Before delving into a discussion about care of the uninsured and underserved mentally ill population, it is important to reflect on the historical under-representation of the field of mental health as a whole from a medical, political, social, and economic standpoint. The approach to the care of the mentally ill has been an area of debate for centuries, and the evolution of the field of mental health and substance use disorder has often lagged behind other areas of health care and social services. Following an extensive period of institutional care of the mentally ill using therapeutic asylum, a revolutionary movement came to light in the 1960s with the promise of delivering comprehensive community-based mental health services to support the de-institutionalization of the mentally ill. The Community Mental Health Movement was ethically strong and philosophically progressive, yet it was very poorly funded, and services were intermittently dispersed and fragmented. The challenge to implementation grew more daunting as a result of a drastic concurrent increase in our country's population, an epidemic rise in drug and alcohol use disorders, and the worsening medical and social infrastructures. Communities in the United States continue to experience the unfavorable consequences of this movement, while poorly equipped criminal justice systems, and overwhelmed emergency medical and homeless services are left to deal with the results of this tragic legacy. In an era where a general healthcare care crisis has received little attention, the severe limitation of services for the mentally ill and those affected with substance use disorders is not an exception to the rule. Rather, it has become a sad symbol of the neglect for the needs of this special community which has traditionally received a disproportionately small amount of funding (federal and otherwise), attention to reform and policy, and medical services. This is especially concerning, given the social and moral burden that mental illnesses engender. According to the World Health Organization, mental disorders collectively account for more than 15% of the overall burden of disease from all causes and are among the most disabling. To put this into more tangible terms, five of the top ten causes of disability worldwide are mental health conditions (Depression #1, Alcohol use #4, Bipolar Disorder #6, Schizophrenia #9, and Obsessive Compulsive Disorder #10) (Murray and Lopez 1996).
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