The mental health commissionership: major changes over a decade.

During the past decade major changes have occurred in the role of the state mental health program director. Those changes have made that position more complex, more administrative, and less medical. The author discusses four themes in particular: the growing belief in the desirability of employing professional managers, the increasing requirements for quantitative information, the loss of confidence in the overriding treatment ideology of deinstitutionalization, and managerial constraints imposed by consent decrees. Such changes make the role of the commissioner more important, yet more difficult.