THE POLITICAL-DEVELOPMENT OF PROGRAM REALIGNMENT - CALIFORNIA 1991 MENTAL-HEALTH-CARE REFORM

This article reviews the legislative process that resulted in the most significant reform of California's public mental health system in nea rly 25 years. The reform, termed ''Program Realignment,'' decentralize d administrative and fiscal control of the mental health system from t he state to the county level. The system prior to Program Realignment is discussed here to reveal an already diverse and decentralized count y mental health system, fiscal distress, and general dissatisfaction w ith the system. From these conditions, the objectives of the relevant political actors arose. By tracing the policy development process of P rogram Realignment, several independent variables are revealed that he lp explain how and why this legislation came into being and allow gene ralization of this case to other states' experiences. These independen t variables are an urgent need for action within a limited time frame, a preexisting knowledge base and well-developed policy networks, a sp irit of bipartisan cooperation, and the presence of strong leadership. Preliminary evidence suggests that consolidation of fiscal and progra mmatic authority at the focal level has reduced fragmentation of servi ces and increased fiscal flexibility. However; there is concern that t he quality of care offered by the state's 59 local mental health progr ams will become increasingly disparate and that increased financial fl exibility may not be used to improve services for clients but to save money for focal governments. Lessons from California's experience can alert other states to the pros and cons of this policy approach to pro viding mental health services and inform policymakers in other states of the steps involved in bringing about such a policy change.