The McKinney Act: New England Responses to Federal Support for State and Local Assistance to the Homeless and Mentally Ill

The Stewart B. McKinney Homeless Assistance Act of 1987 builds on the work of state mental health authorities and the National Institute of Mental Health in the early 1980s. The act and its subsequent amendments are designed to organize, coordinate, and enhance federal support to the states in financing the development of shelter, health, housing, employment, and support services to homeless persons. There is a special focus in the act on assisting homeless persons with handicaps. In the main, the New England states have met the requirements of the act to provide mandated essential services, which include outreach; community mental health, crisis, and rehabilitation services; health and substance-abuse services; training of homeless service providers; case management, including service planning, benefits assistance, and service coordination; and supportive residential services. While the federal funds available are insufficient to cover the majority of costs associated with serving homeless and mentally ill persons, states report their utility in targeting high-needs areas, supporting demonstrations of service innovations, creating incentives for state and local matching funds, and focusing on vulnerable subpopulations. State advocates credit the McKinney Act mental health programs for stimulating localities\u27 interest in and ability to attract HUD funding for housing special needs persons among those homeless. Within the contrary New England economic context, the federal contribution is an important resource and stimulus to state spending

State Mental Health Policy: Critical Elements of Public-Sector Managed Behavioral Health Programs for Severe Mental Illness in Five States

The term “managed care” may be used to describe a wide variety of arrangements that have different structures, functions, and effects on the care of people who have behavioral health disorders. The evaluation of public-sector managed care plans has been hindered by a lack of a systematic vocabulary for describing them and a lack of instruments to operationalize this vocabulary into a set of measurement procedures. We developed and pilot tested an instrument to be used in categorizing public-sector managed care arrangements (1). The instrument was used to collect descriptive data on managed care plans in the Managed Behavioral Health Care in the Public Sector Study conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). In this multisite study, a competitive process was used to fund 21 sites in order to evaluate managed behavioral health services for four target populations. Here we report preliminary descriptive data from five SAMHSA sites at which the impact of managed care on adults with severe mental illness— one of the most vulnerable and important public-sector target populations— was studied