Rochefort updates his classic comprehensive review of mental health policy issues in American society, beginning with early practices that predate the formal "mental health system" and ending with current debates, about parity insurance coverage for mental illnesses, managed care, and Medicaid reform. At the same time, he provides a perspective on mental health policy analysis that draws on diverse work in the policy sciences, looks to both applied and theoretical concerns, and gives full recognition to the distinctive nature of mental health care problems. This new edition will be of enhanced value to policymakers in the mental health field as well as to students of American social welfare policy and public administration in general.

David Mechanic

The traditional mental health specialty sector has had an insular view of its terrain, focusing on internal battles among ideological camps; among the varying mental health professions; among functions such as prevention, treatment, and rehabilitation; and among forces battling over the distribution of limited categorical funding. But these debates, however important, have been a sideshow to the more influential social, medical, and welfare policies at a macro level that have shaped substantially the configuration of financing and organization of mental health care in the United States.

It is imperative that constituencies understand the relationship of mental health to general health and welfare services and the extent to which national and state policies in health and welfare can provide opportunities or constrain the mental health system for decades to come. As David Rochefort shows in this book, the unexpected outcomes often resulting from disjointed policymaking across varying governmental sectors have had, and will continue to have, crucial implications for mental health care delivery.

Mental health services have evolved over a long history and have a culture of their own. While the mental health sector and its clients have moved closer to medicine in recent years, they still suffer from stigma, discrimination, and exclusion. Experts continue to debate the extent to which mental health services fit the medical paradigm, but it is evident that persons with severe and persistent mental illness require housing, vocational, and social welfare services, as well as medical and psychiatric care. This means that service provision will continue to be complex, depending on assistance provided by varying categorical programs at dif-