New Federalism, New Freedom, and States' Rights: The Uncertain and Fragmented Direction of Public Mental Health Policy in the United States

Volume 4. The Profession of Social Work
III. Policy to Practice and Practice to Policy
King Davis

King Davis

University of Texas—Austin, Hogg Foundation for Mental Health, School of Social Work, Austin, Texas, US

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Abstract

Considerable progress has been made within the past decade in knowledge and treatment of mental illness. Historically, mental health care has been under the aegis of state and local governments, with state general funds as the major source of support. However, recent federal reports conclude that the overall quality of these services remains fragmented and the future direction is uncertain at best. As a result, the federal government has proposed to transform mental health care systems beyond that brought about by the community mental health movement. Although state governments maintain ownership and responsibility for the level of services, the federal government has used four related financial and legal strategies to reduce historic control by the states and move them toward transformation. Tension over the extent of federalism characterizes the relationships between state and federal levels of government. The vast economic contribution of mental health services (jobs and purchases) slows the acceptance of transformation change at the state level sought by the federal government. Nationalization of existing state systems of mental health by the federal government offers a means of rapidly improving quality of mental health care and eliminating fragmentation and uncertainty.

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