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| Long title | A bill to improve the provision of mental health services and otherwise promote mental health throughout the United States; and for other purposes. |
|---|---|
| Acronyms (colloquial) | MHSA |
| Enacted by | the 96th United States Congress |
| Citations | |
| Public law | Pub.L. 96-398 |
| Codification | |
| Acts amended | Community Mental Health Centers Act, Public Health Service Act, Social Security Act |
| Titles amended | 42 |
| U.S.C. sections created | 42 U.S.C. §§ 9401–9523 |
| U.S.C. sections amended | 42 U.S.C. § 210, § 225a, § 242a, § 300m, § 1396b, § 2689 |
| Legislative history | |
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The Mental Health Systems Act of 1980 (MHSA) was an United States legislation signed by President Jimmy Carter which provided grants to community mental health centers. In 1981 President Ronald Reagan, who had made major efforts during his Governorship to reduce funding and enlistment for California mental institutions, pushed a political effort through the Democratically controlled House of Representatives and a Republican controlled Senate to repeal most of MHSA.[1] The MHSA was considered landmark legislation in mental health care policy.
Historical Background
In the backdrop of the 1960s and 1970s there was a rise in the community health movement as a response to deinstitutionalization efforts in health care. Coinciding with a movement during the 1970s for rehabilitation of people with severe mental illnesses, the Mental Health Systems Act supported and financed community mental health support systems, which coordinated general health care, mental health care, and social support services.[2] Before this movements gained momentum, mentally ill individuals were often placed in some state run psychiatric hospitals for extended periods, where they received long-term custodial care. [3] The community mental health movement sought to shift the focus of care from institutional settings to community-based services, transitioning from care to community based services, aiming for more compassionate and efficient treatment with the goal of providing more humane and effective treatment for those struggling with their mental health. [4] One pivotal legislation supporting this shift was the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963, also known as the Community Mental Health Act (CMHCA). It provided federal funding for the establishment of community mental health centers (CMHCs) across the country.[5] These centers were intended to offer a range of mental health services, including outpatient care, crisis intervention, and rehabilitation, with the goal of reducing the need for long-term institutionalization.[6] However, by the late 1970s, it became clear that the initial promise of the community mental health movement had not been fully realized. While many CMHCs had been established, they faced challenges in securing ongoing funding and providing comprehensive services to individuals with mental illnesses.[7] The law followed the 1978 Report of the President's Commission on Mental Health, which made recommendations for improving mental health care in the United States. While some concerns existed about the methodology followed by the President's Committee, the report served as the foundation for the MHSA, which in turn was seen as landmark legislation in U.S. mental health policy.[8] In response to these challenges, Congress passed the Mental Health Systems Act in 1980.
The short life of The Mental Health Systems Act of 1980
The Mental Health Systems Act (MHSA) of 1980 could be considered as some sort of landmark legislation passed by the United States Congress, it has as its main goal to fundamentally reform the mental health care system in the country by emphasizing in community based care where focus of mental health services would shift from institutionalization towards community-based, where states would provide appropriate treatment and related services in most supportive settings, with oversight and funding.[9] It tried to address deficiencies and shortcomings of the existing mental health system by boosting federal funding and support for community-based services. The act emphasized the importance of comprehensive, integrated mental health care that addressed the needs of individuals across the lifespan and provided support for services such as crisis intervention, rehabilitation, and housing. The MHSA represented a moment in the evolution of health policy in the United States as it was enacted during a time when there was increased awareness and advocacy for mental health services. The goal was to revitalize the community health movement that began in the 1960s by prompting states to amend their laws to ensure protection and services for mental health patients while enhancing community based mental health services at a national level. Additionally it introduced a Patients’ Bill of Rights Act, which served as the Patients’ Bill of Rights specifically tailored for mental health patients. It also included an advocacy provision offering grants for experimental pilot programs designed to provide mental health advocacy services to individuals, with mental disabilities. [10]
Key components of the Mental Health Systems Act included:
- One of the aspects of the Mental Health Systems Act involved allocating block grants to states to bolster the establishment and growth of community health services. The block grants gave states flexibility in using funds allowing them to customize services to fit the unique needs of their communities. These grants were designated for establishing and expanding community health centers nationwide. The goal was to offer a range of health services, such, as prevention, diagnosis, treatment and rehabilitation at the community level rather than in large institutions. [11]
- The Mental Health Systems Act provided funding to states for creating and implementing community based health services with a focus on building an accessible mental health care system that emphasized research and evaluation to enhance services. It also set aside funds for research on illness prevention, treatment effectiveness and the structure of health systems.[12]
- Furthermore the Mental Health Systems Act stressed the importance of collaboration among state and local governments well as between mental health providers, social service agencies and other community groups. It acknowledged that meeting the needs of individuals with illnesses required a unified approach involving various disciplines.[13]
Despite its objectives some members of Congress and the Reagan administration opposed the Mental Health Systems Act due to doubts about the governments role, in funding and supervising mental health services.[14][15][16]
Repeal of most of the provisions in 1981
The Omnibus Budget Reconciliation Act of 1981, passed by a Democratic-controlled House of Representatives and a Republican-controlled Senate, and signed by President Ronald Reagan on August 13, 1981, repealed most of the Mental Health Systems Act. The Patients' Bill of Rights, section 501, was not repealed; per Congressional record, the Congress felt that state provisions were sufficient and section 501 served as a recommendation to states to review and refine existing policies.[17]
Most of the provisions, in 1981 were repealed by President Ronald Reagan after taking office as part of his efforts to cut spending and reduce the governments involvement in social welfare programs.[18]
Of the Mental Health Systems Act Reagans administration introduced the Omnibus Budget Reconciliation Act of 1981 which combined funding for social service programs, including mental health services into a single grant given to states. Supporters believed this approach gave states flexibility and independence. Critics feared it would result in reduced funding for mental health services and go against the community mental health movements objectives.[19] The repeal occurred within the broader context of shifting political ideologies and priorities in the United States, following the election of President Ronald Reagan in 1980. Reagan advocated for smaller government, reduced federal spending, and greater emphasis on states' rights and local control. With a focus on government decreased spending and promoting states rights and local governance there was a reevaluation of federal involvement and financing in areas, like mental health. In 1981, the Omnibus Budget Reconciliation Act (OBRA) was approved by the National Congress and signed into law by President Reagan.[20] It included provisions that repealed most of the MHSA, discontinuing federal funding and the support for community mental health centers established under the MHSA. OBRA redirected mental health funding mechanisms and transferred more responsibility for mental health services to the states, reducing significantly federal funding for mental health programs. [21][22] The repeal of most provisions of the MHSA in 1981 reflected broader shifts in political priorities, budgetary constraints,[23] and changing attitudes toward federal involvement in mental health policy and funding. It was primarily driven by several reasons and circumstances.
Consequences of the Repealment
Undoubtedly the repeal of the Mental Health Systems Act had an effect on the health system in America. The decrease in funding for health services led to service cuts and closures of numerous community mental health centers. Individuals with illnesses encountered increased difficulties, in accessing care with facing homelessness, incarceration or inadequate support. The Mental Health Systems Act of 1980 was an initiative aimed at enhancing and broadening community based health services across the country. Yet its influence was brief as changes, in politics during the 1980s resulted in its removal and a notable decrease in government backing for health programs. Though the objectives of the community mental health initiative are still applicable today the difficulties in obtaining funding and assistance, for health services persist as a significant issue.[citation needed]