In April 1978 the President’s Commission on Mental Health submitted a report containing more than 100 major recommendations to President Jimmy Carter. "Madness and Government: Who Cares for the Mentally Ill?" by Henry A. Foley and Steven S. Sharfstein, M.D. (American Psychiatric Publishing Inc., 1983), contains a discussion of the report and subsequent legislative activity. Here are some excerpts:

"In urging a more focused effort to coordinate general health and mental health services, the commission’s report took on a particular systems cast. In this, it was reflecting the new thinking in the field, which sought ways to transform the de facto mental health service system into an intentional system that would articulate with other systems of health and human services. . . .The practical implication of this shift in focus was recognition of the need of life and social supports and opportunities in addition to mental and general health care services [for those with chronic mental illness].

"The report highlighted the scarcity of third-party financing; the need for federal support for indirect services; . . .inflexibility in initiating new programs; needs of underserved populations, especially the chronically mentally ill, elderly, children, and minorities; the erosion of the national research capacity; and the continuing need for training programs and the responsibility of federally supported trainees to pay for their training by service in programs with few personnel resources."