A model for mental health

February 14, 1994

Private philanthropy can't solve social ills, but it can point the way toward promising solutions. Since 1986, Baltimore has had the benefit of an unusual private-public partnership in the administration of services to mentally ill adults throughout the city. Baltimore Mental Health Systems, Inc. (BMHS), originally funded by a $2.5 million grant from the Robert Wood Johnson Foundation, has become the city's central mental health authority. The agency is technically separate from the Baltimore City Health Department, through which its funding flows. But four government officials, including the city health commissioner, sit on the system's board to insure accountability.

BMHS does not deliver services itself, but concentrates on planning, coordinating and overseeing various programs designed to treat mental illness. Stephen T. Baron, president of BMHS, also stresses the system's role of fostering the values that should guide the delivery of services.

So far, the results have been impressive. BMHS has improved the delivery of services. It has strengthened the city's ability to respond to psychiatric crises, created a better system for managing and tracking individual cases and expanded mental health services to many people who previously got none at all, including many homeless adults. Some of its most notable accomplishments have been in providing affordable housing to adults who, with appropriate support networks, can live on their own.

These achievements have made the system a model for other jurisdictions as well. Dr. Miles F. Shore, a Harvard professor who monitored BMHS as a director of the Robert Wood Johnson Foundation, has described the system as a health care equivalent of an Inner Harbor development. As one sign of its success, the system was handed responsibility last summer for the city's child and adolescent mental health services.

As the BMHS experiment demonstrates, the quality of social services can often depend as much on how money is spent as on how much is allocated. The deinstitutionalization of mental patients in the 1970s and '80s presumed that community-based services would replace residential treatment. But in most instances those services were not in place, and that gap led to tragic outcomes for many patients and their families. Mental health services aren't perfect in Baltimore, but under BMHS the pieces of a comprehensive, humane, well-coordinated and effective program are falling into place.

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