GOVERNMENT AND MENTAL-HEALTH POLICY - A STRUCTURAL-ANALYSIS

It is generally recognized that mental health policy is shaped by the interaction of complex social, economic, intellectual, and medical var iables. An often neglected, yet significant, factor, however, is the v ery structure of the American political system that was created by the adoption of the federal Constitution in 1789. The constitutional fram ework made intergovernmental relations-local, state, federal-important determinants in shaping and transforming social policy in general and mental health policy in particular. The division of power among three levels of government created incentives to shift responsibilities, wh ich in turn changed and distorted coverage patterns. thereby inadverte ntly transforming both costs and policy goals. It is thus critical to take into account the ways in which America's political structure medi ates and recasts the context of mental health policy.