A Note About the Papers on Care of the Least Well Off in Mental Health Services

As health care resources grow tighter, mental health program managers and policy makers in both the public and the private sectors must increasingly make decisions setting priorities for service delivery. On March 27, 1998, the special committee on treatment of seriously mentally ill veterans of the undersecretary for health of the Department of Veterans Affairs, together with the VA's Connecticut-Massachusetts Mental Illness Education Research and Clinical Center, sponsored a conference on the obligation to the least well off in setting mental health service priorities. The conference, which took place at the Cannon Office Building of the U.S. House of Representatives in Washington, D.C., was held in honor of Paul Errera, M.D., director of VA's Mental Health and Behavioral Science Service from 1985 to 1994, and Thomas Horvath, M.D., current director of the Strategic Health Group for Mental Health at VA headquarters, who have provided strong leadership in recognizing the nation's responsibility to veterans disabled by mental illness.

A consensus statement developed by the conference presenters, which was reproduced in the October 1998 issue of Psychiatric Services (pages 1273-1274,1290), had as one of its foundations the tenet that "civilized societies have a deep and irrevocable obligation to people with serious mental illness." One of its conclusions was that "as VA and other health care systems undergo momentous changes in their operation, political leaders and health care administrators must be aggressive in preserving and enhancing services for this population."

This issue presents three papers from that conference that elaborate in greater detail the foundations for the consensus statement from the fields of psychiatry, ethics, economics, and public policy.