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The National Institute of Mental Health (NIMH), established at the end of World War II, had an important influence on the growth of medical sociology and especially on social research in mental health. Its first director, Robert Felix, sought to include the social sciences as basic sciences for the study of mental health issues and problems. He strongly supported PhD training and extramural research and contributed to the growth of sociology, anthropology, and psychology as disciplinary areas. The fact that initially public support for sociology largely came through NIMH rather than other disease-oriented institutes explains the dominance of mental health concerns within the development of medical sociology. With increasing numbers of sociologists trained in NIMH programs, medical sociology became one of the largest and most active sections of the American Sociological Association (ASA). Felix was committed to bringing a public health perspective to the study and treatment of persons with mental illness, a viewpoint that began to erode during the Reagan administration when politics forced NIMH into a more insular disease perspective. The public health view has now again gained traction on the nation's health agenda, with a renewed interest in social determinants of health and socioeconomic and ethnic/racial disparities.
In earlier decades, training programs encompassed broad areas of social psychology, social organization, and social methodology; this breadth encouraged the wide range of substantive interests and theoretical and methodological approaches exhibited in this Handbook. NIMH predoctoral and postdoctoral awards supported my training in the 1950s, and probably many, if not most, of the contributors to this Handbook had similar support during their disciplinary training. I have been involved for more than fifty years in running such training programs at the University of Wisconsin and Rutgers University; in the earlier decades these programs had a strong focus on promoting and expanding knowledge and methods in the basic areas of the discipline. Many of those who participated in these and related programs have contributed importantly not only to mental health but also to their disciplines. Programs funded today are much more focused on problem areas and interdisciplinary efforts, but it remains essential for researchers to be strongly involved with the conceptual, theoretical, and methodological advances in their disciplines if they are to be effective partners in interdisciplinary collaborations.
Mental health services depend both on efficacious drug and interpersonal interventions and strategies for financing, organizing, and delivering these services. In recent years, much attention has been devoted to approaches that seek to coordinate needed care and to provide it in the most cost-effective ways. Cost constraints encourage the substitution of alternative community treatments for expensive inpatient care and the identification of appropriate ways to link effectively the varying care components. The mechanism most commonly advocated is case management, but the concept is applied in diverse ways and has little agreed upon meaning and disparate outcomes. This paper discusses and evaluates concepts of case management and a variety of other systems interventions designed to reduce fragmentation. It also reviews approaches to managed care, including mental health capitation and utilization management. New organizational technologies are likely to change dramatically professional practices and standards and the future provision of mental health care.