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At the National Council for Community Behavioral Healthcare annual conference held in New Orleans, attention was directed to the celebration of the 40th anniversary of the community mental health center movement. To most people, this may not sound like a momentous occasion. In fact, it was, especially for people whose lives are affected by behavioral health problems like mental health diseases or addictions. It was an occasion to review the forty years of progress in behavioral health care and behavioral health care management since President John F. Kennedy signed into law the Mental Retardation Facilities and Community Mental Health Centers Construction Act of 1963.

President Kennedy called it a "bold new approach" that substituted custodial institutional care with comprehensive community care.

We have all heard sad stories of asylums and bedlams where suffering mental health patients and addicts were confined. And while, with advances in pharmacology and the psychological sciences, these institutions were improved and modernized over the years, it was not until the movement was underway that the philosophy of institutionalization was abandoned—or at least subordinated—to a more socially humane philosophy of care.

Many states took the lead in what became known as "deinstitutionalization." In the past 40 years since the passage of the Act, the number of institutional mental health beds has been drastically reduced in New York; facilities have been closed and boarded up. Patients under care were screened and discharged to their homes; while at the same time programs of therapy were set up and administered to them as outpatients in community mental health centers. These centers are sponsored by governmental jurisdictions, county or city, by hospitals or by independent freestanding providers.

In New York State, there are more than 3,000 programs that provide care to outpatients through community mental health organizations. The rationale for this far-reaching system change was the pursuit of better care. And this has proven correct. Out of the movement have come more precise therapies to address individual needs. In my hospital, for example, we have an outpatient clinic for children with mental retardation impairment distinct from a clinic for children with mental disease. A whole array of drugs is available to target specific diseases. There has grown up a parallel support group movement where outpatients can obtain information as well as social encouragement among peers. Moreover, socialization with family has proven to be a valuable therapy not only for relieving symptoms of mental illness, but also for giving a sense of peace and confidence to the patient.

We accept the benefits and advantages of the community health center movement today casually, forgetting the enormous change it is from the old institutional days of state and county hospitals "for the insane." But the movement is not over. The expectations for improving the health of our patients are greater. The movement relies more than ever on good management skills to shape emerging programs and integrate them fully into the overall healthcare system. With the shift in emphasis from inpatient to outpatient care, behavioral healthcare managers are called upon to apply principles of management in a care environment characterized by the dynamism of new payer systems (HMOs) and the fusion of mental health services with addiction services. It helps as we do this work to be constantly aware that we serve a population of chronically affected persons who are walking among us and working beside us as our friends and neighbors.

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