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© 1995 Faculty of Public Health Medicine of the Royal Colleges of Physicians of the United Kingdom

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Challenges in the provision of mental health services: some cautionary lessons from US experience


David Mechanic, René Dubos Professor and Director (and Visiting Scholar, King's Fund Institute, London)

Institute for Health, Health Care Policy and Aging Research, Rutgers University 30 College Avenue, New Brunswick, NJ 08903, USA

This paper examines the difficulties of organizing community care in large urban areas for persons with serious and persistent mental illness. Such care requires organizing functions comparable with those available in hospital in contexts with little control over patients and their whereabouts. It also requires coordination between governmental levels and varying health, social services, housing and rehabilitative agencies, each with their own bureaucracies, cultures, priorities, reward structures, and systems of accountability. Fragmentation is an inevitable challenge common to both the United States and United Kingdom. Strategies used in the US context are examined in the light of developments in the United Kingdom, and cautionary lessons are suggested for policy and implementation in the UK context.


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