Challenges in State Mental Health Policy and Administration

Abstract

Prologue: In a federalist government, states often act as laboratories for innovation in the development of policies that can be put into place around the nation, or that can meet the unique needs of a state s population in a way that a centralized policy cannot. In mental health, states have proved to be especially fertile ground, not only for testing new policies but for providing needed care to chronically mentally ill people. In the 1960s, as this essay narrates, the federal government took on increased responsibility for providing care; that responsibility returned to the states with Ronald Reagan's “New Federalism” in the 1980s. “The situations of states vary widely,” authors David Mechanic and Richard Surles state, “but it seems clear that the states and localities will remain providers or payers of last resort for the most seriously mentally ill.” The essay by Michael Hogan elsewhere in this volume of Health Affairs details Ohio's approach to arranging and paying for services for its mentally ill; this essay describes in more general terms the environment for state mental health policy, the role of federal authorities, and the challenges states face in meeting the needs of their mentally ill citizens during a time of fiscal austerity. Mechanic, widely recognized for his contributions to mental health policy research, is René Dubos Professor of Behavioral Sciences and University Professor at Rutgers University. He directs the Rutgers Center for Research on the Organization and Financing of Care for the Severely Mentally Ill. A frequent contributor to Health Affairs , Mechanic is a member of the journal's editorial board. Surles is commissioner of the New York State Office of Mental Health, a position he has held since 1987. He previously served as the chief mental health official in the city of Philadelphia and the state of Vermont. Along with several of his colleagues, he published a review of New York State's mental health case management system in Health Affairs , Spring 1992.