Strategies for improving services for the chronic mentally ill.

A central goal of policies aimed at improving care of the chronic mentally ill is better service coordination and integration. The author examines four current policy strategies--continuous care teams, local mental health authorities, integrated entitlement programs, and capitation payment systems--and discusses their incorporation in four model programs of integrated services. The programs differ in the degree to which they attempt to direct service coordination at the patient level, but all four programs have created local mental health authorities to oversee services. The success of any of the policy strategies depends on a system's capacity not only to regulate services but to ensure that presumed incentives to deliver cost-effective services filter down to well-trained and motivated front-line staff.