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Intended to provide public policy context for the December 1999 Surgeon General's Report on Mental Health, this background paper discusses the historic skepticism about the efficacy of treatment of mental illness in this country, insurance practices that have discriminated against mental illness and the reasons for them, the disproportionate share of mental health funding provided by government sources such as Medicaid and state general revenues, the role of state and local public government as providers of catastrophic coverage for mental illness, the cascading cost-shifting game in mental health finance, obstacles to needed treatment (including popular attitudes toward mental illness), the history of deinstitutionalization and the shift to community-based services, and the declining share of national health spending going to mental health. It also examines purposes served by the report, including translating science into language understandable by the lay public, eradicating stigma and bias, affirming the efficacy of treatment, and emphasizing the importance of culturally competent services. Finally, the paper briefly reviews the agenda for future action contained in the report.

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