ABSTRACT
Unlike most other countries, the US does not have a national mental health system or any one federal entity that is responsible for overseeing the delivery of mental health services. Rather, the patchwork of services for mental disorders in the US is a de facto system of care made up of a range of financing mechanisms, patient populations, and sectors (Regier, Goldberg, & Taube, 1978; Regier, Narrow, Rae, Manderscheid, Locke, & Goodwin, 1993). Mental health care is delivered in different service sectors, and this chapter focuses primarily on the two service sectors that are part of the formal health system. The specialty medical sector comprises care by mental health professionals (e.g., psychologists, psychiatrists) in settings dedicated to behavioral health services. The general medical/primary care sector consists of primary care physicians and allied medical professionals (e.g., nurse practitioners) who may provide mental health treatments as part of a broader array of health services. Three additional service sectors, the human services, voluntary support, and complementary and alternative medicine sectors, are not part of the formal health system, but are nonetheless important in the delivery of mental health care. While these will not be a focus of this chapter, we describe them briefly below. The human services sector consists of religious services as well as social welfare, criminal justice, and educational services. For the general adult population in the US, members of the clergy may be the only point of contact for persons with mental distress and more serious conditions (Wang, Berglund, & Kessler, 2003). The voluntary support network refers to self-help groups and organizations. This sector, which grew out of the Alcoholics Anonymous program developed in the late 1930s, has had growing importance for persons with more serious and persistent mental illness. A total of 13.3% of the US population report having attended a 12-step meeting for alcohol or other conditions (Room & Greenfield, 1993). Mental health consumers who have received certification as peer specialists help train other peers to work towards goals of mental health
and recovery. Medicaid programs in 25 states now reimburse services for these peer specialists, who are increasingly moving from the voluntary sector to the formal mental health workforce (Davidson, Chinman, Sells, & Rowe, 2006). The complementary and alternative medicine (CAM) sector is comprised of healers, such as chiropractors, who provide a range of treatments not formally taught in medical schools or reimbursed by health providers. A substantial proportion of persons in mental health treatment also are engaged in CAM treatment (Druss & Rosenheck, 2000).
