The NIMH community support program: Pilot approach to a needed social reform

Abstract

NIMH plans for a pilot program to address current service delivery problems affecting the adult mentally disabled in an era of deinstitutionalization are described. Inadequacies in existing services as seen by the press, professionals, a consumer, and Congressional investigators are discussed. Reference is made to legal and judicial pressures on the service system that have necessitated a more concerted approach to serving mentally disabled people in the least restrictive setting. During the past 4 years, NIMH has attempted to provide leadership in seeking needed improvements, and sought to develop a consensus from representative individuals and groups about goals of a reform effort and strategies that might be tested. Two outcomes of this participatory planning process are presented: a reconceptualization of the service elements required by the target population, and the 'community support system' model as it is reflected in the NIMH Community Support Program, a pilot strategy for stimulating change. Interagency and intergovernmental aspects of the pilot program, designed to provide a framework within which improvements can be developed and evaluated, are discussed. Key program evaluation issues, tentative NIMH plans for an evaluation strategy, and methodological problems are noted.