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Objective. We examined trends in delivery of mental health and substance abuse services at the nation’s community health centers. Methods. Analyses used data from the Health Resources and Services Administration (HRSA), Bureau of Primary Care’s (BPHC) 1998 and 2003 Uniform Data System, merged with county-level data. Results. Between 1998 and 2003, the number of patients diagnosed with a mental health/substance abuse disorder in community health centers increased from 210 000 to 800 000. There was an increase in the number of patients per specialty mental health/substance abuse treatment provider and a decline in the mean number of patient visits, from 7.3 visits per patient to 3.5 by 2003. Although most community health centers had some on-site mental health/substance abuse services, centers without on-site services were more likely to be located in counties with fewer mental health/substance abuse clinicians, psychiatric emergency rooms, and inpatient hospitals. Conclusions. Community health centers are playing an increasingly central role in providing mental health/substance abuse treatment services in the United States. It is critical both to ensure that these centers have adequate resources for providing mental health/substance abuse care and that they develop effective linkages with mental health/substance abuse clinicians in the communities they serve.

As part of the 19th annual Rosalynn Carter Symposium on Mental Health Policy, held in 2003, an anonymous online survey of symposium participants was conducted to gain insight into participants' perceptions of the impact on their organizations of the President's New Freedom Commission and its recommendations. The participants were national mental health leaders representing a broad range of mental health agencies and organizations. The results of the survey suggest that the New Freedom Commission has had a substantial impact on the organizations represented at the symposium. Findings on successes and challenges in implementing the recommendations suggest areas for ongoing efforts to transform mental health care.

Mental, neurological, and substance use (MNS) disorders are leading causes of the global burden of disease and profoundly impact the social and economic well-being of individuals and communities. The majority of people affected by MNS disorders globally do not have access to evidence-based interventions and many experience discrimination and abuses of their human rights. A United Nations General Assembly Special Session (UNGASS) is needed to focus global attention on MNS disorders as a core development issue requiring commitments to improve access to care, promote human rights, and strengthen the evidence on effective prevention and treatment.

IN 1928, BENJAMIN MALZBERG, A YOUNG EPIDEMIOLOgist in New York State’s Division of Mental Hygiene, began a groundbreaking study examining causes of mortality in New York State’s mental hospitals. During the ensuing 3 years, Malzberg reviewed every death that occurred throughout the state’s psychiatric hospital system; his findings were both surprising and troubling. Patients in these hospitals died an average of 15 years younger than the general population of New York State. Malzberg speculated that these excess deaths were likely due to a complex combination of factors