Loaded Dice: Reformism and Constraint in Contemporary U.S. Mental Health Policy

Abstract

A number of important reforms are under way in contemporary U.S. mental health policy making. Innovations are occurring in such areas as parity for insurance coverage for mental health problems, children's mental health services, and the expansion of community support systems for individuals with severe and chronic mental illnesses. In each case, however, the scope and effectiveness of policy changes are limited by resource shortages, political ambivalence, and program structures that are decentralized, fragmented, and poorly co-ordinated. Thus, although innovation is a valuable engine of change in mental health systems, its impact depends largely on longstanding political, economic, and organizational forces that transcend the mental health sphere.