The Obligation of Mental Health Services to the Least Well Off

Since the 1970s public mental health policy has given priority to the least well off—those with the most severe impairments and those who are most indigent. Reforms during this era have focused on the social welfare as well as the health and mental health needs of this population. The author briefly examines the key service demonstration programs and policy changes of the past 20 years in the light of society's obligation to the least well off. Despite a variety of policy threats to the priority accorded this population in the 1980s, the focus on the least well off has been sustained. The mental health field could do a much better job, however, in implementing the lessons learned from service demonstration programs. Recent changes in managed care and social welfare policy challenge the field's commitment to the least well off. However, the rise in consumerism and self-advocacy has sounded a more optimistic note from a population determined no longer to be least well off.