Ideology and policy termination: restructuring California's mental health system.

Abstract

The recent profound transformation of the California mental health system is viewed from the perspective of policy termination--that phase in the overall policy process involving the cessation or redirection of policy. State mental hospitals have been phased out, and the responsibility for patients has been shifted to local mental health programs. This article explores the processes of policy and organizational change that occurred with mental health reform and uncovers a number of significant policy outcomes associated with that change. The consequences of the new mental health policy are found to be intimately related to the manner in which previous policy was terminated. In conceptualizing the role of termination, an experimental approach to the development of public policy is contrasted with policy innovation justified on the basis of ideology. It is argued that the numerous resistances to the termination of current policy weaken the prospect of policy innovation. Ideological commitment is the powerful force that overcomes these resistances. But this in turn produces a policy context in which important termination considerations are systematically ignored. The ideology of community mental health, emerging concurrently with changes in certain characteristics of the larger social structure, served to augment and legitimize the redirection in medical health policy. Mental health reform in California, although leading to the provision of services to an expanded population, resulted in the neglect of the more severely disabled.