Am J Psychiatry 1992; 149:175-183
Copyright © 1992 by American Psychiatric Association
Community mental health and mental retardation services in the United States: a comparative study of resource allocation
D Braddock
School of Public Health, University of Illinois, Chicago 60608.
OBJECTIVE: Preliminary studies suggest that during the 1980s, spending for
community mental retardation services in the United States may have grown
much more rapidly than spending for community mental health. The primary
objective of this study was to test empirically the validity of this thesis
on a national basis. An additional objective was to determine why such a
distinction in community spending patterns might have evolved nationally.
METHOD: The study used states as the units of analysis and employed a
five-factor hierarchical regression to predict variance in mental health
and mental retardation spending. Factors were state size, state wealth,
degree of federal assistance, state civil rights activity, and strength of
consumer advocacy groups. Strong roles for the civil rights and consumer
advocacy factors were hypothesized. A collateral opinion survey in the 10
states exhibiting the greatest within-state difference in community mental
health and mental retardation spending was also completed. RESULTS:
Community mental retardation spending grew nearly four times more rapidly
than community mental health spending in the 1980s. The consumer advocacy
and civil rights factors were strongly associated with spending for
community mental retardation services in the states, but these factors did
not predict spending for community mental health services. CONCLUSIONS:
Study recommendations included strengthening mental health family and
consumer advocacy groups in the states and promoting systematic exchange
between the mental health and mental retardation fields through joint state
planning initiatives, studies, and conferences. The need for Medicaid
reform is a unifying theme in both the mental health and mental retardation
fields.
