This book is a collaborative work by a historian (Gerald N. Grob) and a psychiatrist (Howard H. Goldman). At first glance our respective disciplines appear to be far apart. Appearances, however, can be deceiving. Both of us have spent much of our careers studying mental health policy, the role of government (local, state, and national), the practice of psychiatry and allied mental health disciplines, and, above all, the fate of individuals with severe and persistent mental illnesses. We have been fascinated by the claims of successive generations that their policies would resolve the pressing needs of individuals whose severe mental illnesses have often created dependency and thus required either public or private assistance. What is equally fascinating is the fact that many [solutions] have embodied an ideological agenda that often lacked any basis in reality and ignored available empirical data.
This book attempts to trace the evolution of federal mental health policy from World War II to the beginning of the twenty-first century. These decades have been marked by a determined effort both to shift the locus of policy away from institutional to community care and to transfer leadership and authority from the states to the federal government. As a result of America's peculiar federal system, intergovernmental rivalries and efforts to shift costs to different levels of government have played an important if overlooked part in the transfer of power and the reshaping of policy. In recent decades, moreover, policy outcomes have often reflected the actions of federal bureaucrats who are responsible for developing the guidelines to implement legislation. At the same time the growing preoccupation with psychological maladjustment and the creation of myriad diagnostic categories have also brought new groups into the mental health arena. The decline of traditional mental hospital care and the rise of a community care policy, paradoxically, created a fragmented rather than a unified mental health system. Those most in need-persons with severe disorders-have often proved to be the losers.
In tracing the history of mental health policy, we have emphasized intergovernmental relationships and the rise of federal authority. We could have written a separate volume about state mental health policy, since that is where many of the innovations in services and government stewardship of mental health have occurred during the same time period. But we have focused on . . .