The United States
Christopher G. Hudson
Mental health policy in the United States has been an arduous and ambivalent struggle of Americans to care for those who experience the anguish of mental illness. It has been marked by periods of idealistic policy development aimed at the widespread prevention and cure of mental illness, as well as by periodic retreats to containment, control, and avoidance of mutual responsibility.
The ambivalence of the U.S. response has been complicated by several key political and socioeconomic features of this nation. Its population of 250 million and its extensive ethnic and racial heterogeneity pose formidable barriers for independent-minded Americans in assuming responsibility for those in need. The ideal that the United States should be a "melting pot" of diverse immigrant groups has taxed Americans' tolerance for diversity, especially when those who are different suffer the pain and stigma of psychosis. The United States also is struggling to address itself to the special problems of two key subpopulations. The "baby-boom" generation, a large population cohort that came about as a result of GIs returning from World War II, has been progressing through the stages of the life cycle, highlighting and often experiencing unique mental health problems. Most recently, this generation has contributed to a swelling of the ranks of "young chronics," often-hostile, hard-to-engage, and severely mentally ill persons ( Bachrach, 1982, p. 189). In addition, the growing population of older adults, as in many industrialized nations, has also posed an ongoing challenge in adapting services to the multiple economic, health, and psychosocial problems of this population.
Mental health policy making in the United States has been further complicated by the country's political structure. Its Constitution and subsequent legal prec