Talbott J A, Sharfstein S S
Hosp Community Psychiatry. 1986 Nov;37(11):1126-30. doi: 10.1176/ps.37.11.1126.
The estimated 1.7 to 2.4 million Americans who suffer from chronic mental illness are poorly served by the current nonsystem of services. No agency at any level is responsible for coordination of funding, treatment, and care. Since the mid-1950s funding has become increasingly fragmented as state mental hospitals have been depopulated, community services have been developed, and federal entitlement programs such as Medicaid, Medicare, and Social Security Disability Insurance have been introduced. To overcome the problems of fragmented funding and uncoordinated services, the authors propose establishment of a new federal entitlement program for the chronic mentally ill that would pool all existing funds regardless of the source. States would be empowered to develop a single administrative agency with responsibility for coordinating a comprehensive program of services.
目前这种毫无体系的服务状况难以满足估计达170万至240万患有慢性精神疾病的美国人的需求。各级政府均无机构负责资金、治疗及护理的协调工作。自20世纪50年代中期以来,随着州立精神病医院病人数量减少、社区服务得到发展以及诸如医疗补助、医疗保险和社会保障残疾保险等联邦福利项目的引入,资金来源变得日益分散。为克服资金分散和服务不协调的问题,作者建议为慢性精神病患者设立一项新的联邦福利项目,该项目将整合所有现有资金,不论其来源如何。各州将有权设立一个单一的行政机构,负责协调全面的服务项目。