In Reply: I admire Dr. Ozarin, who was one of the few NIMH staff members in the 1970s and 1980s who was aware of the increasingly obvious failure of deinstitutionalization. But her letter alludes to one source of the problem. When NIMH did make money available for model programs, it was usually done with little or no coordination with the states, or evaluation, or follow-up. Funding for the community mental health centers (CMHCs), for example, specifically bypassed the state mental health agencies. NIMH then did virtually nothing to ensure that the CMHCs provided care for individuals with serious mental illnesses. NIMH acted as a federal Santa Claus but was nowhere in sight a month later when the toys had been broken.

Dr. Ozarin also asks, "Where were the researchers in the universities and medical schools?" In the mid-1970s, NIMH was giving psychiatric training programs more than $100 million each year with no strings attached. Why didn't NIMH require them to do something for the money?