When Allan Horwitz and Teresa Scheid prepared the first edition of this volume in 1998, there was much apprehension over the future of mental health care reform. This apprehension increased with the second edition, and is somewhat abated with the passage of the Affordable Care Act, which provides the opportunity to improve mental health service offerings. A series of tragic mass shootings – especially those at Sandy Hook Elementary School in Newton, Connecticut, and at the Emanuel African Methodist Episcopal Church in Charleston, South Carolina – has also provided impetus for policy makers to examine mental health services. At the same time, there is also renewed interest in exerting greater social control over people with mental health problems (i.e., loosening criteria for involuntary commitment, imposing additional limitations on the ability to possess guns). In Part III, we address the system of mental health care services and those policies that shape care delivery systems.
Mental health care must be understood in terms of its wider social context: the care and treatment provided to individuals with mental health problems reflects wider social values and priorities. Hence, the mental health system (i.e., the network of organizations, services, and health care professionals) will change as society changes. Specifically, widely held values and beliefs about mental health and attitudes toward the mentally ill as well as professional treatment preferences will shape the political climate, economic priorities, and the type of services available. It is for this reason that it is so difficult to achieve consensus on what type of system of care will work, and why it is so difficult to implement change (Mechanic, 2006).
As David Rochefort (1999) has argued, mental health policy has been plagued by recurrent tensions and ambiguities. Mental health care in the public sector is shaped by federal, state, and local policies and varies widely from community to community. While there have been several federal reports on the state of mental health care in the US (e.g., the 1999 Surgeon General's Report on Mental Health, the 2003 Presidential Commission on Mental Health), there has been no clear-cut federal policy such as that which emerged in 1963 with the Community Mental Health Reform Act. As noted by Wolff (2002), in the US mental health policy is framed at the state level, and there is tremendous state variation.