• Report

Initiatives of the FY 2004 mental health systems transformation grantees


Anderson, W., O'Keeffe, J., & O'Keeffe, C. (2009). Initiatives of the FY 2004 mental health systems transformation grantees. (Real Choice Systems Change Grant Program). Baltimore, MD: Centers for Medicare & Medicaid Services.


Mental illness is the leading cause of disability in the United States, and serious mental illnesses such as schizophrenia, bipolar disorder, and severe depressive disorders can be especially disabling if undiagnosed or untreated. Individuals with serious mental illnesses experience substantial limitations in major life activities, at home, at work, and in the community. Each year, approximately 6 percent of the U.S. population experiences a serious mental illness.

The delivery of publicly funded mental health services has evolved over the past decades from a system that consisted of large state-run mental institutions, funded solely with state funds, to a community support system (CSS) that strongly emphasizes support for individuals in the community rather than confining services to fixed-site clinics and offices. The CSS philosophy recognizes that individuals with serious mental illnesses frequently need supports beyond treatment and clinical services to help them live successfully in community settings. The CSS framework includes traditional mental health services, which have been enhanced by the development of a wider array of effective medications to treat mental disorders, improvements in medication management, and the identification of "evidence-based practices" (EBPs) that have demonstrated efficacy and cost-effectiveness in securing positive outcomes for individuals with serious mental illnesses.