Stephen Metraux, PhD
Assistant Professor of Health Policy
Health Policy Program
University of the Sciences in Philadelphia
Email: s.metrau@usip.edu

While community living is now a centerpiece of mental health policy, its implementation has been problematic and offers numerous challenges for those interested in the economic, social and psychiatric well being of persons with severe mental illness. Along with this concern has come the realization that providing effective community mental health services requires a better understanding of how these services, and the individuals receiving these services, interact with other public systems, particularly in the areas of health, housing, and criminal justice.

WHAT IT ENCOMPASSES

Over the last half century, a primary goal of mental health policy has been to integrate persons with psychiatric disabilities into all aspects of community life to the maximum extent that is possible and that they desire. One means by which to assess the successes and shortcomings of this community integration process is by examining the utilization of different public systems such as housing, income support, Medicaid, homeless services and corrections.

WHAT IS ITS IMPORTANCE TO HEALTH POLICY

The deinstitutionalization of persons with psychiatric disabilities represents one of the most significant shifts in 20 th Century health policy. Research on mental health services and related services in the community is vital to ensuring that persons with psychiatric disabilities realize the improved quality of life and access to care that was a promised outcome of deinstitutionalization.

BRIEF HISTORY OF RESEARCH ON THIS SPECIAL TOPIC

Since the mid 1950’s, the provision of mental health services in the US has increasingly de-emphasized the role of the asylum. This has resulted in basic shifts to where 1) mental health services now are predominantly ambulatory and community-based; 2) psychiatric hospitalizations are chiefly short term stays designed to treat bouts of acute symptoms onset; and 3) persons with psychiatric disabilities, unless they are judged to be extremely ill or dangerous, now live most of their lives in community settings. As deinstitutionalization becomes a fait accompli, research on community mental health services has encompassed both the problematic implementation of this new paradigm and the extent to which persons with psychiatric disabilities have become integrated into the community.

PROMISING AREAS OF NEW RESEARCH

A growing area of research focuses on the process of community integration for persons with psychiatric disability. This research has increasingly come to focus on the social and economic barriers that impede successful community integration and the means by which to overcome these barriers. Alternately, the shortcomings of community integration, as well as the most acute challenges to this process, are highlighted by the disproportionate representation of persons with psychiatric disability among populations who are impoverished, incarcerated and homeless.

FACULTY MEMBER’S PUBLICATIONS RELATED TO THIS TOPIC

Métraux, Stephen & Dennis P. Culhane (2004). “Homeless Shelter Use and Reincarceration Following Prison Release: Assessing the Risk.” Criminology & Public Policy 3(2): 139-160.

Metraux, Stephen, Steven C. Marcus, & Dennis P. Culhane (2003). "Assessing the Impact of the New York/ New York Supported Housing Initiative for Homeless Persons with Severe Mental Illness on Public Shelter Use in New York City." Psychiatric Services 54(1): 67-71.

Rothbard, Aileen B., Stephen Metraux & Michael B. Blank (2003). “The Cost of Care for Medicaid Recipients with Serious Mental Illness and HIV/AIDS.” Psychiatric Services 54(9): 1240-1246.

Culhane, Dennis P., Stephen Metraux & Trevor R. Hadley (2002). "The Impact of Supportive Housing for Homeless People with Severe Mental Illness on the Utilization of the Public Health, Corrections, and Emergency Shelter Systems: The New York- New York Initiative." Housing Policy Debate 13(1): 107-163.

Metraux, Stephen (1999). “Waiting for the Wrecking Ball: Skid Row in Postindustrial Philadelphia.” Journal of Urban History 25(5): 690-715.