The politics of closing state mental hospitals: a case of increasing policy gridlock.
There are political and administrative barriers to closure of the remaining state mental hospitals. Some of these barriers owe their existence to the current lack of community-based alternatives for the care and treatment of the severely mentally ill. In addition, uncertainty of the future funding and regulatory commitment of state governments to community programs contributes to an unwillingness by influential groups to recommend or implement closure. Finally, other barriers include rigid budgetary processes, the self-interest of public employees, and the lack of consensus in the decision making process. The result is that even when the case for closure of a state mental hospital is convincing, these political and administrative factors can cause "policy gridlock." This article describes how such policy gridlock occurs and offers several suggestions as to how it can be prevented.
Department of Health Services Administration, Florida International University, N. Miami 33181.
F W
FW
Becker
D003155:Community Mental Health Centers / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D006271:Health Facility Closure; D006778:Hospitals, Psychiatric / Q000639:trends*; D006783:Hospitals, State / Q000639:trends*; D006801:Humans; D008134:Long-Term Care / Q000191:economics; D008297:Male; D008484:Medicaid / Q000191:economics; D001523:Mental Disorders / Q000534:rehabilitation; D008605:Mental Health Services / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends; D014481:United States; D000078329:Workforce