Mental Health Policy: Fundamental Reform or Incremental Change?

  • Howard H. Goldman
  • Joseph P. Morrissey


The history of mental health policy has been characterized by a series of cycles of fundamental reform, each followed by a period of incremental gains. The nineteenth-century moral treatment movement gave rise to the asylum. The mental hygiene movement of the turn of the twentieth century led to the development of small inpatient units and outpatient services in academic medical centers. Community mental health centers were introduced by a reform movement in the 1960s, which also brought us Medicare and Medicaid. And a community support movement in the 1970s and 1980s shifted the focus from the early treatment of mental illnesses to providing support for individuals already disabled by mental disorders. What might look like retrenchment to the fundamental reformers can look like slow progress to those on the ground. A sequence of incremental changes can bring progress, even in conservative times. At this point in time, as we find ourselves immersed in the uncertainty about the future of health reform and the place of behavioral health within it, there are many questions for mental health policy. This chapter explores those questions and issues in the United States.


  1. 1.
    Gil, D. (1973). Unraveling social policy. Cambridge, MA: Schenkman.Google Scholar
  2. 2.
    Grob, G. N., & Goldman, H. H. (2006). The dilemma of federal mental health policy: Radical reform or incremental change? New Brunswick: Rutgers University Press.Google Scholar
  3. 3.
    Morrissey, J. P., Goldman, H. H., & Klerman, L. V. (1980). The enduring asylum: Cycles of social reform at the Worcester State Hospital. New York: New York Grune and Stratton.Google Scholar
  4. 4.
    Morrissey, J. P., & Goldman, H. H. (1984). Cycles of reform in the care of the chronically mentally ill. Hospital & Community Psychiatry, 35(8), 785–793.Google Scholar
  5. 5.
    Goldman, H. H., & Morrissey, J. P. (1985). The alchemy of mental health policy: Homelessness and the fourth cycle of reform. American Journal of Public Health, 75(7), 727–731.CrossRefGoogle Scholar
  6. 6.
    Grob, G. N. (1966). The state and the mentally ill. Chapel Hill: University of North Carolina Press.Google Scholar
  7. 7.
    Grob, G. N. (1973). Mental institutions in America: Social policy to 1875. New York: Free Press.Google Scholar
  8. 8.
    U.S. Department of Health and Human Services. Office of the Surgeon General. (1999). Mental health: A report of the surgeon general. Rockville, MD.Google Scholar
  9. 9.
    U.S. Department of Health and Human Services. (2004). The promise. Rockville, MD: President’s New Freedom Commission on Mental Health.Google Scholar
  10. 10.
    Americans with Disabilities Act of 1990. Public Law 101–336. (1990). 108th Congress, 2nd session (July 26).Google Scholar
  11. 11.
    Olmstead v. L.C. (1999). 527 U.S. 581.Google Scholar
  12. 12.
    Lieberman, J. A., Dixon, L. B., & Goldman, H. H. (2013). Early detection and intervention in first-episode schizophrenia: A new therapeutic model. Journal of the American Medical Association, 310(7), 689–690.CrossRefGoogle Scholar
  13. 13.
    Goldman, H. H., Karakus, M., Frey, W., & Beronio, K. (2013). Financing first episode psychosis services in the United States. Psychiatric Services, 64(6), 506–508.CrossRefGoogle Scholar
  14. 14.
    Dixon, L. B., Goldman, H. H., Bennett, M., Wang, Y., McNamara, K. A., Mendon, S. J., … Essock, S. M. (2015). Implementing coordinated specialty care for early psychosis. Psychiatric Services, 66(7), 691–698.Google Scholar
  15. 15.
    Frank, R. G., Goldman, H. H., & Hogan, M. (2003). Medicaid and mental health: Be careful what you ask for. Health Affairs, 22(1), 101–113.CrossRefGoogle Scholar
  16. 16.
    Goldman, H. H. (2010). Will health insurance reform in the United States help people with schizophrenia? Schizophrenia Bulletin, 36(5), 893–894. Scholar
  17. 17.
    Goldman, H. H., & Karakus, M. C. (2014). Do not turn out the lights on the public mental health system when the ACA is fully implemented. Journal of Behavioral Health Services Research, 41(4), 429–433.CrossRefGoogle Scholar
  18. 18.
    Frank, R. G., & Glied, S. A. (2006). Better but not well. Baltimore, MD: Johns Hopkins University Press.Google Scholar
  19. 19.
    Goldman, H. H. (2002). Parity—Prelude to a fifth cycle of reform. Journal of Mental Health Policy and Economics, 5(3), 109–113.Google Scholar
  20. 20.
    Foley, H. A., & Sharfstein, S. S. (1983). Madness and government: Who cares for the mentally ill? Washington, DC: American Psychiatric Association.Google Scholar
  21. 21.
    Department of Health and Human Services Steering Committee on the Chronically Mentally Ill. (1980). Toward a national plan on the chronically mentally ill. Washington, DC: U.S. Public Health Service.Google Scholar
  22. 22.
    Koyanagi, C., & Goldman, H. (1991). Quiet success of the national plan for chronic patients. Hospital & Community Psychiatry, 42(9), 899–905.Google Scholar
  23. 23.
    Koyanagi, C., & Goldman, H. H. (1992). Inching forward. Alexandria, VA: National Mental Health Association.Google Scholar
  24. 24.
    Kennedy, J. F. (1963). Message from the president of the United States relative to mental illness and mental retardation. Washington, DC: U.S. Government Printing Office.Google Scholar
  25. 25.
    Hennessy, K. D., & Goldman, H. H. (2001). Full parity: Steps toward treatment equity for mental and addictive disorders. Health Affairs, 20(4), 58–67.CrossRefGoogle Scholar
  26. 26.
    Goldman, H. H. (2006). Progress in mental health policy in conservative times: One step at a time. Schizophrenia Bulletin, 32, 424–427.CrossRefGoogle Scholar
  27. 27.
    Hustead, E., Sharfstein, S., Muszynski, S., Brady, J., & Cahill, J. (1985). Reductions in coverage for mental and nervous illness in the federal employees health benefits program: 1980–1984. American Journal of Psychiatry, 142(2), 81–186.Google Scholar
  28. 28.
    Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). (2008). Public Law 110–175, July 15, 2008.Google Scholar
  29. 29.
    Goldman, H. H. (1997). Parity redux. Harvard Review of Psychiatry, 5, 91–93.CrossRefGoogle Scholar
  30. 30.
    Goldman, H. H., Frank, R. G., Burnam, M. A., Huskamp, H., Ridgely, M. S., Normand, S. T., … Blasinsky, M. (2006). Behavioral health insurance parity for federal employees. New England Journal of Medicine, 354(13), 1378–1386.Google Scholar
  31. 31.
    Barry, C., Huskamp, H., & Goldman, H. H. (2010). A political history of federal mental health and addiction insurance parity. Milbank Quarterly, 88(3), 404–433.CrossRefGoogle Scholar
  32. 32.
    The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (MHPAEA). (2008). Sections 511 and 512 of Division C of Public Law 104–343, October 3, 2008. U.S. Congress: House of Representatives.Google Scholar
  33. 33.
    Patient Protection and Affordable Care Act (PPACA). (2010). 42 U.S. Congress: 18001.Google Scholar
  34. 34.
    Gilbody, S., Bower, P., Fletcher, J., Richards, D., & Sutton, A. J. (2006). Collaborative care for depression: A cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine, 166, 2314–2321.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2020

Authors and Affiliations

  • Howard H. Goldman
    • 1
  • Joseph P. Morrissey
    • 2
  1. 1.University of Maryland School of MedicineBaltimoreUSA
  2. 2.Cecil G. Sheps Center for Health Services ResearchUniversity of North Carolina at Chapel HillChapel HillUSA

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