Abstract
This banded dissertation explores opportunities for improved outcomes from the U.S. mental health system. A literature review was conducted to examine the significant events influencing the U.S. mental health system from the end of WWII to 2021. In addition, a thematic analysis of government documents highlighted the current outcomes of the U.S. mental health system for people with a serious mental illness. The findings showed that a disproportionate number of people with a serious mental illness are experiencing homelessness and incarceration. The reviews of both the historical trajectory and current status of the U.S. mental health system were conducted to aid in future planning to create better outcomes for people with a serious mental illness. Furthermore, an additional literature review of studies that used magnetic resonance imaging elucidated the current knowledge about serious mental illness. The magnetic resonance imaging data demonstrated, that for multiple serious mental illnesses, periods of active symptoms can result in structural changes in the brain which indicates the prevention of decompensation as a priority. Housing First is a model of prevention; however, the current data regarding this model are considered questionable due to quasi-experimental methods considered to be lacking in rigor. A systematic review of randomized controlled trials was conducted and the highest levels of evidence demonstrated that the Housing First model is more effective than treatment as usual with housing stabilityand cost-effectiveness outcomes. A national graduate-level social work course was created to facilitate the expanded provision of the Housing First model with fidelity.