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Abstract
This dissertation is an analysis of social mental health policy pertaining to the treatment of individuals with serious mental illness (SMI), otherwise known as the historic psychiatric institutional population. Although vast improvements in mental healthcare have been witnessed in the last 50 years, individuals with the most severe conditions continue to receive inadequate care. The present dissertation examined national, state, and local mental health policies pertinent to the care of individuals with SMI; while also evaluating the relationship between policy making at various levels of government.
The local policy making analysis involved a case study of privatization of a publically-funded county mental health treatment system with both urban and rural districts in a Midwestern state. The case study methodology included a detailed chronology of local events pertinent to mental health policy; describing the real-world context in which administrative policies, actual practices, and outcomes, intended and unintended, occur. Additional methodology evaluated the treatment system before and after the transition, along with several hypotheses.
The results of the case study indicate that features of policy and administration at the national and state level had meaningful effects at the local level. While not necessarily intended, positive or beneficial, the policy changes resulted in fewer evidence-based practices, decreased funding, higher indirect costs (“overhead”), public safety risks, and less innovation in services intended for individuals with SMI.
Stimulated by ideological interest in “privatization” of public services, preliminary data suggests the changes arguably accomplished the goal of reducing county government involvement in healthcare, but did not accomplish the goals of reduced costs or better services for those with SMI. Services and resources were shifted away from the SMI recipient population. Although partly due to lack of experience and expertise with SMI in the private sector, state and local policy could have prevented this shift by more effectively directing resources to non-government providers with relevant capabilities and intent to serve the SMI population. The poor outcomes cannot be characterized as a failure of privatization per se, but of failure to use policy to protect a vulnerable population with no market value in the behavioral health service industry.
