among the homeless in these countries too, the combined result of inadequate development of community-based mental health services and a shortage of suitable low-income housing. At the cross-national level of analysis, it is easy to see that homelessness emanates not only from social, economic, and political circumstances within a particular society, but also from global trends of economic dislocation, class polarization, and welfare state retrenchment ( Daly, 1996).
What the comparative perspective also brings into focus, however, is the way responses to the homelessness problem reflect varying national styles of social problem-solving. As Daly ( 1996: 243) puts it, "different responses to homelessness [by different societies] are conditioned by our disparate notions of individual, community, society, and state; these concepts, in turn, are products of our culture and history." In this light, the distinctively American approach to homelessness is one marked by a special blend of local autonomy, welfare restrictions, voluntarism, distrust of the public sector, and an individualistic rather than community orientation ( Daly, 1996: chapter 13). Thus, to understand halting U.S. policy on homelessness--and its impact on the mentally ill--is to confront values and institutions that are basic to the American experience.
There is no simple way to summarize U.S. mental health policy in the late 1990s. The many developments taking place are not marked by great coherence or planning, and opposing directions are evident. The essayist Ralph Waldo Emerson once wrote: "The voyage of the best ship is a zigzag line of a hundred tacks. . . . See that line from a sufficient distance, and it straightens itself to the average tendency." With the passage of time to give us that distance, today's events in the mental health sphere undoubtedly will present a more unified picture, one that is amenable to closer analysis and appraisal.
For now, however, it seems best to say only that a number of strong trends are apparent. Among these are an expanding state role in service system design and financing, the pervasive influence of health care market changes, and a search for privatized solutions to public-sector problems. If any one contemporary process is dominant, it is the movement toward managed care, in which all three of these themes intersect powerfully. Perhaps more than ever before, U.S. mental health policy is being defined piecemeal by decisions made in myriad legislative, administrative, and legal venues. The interests of persons with mental illness conceivably can be served in such an environment, but not, past experience with both institutional and community care systems tells us, in the absence of sustained oversight and political activism.
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Publication information: Book title: From Poorhouses to Homelessness:Policy Analysis and Mental Health Care. Edition: 2nd. Contributors: David A. Rochefort - Author. Publisher: Auburn House Paperback. Place of publication: Westport, CT. Publication year: 1997. Page number: 259.
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