Integration of Community-Based Services for the Severely Mentally III and the Structure of Public Funding: A Comparison of Four Systems

Despite strong interest by health care services researchers in studying community-based service delivery to persons with severe mental illness, few understand the relationship between the structure of public funding and differences in how mental health care delivery systems are organized. In particular, the structure of public funding may have a substantial effect on the nature and extent of integration among the various service providers that comprise a community's delivery network. Such an understanding is critical if mental health policymakers are to use their influence on funding to guide the structure of service delivery. To investigate this issue, we compared community mental health care systems in four U.S. cities. We found that services will be integrated regardless of the structure of public funding but that the structure of integration among providers will be affected. Spccilically strong fiscal control by the state is conducive to delivery systems that are integrated through the core mental health care agency in a community, whereas weak fiscal control is more likely to result in decentralized integration among system providers.