The Young Chronic Patient and the NIMH Task Force Report
Barely two decades after the passage of the Community Mental Health Centers Act and the thrust toward deinstitutionalization, a new generation of young, severely mentally ill patients who had never set foot inside a state mental institution began to emerge. These post-World War II “baby boomers” (Bachrach, 1982) experienced illness onset at a time when long-term care provided by state mental hospitals was being replaced by acute-care services available in emergency departments, general hospital psychiatric units, and outpatient clinics. Findings from early studies of “young adult chronic patients” presaged the clinical and social issues that would challenge mental health professionals in years to come: the widespread use of alcohol and street drugs, frequent hospitalizations and use of crisis services, denial of illness and non-compliance with prescribed outpatient follow-up care, self-destructive behavior and violence, contact with the criminal justice system, and residential instability (Caton, 1981; Lamb, 1982; Pepper et al., 1981; Schwartz & Goldfinger, 1981; Sheets et al., 1982).
In the years that followed, homelessness continued to plague people with severe mental illness. In response, the NIMH established the Federal Task Force on Homelessness and Severe Mental Illness, involving federal departments responsible for aspects of service delivery to this population. The Task Force recommended greater collaboration of federal, state, and local governments, and a grants program was developed to encourage integrated systems of treatment, housing, and support (Federal Task Force on Homelessness and Severe Mental Illness, 1992).