System effects of the Kansas Mental Health Reform Act of 1991

This paper analyzes the impact of the Kansas Mental Health Reform Act on cl ient outcomes. The Act is of general interest because it reflects a trial o f greater accountability without major changes in financial incentives. It made Community Mental Health Centers [CMHCs] gatekeepers that were accounta ble for services for adults with severe and persistent mental illnesses. Th e Act sought reductions in hospitalizations rates, expanded use of communit y support services, and increased independent living. The structure of the Act and Client Status Reports allow rigorous examination of these outcomes. The number of clients served increased significantly. Even though hospital days fell by 23%, there is no clear evidence that the Act itself reduced h ospital days per client. The proportion of community support program client s residing independently rose significantly; the proportion participating m eaningfully in the labor market fell. The goals of the Act were realized ov erall, but the performance of CMHCs varied considerably.