history

boronow, 5/1/2007 1p lecture

1954 thorazine developed
1955-1965. no outpatient services available, de institutionalizing
1966- JFK and LBJ started social services like
Medicare 1964
Medicaid 1965
Community Mental Health Act 1965 (which Sharfstein helped implement in the 1970s)
SSDI linked with Medicare; qualify for SSDI after 1.75 yrs of working, after 2 yrs of working qualify for Medicare
SSI linked with Medicaid

NYC- psychiatric ghettos. one of which was in South Beach of Brooklyn. slums of poor conditioned housing, substance abuse, prostitution. near Kings County Hospital.

1985 Project House in Maryland; has a waitlist of years
Board and Care "cottage" industry in the city
group homes

Fountain House in NYC, a clubhouse of sorts, started by and for people with psychiatric problems; dependent on charity

1990s, psychiatric rehab programs. New Adventures

1990s, managed care. GreenSpring --> Magellan of today
1st TN- destroyed the med care system
2nd MA- some resistance, coming fr Boston
3rd NY- more entrenched in social programs. ASO
4th MD
mental health clinics with salaried workers, block grants
being phased out by
small business model, where the bottom line is the end point