In his introductory article, David Rochefort has set forth his argument for the importance of mental health policy research. His article references many areas where there exist opportunities to make a substantial contribution to the developing body of knowledge in this field. A summary of some of these would include: (a) continued study of the evolution of mental health policy, (b) the impact of the "megatrend" of privatization of mental health care, and (c) the study of local experiments for client-based integration of resources.
For well over a decade, federal moneys to support mental health activities have been made available to the states through block grants. To a large extent, each state was allowed to determine how those moneys would be used. As a result, the policies that were adopted show wide. variation across the fifty states. Hudson and Cox (1991) observed that state mental health has become a rich source of policy, programmatic, and practice experimentation. What is the infrastructure in each state that helped shape policy? What forces contributed to policy development, both internal and external to state government? Who were the significant players? What was the role played by the courts, if any? Did consumers participate in the setting of goals and the development of policy?
Ideally, if the case studies followed a similar format and researched common issues, we might well gain insight as to what issues are generic and must be addressed by all states, and what issues are unique to each state. For example, Rochefort's article documents the success of what he refers to as "the latest macro shift in mental health policy toward a deinstitutionalized system."c This shift has occurred in all states. The resultant policy thrust toward "communitization," however, has developed differently in each state.
The article by Governor Celeste and Pamela Hyde discusses how one governor was successful in implementing substantial and significant change in the system of mental health in one state. Indeed, it discusses the processes that moved the state through the era of deinstitutionalization into the era of communitization.
Thompson (1991, p. 166) has written of the importance of studies of the policy implementation process and the need to keep the study of health policy implementation on "the analytic front burner." Rochefort's article references Eugene Bardach's (1977) "classic work on the delivery of community mental health services in California."
Governor Celeste's article discusses the multiple bureaucratic, organizational, social, and economic forces that together helped determine the outcome of his efforts to implement new policies within the existing mental health system in Ohio. Health Affairs (Fall, 1992) contains an article by Hogan (1992) that reports on developments in Ohio since 1992. Indeed, this tenth anniversary issue of Health Affairs is devoted entirely to articles on mental health policy.
Several authors have written of the difficulties and complexities involved in trying to shift a system from an emphasis on institutions to community-based programs; among them are Hudson and Cox (1991), Lipson (1991), Rochefort and Pezza (1991), and Rochefort (1993). The application of their collective insights is there to guide further case studies of policy implementation.
It has been suggested that one particular locus of resistance to change is the fact that multiple levels of government are involved - federal, state, and local. This diffusion of effective authority has been noted by Marmor and Gill (1990) to stimulate agreement of the "problem" that is to be solved and rewards innovative proposals, but retards implementation. Studies of efforts to implement change in mental health policy might well shed light on how significant a factor these multiple levels of government are, and in what ways they impact …