Public Image of Mental Health Services

Abstract

Planning the efficient distribution and delivery of health and welfare services is more than a process of matching needs and resources plus the filling of service gaps. Present practice requires working with a conglomeration of inadequate data subject to diverse interpretations; following hunches based on varying experience; resolving power conflicts; considering ideas whose time (according to their proponents) has come; and responding to the clear urgencies of the moment. What complicates the problems even more is that planners-especially in the mental health field-must deal with unclear and competing definitions of community, different ideas of who makes up the consumer population, who are the authorized professionals and even controversy about what the illnesses may be. It is no wonder, therefore, that the program undertaken in New York City on the basis of the State Community Mental Health Services Act of 1954-impacted from outside' by concurrent and subsequent federal activity-has variously zigzagged, spurted ahead, regressed, drifted, yet inexorably expanded. The agency has grown into an organism whose work in some areas (e.g., growth of permanent investment and quantity of resources) has been relatively successful; in other areas (standard setting) modest and in still others (leadership, coordination, comprehensiveness and continuity of service) questionable. New York City has at least pioneered; its mental health agency