Search

The extent of change in the performance of local mental health authorities (LMHAs) and in the development of community support systems (CSSs) is assessed for nine demonstration cities that participated in the RWJF Program on Chronic Mental Illness and one comparison site. Parallel measures of LMHA and CSS performance were obtained from two data sources (key informant and interorganizational network surveys) conducted at each site at two times during the demonstration: 1989 and 1991. Findings indicate that the LMHAs were successfully implemented at most demonstration sites, but changes in the CSSs lagged behind LMHA performance levels. The amount of system change tended to be greater when estimated from network versus key informant data.

Community-based services for mentally ill individuals have developed in a fragmented and uncoordinated manner over the last 30 years. In response, the RWJF initiated a five-year demonstration in nine cities: the Program on Chronic Mental Illness (CMI). The project's background is described, as are its accomplishments and limitations. One outcome of sponsorship by the RWJF and the U.S. Department of Housing and Urban Development was to assure the problem of CMI a place in the public policy agenda. Despite specific improvements in quality of life for individuals with CMI, however, there was no general improvement for this population. The program thus demonstrated that structural changes alone are insufficient; quality of care must be attended to as well. Despite its drawbacks, the project revealed that interventions can be implemented with positive results.