly in their midst. Adequate funding for treatment and programs never followed, and many people were left without the support they desperately needed. Consequently, many patients wound up homeless or incarcerated.

It is a tragedy that endures today.

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