Individuals with chronic mental illness face enormous challenges getting the care they need. Not only do they have to cope with their illness, but they and their families must also try to arrange services from two complex and often unreceptive systems of care: the medical system and the social service system. Following the movement of patients from state mental hospitals to community settings, the problems faced by people with chronic mental illness became more visible to the American public.
In 1987 and 1988, the Robert Wood Johnson Foundation launched three national programs to improve services for people with chronic mental illness. Two of them—the Mental Health Services Program for Youth, which was examined by Leonard Saxe and Theodore Cross in last year's Anthology, and the Program on Chronic Mental Illness, which is discussed in this chapter—attempted to better coordinate mental health care services. The third program, the Mental Health Services Development Program, did not focus on improving systems of care but, rather, on improving the quality of clinical and social services.