Implementing the lessons of mental health service demonstrations: human rights issues

Is the failure to implement the lessons of mental health service demonstrat ions an ethical problem? This paper reviews the experience with evaluating multi-site service demonstration programs in the United States. Some of the lessons have been adopted and others have not. There appears to be a patte rn to the adoption of lessons: ideological and inexpensive changes in organ ization or treatment approach are more likely to be adapted than costly cha nges in the availability of services or 'transfer' resources (such as disab ility benefits or rental subsidies) to support independent housing. The pap er reviews this experience for demonstrations such as the Community Mental Health Centers program, the Community Support Program, and the Robert Wood Johnson Foundation Program on Chronic Mental Illness, and it discusses pros pects for current federal demonstrations.