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U.S. General Accounting Office Issues Report on Community-Based Services for People With Severe Mental Illness

For Immediate Release, December 29, 2000
Contact: Chris Marshall

On December 19, the General Accounting Office (GAO) - an investigative arm of Congress - issued a long awaited report on community-based mental illness treatment services. This report was requested last year by Senate Finance Committee Chairman William V. Roth (R-DE) and the Committee's Ranking Democrat, Daniel Patrick Moynihan (D-NY). Both senators have had a long interest in mental illness, particularly Senator Moynihan, who served on a landmark reform commission in New York State in the 1960s under the late Governor Averell Harriman and was involved in drafting the Community Mental Health Center Act of 1963 in the Kennedy Administration. Unfortunately, neither senator will be returning to the Congress in 2001, Chairman Roth having lost reelection and Senator Moynihan retiring.

The GAO report contains several important findings:

  • While mental health spending paralleled the growth in overall health spending between 1987 and 1997, federal mental health spending grew at twice the rate of state and local spending (a trend resulting both from cuts in state-local spending with simultaneous increases in Medicare and Medicaid spending),
  • The focus of treatment for adults with severe mental illness has continued to shift from psychiatric hospitals to the community, a trend the GAO says has accelerated with the development of newer medications that produce fewer side effects,
  • Coordinating and integrating treatment and services through approaches such as the Program of Assertive Community Treatment (PACT), supported employment and supportive housing have proven effective, especially for homeless people with severe mental illness (in part the GAO says because of co-occurring substance abuse disorders),
  • Medicaid continues to be a major source of support for people with severe mental illness, although incentives associated with capitated payment can lead to reduced service utilization (GAO also notes that the federal Health Care Financing Administration is developing a set of safeguards to ensure access to appropriate care for Medicaid managed care).

While this GAO report is an important step forward in documenting trends in community-based programs and spending, it does not include several important issues that were not included in the original questions put forward by Senators Roth and Moynihan. For example, GAO was not asked to determine whether community mental health centers (CMHCs) that have received federal funds have maintained their focus on serving adults with severe mental illnesses or have expanded their mission to prevention of all mental disorders in the broader population. Likewise, the GAO was not asked to assess the link between cuts in state and local spending on community-based services and the growing concentration of adults with severe mental illness in jails and prisons.

The full text of the GAO report can viewed at:

Copies can also be ordered by phone at 202-512-6000, 202-512-6061 (fax), refer to report number GAO-01-224.