Despite these facts, systems of care that treat individuals with serious mental illness are separate from general medical systems of care. From the mid-19th to the mid-20th century, psychiatric care took place in institutions, primarily state hospitals. Since the 1960s, most care has occurred in community settings, such as community mental health centers, day programs, nursing homes, and homeless shelters. These are separate mental health specialty programs; physical health care takes place elsewhere or not at all. Federal and state financing have reinforced two separate systems of care—one for mental health, one for physical health.