Mental health policy development in the States: the piecemeal nature of transformational change.
OBJECTIVE
Transformation--systemic, sweeping changes to promote recovery and consumerism--is a pervasive theme in discussions of U.S. mental health policy. State systems are a fundamental component of national transformation plans. However, it is not clear how the vision of transformation will be balanced against the idiosyncratic political forces that traditionally characterize state policy making. This article examines the development of state mental health policy to assess whether and how it reflects the broader context of transformation versus political forces.


METHODS
Analysis used qualitative evidence collected from semistructured interviews in four states (California, Massachusetts, New Jersey, and New Mexico), which were chosen to capture variation in geography and population, health systems, and political environment. Interviewees included 35 key mental health officials, directors of principal mental health consumer and family advocacy groups, and executives of major mental health provider groups. Interviews were conducted between May 2007 and March 2008.


RESULTS
Many recent state policy priorities in mental health are consistent with the overall goals of transformation, but some are particular to a state's circumstance. The case studies showed that these priorities are largely shaped by executive control, stakeholder interests, and crises. There is mixed evidence on whether these drivers of state priorities reflect an underlying transformative process.


CONCLUSIONS
States' mental health policies are largely guided by the problems and resources of the states: sometimes these forces dovetail with nationwide transformation goals and processes, and sometimes they are idiosyncratic to a particular state. Thus, although states can play an integral role in forwarding transformation, their own mental health policy agendas are not eclipsed by this nationwide movement.
Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15261, USA. rachelg@pitt.edu
Rachel L
RL
Garfield
D006291:Health Policy; D006801:Humans; D007407:Interviews as Topic; D008605:Mental Health Services; D011050:Policy Making; D014481:United States