But one problem with the legislation was that it didn’t provide money to operate the centers long-term.
“Having gotten them off the ground, the federal government left it to states and localities to support,” Appelbaum said. “That support by and large never came through.”
Later, during the Reagan administration, the remaining funding for the act was converted into a mental health block grant for states, allowing them to spend it however they chose. Appelbaum called it a death knell because it left the community health centers that did exist on their own for funding.
Robert Drake, a professor of psychiatry and community and family medicine at Dartmouth College, said some states have tried to provide good community mental health care.
“But it’s been very hard for them to sustain that because when state budget crunches come, it’s always easiest to defund mental health programs because the state legislature gets relatively little pushback,” he said. “Services are at a very low level right now. It’s really kind of a disaster situation in most states.”
Sharfstein points out that most mentally ill people are at a very low risk of becoming violent. He said it’s unthinkable we would go back to the era when people were housed in “nightmare” conditions at overcrowded, understaffed and sometimes dangerous state hospitals.
“The opportunity to recover is much greater now than it was in 1963,” he said.
But for those who do not take their medication, don’t recover from their first episode of illness and don’t seek treatment and support from professionals, they are vulnerable to homelessness, incarceration and death, he said.
Linda Rosenberg, president and CEO of the National Council for Behavioral Health, counts among its 2,100 member organizations many of the original community mental health centers that were built under the 1963 legislation.
“Whenever you pass a piece of legislation, people would like to think that you’ve solved the problem,” she said. “It did some very important things. It laid some ground work. It’s up to us now to move forward.”