In March, the Substance Abuse and Mental Health Services Administration (SAMHSA) published Mental Health, United States, 2004. Since I have been associated with this publication for more than 20 years at the National Institute of Mental Health (NIMH) and the Center for Mental Health Services (CMHS), I thought it important to provide a short historical perspective, together with some comments on the major policy directions reflected through this publication and likely future policy directions.
When MH, US was first developed by NIMH in 1983, it consisted solely of statistical tables thought to be of use to the mental health field. For the most part, these tables were taken directly from the surveys conducted at that time by the NIMH Division of Biometry and Epidemiology. (Additional tables from these NIMH surveys were published recurrently in Health, United States, a publication of the National Center for Health Statistics, and in the Statistical Abstract of the United States.) In response to this and subsequent editions of MH, US, NIMH was told repeatedly that the tables were useful, but that some interpretation should be provided. Hence, textual material was added to draw attention to particular findings and to put the findings into a factual context.
As interpretations and context were added, readers also began to suggest to NIMH and later CMHS that the policy implications of the findings should be explored and that work outside NIMH/CMHS also should be added. These changes were made in the 1990s, and MH, US is the only national policy document in the mental health field published recurrently.
Major Policy Directions
Perhaps the best way to characterize the major policy shifts reflected through the various editions of MH, US is to say that the field has moved from an exterior view, like looking at a store window from the street, to an interior view, in which we are behind the store window examining what's on display. For example, in the 1980s great concern was expressed about counting the number of adults with chronic mental illness, changes in the number of beds in state mental hospitals, increases in the total number of episodes of care in community programs—all exterior views. By contrast, now we are principally concerned with consumer and family empowerment and recovery, as well as delivering effective care, whether in specialty or primary care settings—both views from the inside.
MH, US, 2004has two principal policy foci: service quality improvement and mental health service delivery in primary care settings. Section I introduces the quality improvement model and its application to the mental health field, including the important and evolving role of the modern consumer movement in these developments. Section II reviews current work on measures of quality and documents the critical importance of arriving at a small number of agreed-upon, key measures that span mental health and substance use services. Section III is a call to action on the rapidly growing role of mental healthcare delivered through primary care settings.
Looking to the Future
By the time the 2026 edition of MH, US is published, I suspect that we all hope that consumer recovery and community integration are commonplace, and that consumer and family empowerment is taken for granted. Policy issues in 2026 are likely to include:
ethical concerns with genomic interventions and therapies;
cultural integration and its effects on families and communities;
the role of artificial computer intelligence in prevention and treatment services; and
the emerging role of worldwide standards for healthcare.
This future will be both exciting and threatening. We will be best prepared for it if we recognize the likely trends and then debate them and plan for them in a systematic manner. MH, US can be very useful in both of these endeavors.
Ronald W. Manderscheid, PhD, currently Director of Mental Health and Substance Use Programs at the consulting firm Constella Group, LLC, worked for more than 30 years in the federal government on behavioral health research and policy. He is a member of Behavioral Healthcare's Editorial Board.