Abstract

Howard H. Goldman M.D., Ph.D. 1 , Joseph P. Morrissey Ph.D. 2 , and M. Susan Ridgely M.S.W. 3 1 University of Maryland School of Medicine, 645 West Redwood Street, Baltimore, Maryland 21201 2 Health Services Research Center at the University of North Carolina in Chapel Hill 3 Mental Health Policy Studies Program at the University of Maryland School of Medicine The Robert Wood Johnson Foundation Program on Chronic Mental Illness provides support for broad change in the organization, financing, and delivery of services in public systems of care for chronic mentally ill persons. To address the lack of an organizational locus of responsibility in these systems, the foundation proposed that each of the nine cities participating in the program create a mental health authority that would centralize administrative, clinical, and fiscal oversight. The authors present site-by-site observations of the developing mental health authorities at the end of the program's two-and-a-half-year planning phase. They conclude that although the Robert Wood Johnson Foundation grant represented a significant incentive for innovation, at this relatively early stage in the demonstration authorities at only a few sites bad achieved direct clinical responsibility for chronic mentally ill persons. Although services had expanded, no site had yet developed a comprehensive system of care that included inpatient services as well as a full range of ambulatory, housing, and social welfare services.