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 variables. An often neglected, yet significant, factor, however, is the very structure of the American political system that was created by the adoption of the federal Constitution in 1789. The constitutional framework 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, which in turn changed and distorted coverage patterns, thereby inadvertently transforming both costs and policy goals. It is thus critical to take into account the ways in which America's political structure mediates and recasts the context of mental health policy.