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Book Forum: Psychiatry in Society   |    
Disability at the Dawn of the 21st Century and the State of the States, 6th ed.
STEVEN S. SHARFSTEIN, M.D.
Am J Psychiatry 2004;161:179-a-180. doi:10.1176/appi.ajp.161.1.179-a
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Baltimore, Md.

Edited by David L. Braddock. Washington, D.C., American Association on Mental Retardation, 2002, 498 pp., $99.95.

The politics of disability, both mental and physical, have come of age. Since the publication of the first edition of this volume 20 years ago, a revolution has taken place in the rights of individuals with disabilities and in the financing of services in community-based settings. David Braddock, the editor of this volume, is the Chair in Cognitive Disability and Professor of Psychiatry at the Coleman Institute for Cognitive Disabilities at the University of Colorado. In part 1 of this edition, he and coauthor Susan Parish review in depth public financing for disability across federal, state, and local levels. It is, I believe, the most comprehensive effort to date across all categories of disability (mental, physical, and sensory) since the United States Supreme Court ruled in its critical Olmstead decision (1) promoting community services. Despite the Supreme Court decision, the majority of $109 billion of public support for individuals with disabilities remains in institutional care, especially nursing homes. The chapter by Braddock and Parish is very useful for advocates for the mentally ill because it reviews and compares changes in treatment for the mentally retarded, the mentally ill, and individuals with sensory disabilities such as deafness and blindness.

Part 2 of this volume presents the state of the states, a review of developmental disability and mental retardation services in all 50 states and the District of Columbia. The social policy issues emphasized are the aging of family caregivers; class action litigation associated with waiting lists for residential care; and the Medicaid home and community services waiver, which is the financial engine behind the growth of community services. It should be noted that neglect of individuals with disabilities is always cheapest; the next least costly alternative are economies of scale in large institutions. What is unique in today’s political marketplace is the emphasis on the quality of care for those with disability and the optimism that they can return to full productivity.

Part 3 of this very useful volume is a study of two Midwestern states, Michigan and Illinois, comparing developmental disability policies in two states that are similar demographically and politically but embarked on radically different courses. Illinois primarily emphasizes institutional care, and Michigan focuses on community-based care.

For psychiatrists and advocates for the mentally ill, this volume is especially useful as we argue for parity of insurance coverage and sustained support of Medicaid financing for community-based services. As it becomes increasingly apparent that major mental illness is a brain impairment, the social construction of disability changes when opportunities for treatment, rehabilitation, and community support grow. There is no question that there is a growing sense of optimism for care and treatment of those with disabilities in the 21st century.

Olmstead v LC, 527 US 581; 119 S Ct 2176 (1999)
 
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References

Olmstead v LC, 527 US 581; 119 S Ct 2176 (1999)
 
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