Reflecting on JFK’s Legacy of Community-based Care

The Community Mental Health Act of 1963 set up community mental health facilities across the United States and continues to impact mental health policy.

“I am proposing a new approach to mental illness and to mental retardation. This approach is designed, in large measure, to use Federal resources to stimulate State, local and private action. When carried out, reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability. Emphasis on prevention, treatment and rehabilitation will be substituted for a desultory interest in confining patients in an institution to wither away.”

-- John F. Kennedy
Special Message to the Congress on Mental Illness and Mental Retardation
February 5, 1963

This deservedly famous speech led to a renewed responsibility for the American family—specifically, the need to take care of our brothers and sisters experiencing mental illness or who have disabilities. It is nearly impossible to read this speech 50 years later without reflecting upon its form and content, its practicality and poetry, and President Kennedy’s relationship with his disabled sister Rosemary.

A young John Kennedy took Rosemary to a dance and made her feel at home among the other dressed-up teenagers. As president, Kennedy called for comprehensive community health centers that would support families caring for their mentally disabled members and allow them to “be restored to useful life.” It is clear that his relationship with his sister, the oldest of the Kennedy girls, deeply influenced the man John F. Kennedy would become.

Kennedy's Plan

Before The Community Mental Health Act of 1963, which resulted from Kennedy’s speech, many Americans with disabilities were sent to asylums. This is what Kennedy referred to when he spoke of “custodial isolation.” There was little opportunity for therapy or constructive activity inside these asylums. For the most part, their purpose was to uphold ‘community standards’ by simply keeping people experiencing mental illness out of sight. Care and housing standards differed greatly from state to state, with virtually no federal oversight.

Kennedy proposed a three-part plan for mental health care, with comprehensive community mental health centers at its core. The development of these centers, available in virtually every community in every state, relied less upon federal dictates and rule making than the encouragement of available federal funding. The idea was for states to develop community mental health facilities that best fit their own needs, in terms of geographic availability, inpatient and outpatient mix, and deployment of professional staff and other factors.

An emphasis upon community-based care remains at the heart of American mental healthcare system to this day. President Kennedy also proposed steps to improve care in state institutions, increase research on mental illness, and increase training for professionals and staff who work in the field. For the “mentally retarded"—the term itself is no longer used, another powerful example of how the environment has changed—the president proposed increased prevention, community care centers, and further research into its causes and treatment.

Making Progress in Mental Health

In 2008, Senator Edward Kennedy and his son Representative Patrick Kennedy, President Kennedy’s brother and nephew, respectively, updated The Community Mental Health Act of 1963 with the Mental Health Parity and Addiction Equity Act (MHPAEA). The Act requires that health insurers treat mental and/or substance use disorders in the same way they treat other illnesses.

We asked Patrick Kennedy for comment about how the world of mental health care has changed since his uncle’s speech. He replied:

“President Kennedy gave us a great vision of what could be when he proposed and signed the Community Mental Health Act in 1963. As I travel around the country today, I hear from people affected by mental illness, addiction, or intellectual and developmental disabilities who are energized by the hope and promise President Kennedy introduced into their lives and their families’ lives. But we have to acknowledge that the execution of the vision was flawed, that fragmented implementation of the promise it held out allowed too many people to fall through the cracks. Too many people failed to receive the help they needed. Too many became homeless or were bypassed by our society.

“The parity law I co-sponsored in 2008 and the Affordable Care Act give us new tools and a new opportunity to do what President Kennedy intended. But we have to hold ourselves and each other accountable for their implementation. I believe that if all of us work together—the mental health, addictions, and I/DD (intellectual disability and developmental disabilities) communities—we can achieve the purposes my uncle outlined fifty years ago.”

We can see how this community approach has made for a different world in our own neighborhoods. The street this author lives on has a halfway house and an assisted living facility for people experiencing mental illness. Once when teenagers were harassing a resident of the assisted living facility, I saw a middle-aged woman pull her car over, get out and cross the busy street, only to warmly greet the man and ask him how he was doing. The teenagers got the message and drove away. This is the legacy of a speech given by John F. Kennedy 50 years ago.

Find the full Special Message on Mental Illness and Mental Retardation at the John F. Kennedy Presidential Library and Museum. Learn more about the Community Mental Health Act of 1963 at the National Council for Behavioral Health.

Access more behavioral health and homelessness resources.


Publication Year
2013

Author
Brian Prioleau
Last Updated: 04/19/2016