The distinguished historian of medicine Gerald Grob analyzes the post-World War II policy shift that moved many severely mentally ill patients from large state hospitals to nursing homes, families, and subsidized hotel rooms--and also, most disastrously, to the streets. On the eve of the war, public mental hospitals were the chief element in the American mental health system. Responsible for providing both treatment and care and supported by major portions of state budgets, they employed more than two-thirds of the members of the American Psychiatric Association and cared for nearly 98 percent of all institutionalized patients. This study shows how the consensus for such a program vanished, creating social problems that tragically intensified the sometimes unavoidable devastation of mental illness. Examining changes in mental health care between 1940 and 1970, Grob shows that community psychiatric and psychological services grew rapidly, while new treatments enabled many patients to lead normal lives. Acute services for the severely ill were expanded, and public hospitals, relieved of caring for large numbers of chronic or aged patients, developed into more active treatment centers. But since the main goal of the new policies was to serve a broad population, many of the most seriously ill were set adrift without even the basic necessities of life. By revealing the sources of the euphemistically designated policy of "community care," Grob points to sorely needed alternatives. Originally published in 1991. The Princeton Legacy Library uses the latest print-on-demand technology to again make available previously out-of-print books from the distinguished backlist of Princeton University Press. These editions preserve the original texts of these important books while presenting them in durable paperback and hardcover editions. The goal of the Princeton Legacy Library is to vastly increase access to the rich scholarly heritage found in the thousands of books published by Princeton University Press since its founding in 1905.

This revised and expanded third edition text utilizes a public health framework and the latest epidemiological, treatment, and service systems research to promote a comprehensive understanding of the organization, financing, and delivery of mental health and substance abuse services in the United States. Written by national experts in the field, this timely work will provide policymakers, administrators, clinicians, and public health and behavioral health graduate students with the knowledge base needed to manage and transform mental health service systems, both nationally and locally.The book is unique in providing a public health framework of the most significant issues facing mental health policy makers, administrators, planners, and practitioners. It combines issues (e.g., evaluation; law; ethnicity) that extend across different age groups, treatment settings, and disorders, with issues that are population and disorder specific.The publication of this book is timely for those involved with the debate over national health care reform legislation, and provides important and timely information (on populations at-risk for mental disorders, services, and systems issues) for those responsible for implementing policies and programs resulting from this reform effort.