Mental Health Policy Inquiry, Its Importance, and Its Rewards
Rochefort, David, Policy Studies Journal
The relationship between mental health and public affairs has fascinated scholars of government from as far back as Harold Lasswell's publication of Psychopathology and Politics (1930) and Power and Personality (1948). That interest continues to thrive today in the many college offerings on political psychology, in the pages of the academic journal Political Psychology, and in the ongoing stream of writings on the psychological dimensions of leadership, public opinion, and mass political behavior.
Curiously, however, little comparable attention has been paid to the broader question of the public's mental health and government's role in the provision and financing of mental health care. In short, study of the "psychology of politics" has failed to spawn interest in the "politics of psychology." One would have to be persistent indeed to find an article on the latter subject in a mainstream public policy or political science journal. Even in the pages of specialized health care periodicals, mental health policy analyses are surprisingly few and far between. For example, in the journals Health Affairs and Journal of Health, Politics, Policy and Law, fewer than 10 articles out of a total 100 published in 1993 dealt directly with mental health care issues.
A sophisticated sociology-of-knowledge exploration would be necessary to assess the many possible factors involved in the currently low standing of mental health policy research topics: training opportunities, available project funding, perceived size of the audience, the social stigma of mental illness, and others. Such an examination is not within the compass of this article. However, one can assume that most policy research arises from a sense of the importance of the topic. There are two primary dimensions for gauging such importance. The first is the prominence or impact of a policy area in "real-life" terms, with respect to allocation of resources, political conflict, or social well-being. This may be called its pragmatic significance. The second dimension has to do with the anticipated insights of an area for the public policymaking process in general. This may be called its theoretical significance.
This Policy Studies Journal symposium offers an unusual opportunity to communicate to a broad community of policy researchers the salience of mental health questions. Taking advantage of this opportunity, I intend to argue the case for the importance of mental health policy inquiry on these grounds of both pragmatic and theoretical significance. However, first I will set the stage with brief background on the problem of mental illness and the historical development of mental health policy in the United States.
The Ambiguity of Mental Illness
There are extreme states of emotional and psychological malfunctioning that virtually all observers would identify as pathological. Short of these extremes, however, much ambiguity exists concerning the line between mental normalcy and abnormality. One possible way of identifying mental illness might be to focus on those persons who seek medical attention for a psychological problem. Yet, it is not necessarily the most disordered who choose to enter the treatment system, and a host of social and economic variables complicate the behavior involved in seeking help even when the need for that help has been assessed correctly by the person. In practice, a variety of criteria have been suggested for determining the condition of mental illness, including the performance of social roles, aberrant behavior, and symptomatology (Mechanic, 1989).
One of the most notable efforts to date to develop a comprehensive classification system for mental disorders is the Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association (Goldman & Grebb, 1988). The first version of the DSM was published in 1952. Since that time four updates and revisions have appeared, including the release of …
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Publication information: Article title: Mental Health Policy Inquiry, Its Importance, and Its Rewards. Contributors: Rochefort, David - Author. Journal title: Policy Studies Journal. Volume: 22. Issue: 4 Publication date: Winter 1994. Page number: 653+. © 1999 Policy Studies Organization. COPYRIGHT 1994 Gale Group.
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