Indiana Consortium For Mental Health Services Research Indiana University

Abstract

Reprint # 16: Implementing State-Level Mental Health Policy Reforms in Indiana: Closing a State-Operated Psychiatric Hospital and Passing Major Mental Health Reform Legislation

Elizabeth C. McDonel,* Lucinda Meyer,** and Richard Deliberty***

In recent years, the majority of U.S. states have been engaged in downsizing or altogether closing their state-operated psychiatric hospital systems (Lutterman, 1994). In this article, we describe the factors that helped bring about one such closure, Indiana's Central State Hospital. This facility closed its doors in the midst of public controversy and proposed legislation that would reform, restructure, and refinance state-funded mental health services. We outline events that contributed to, or threatened to derail, these two interrelated reform efforts, and we analyze the local context against the perspective of national trends. Further, we show how this seemingly chaotic array of social and political events and pressures may be not only typical but necessary in the process of successful policy reform.

To accomplish our goals, we apply a conceptual framework for policy analysis suggested by the work of John Kingdon to organize the descriptive data we present. A model for transitioning ideas into policy in the arenas of health care and transportation was given by J. W. Kingdon in his book Agendas, Alternatives, and Public Policies, (1984, 1995). Kingdon's theoretical concepts derived from empirical and qualitative analyses of the policy‑making process at the federal level. The movement to close state psychiatric hospitals and to introduce principles of managed health care into the public sector throughout the United States may be a policy reform whose time has come, but little technical information was available in 1992 concerning implementation of these changes. Although much has been written on deinstitutlonalization generally, little has been documented about the pitfalls of downsizing of state hospitals (Carling, 1992; Carling, Miller, Daniels, & Randolph, 1987; Goodrick, 1990a, 1990b). Kingdon shows us that the path to important public policy change is the survival of the idea over a long course of testing and debate by invested stakeholders. The model is an appealing framework for selection of critical events from the enormous array of descriptive data we have accumulated. We first provide background information on the facility itself and the organization of Indiana hospital and community mental health systems. We then introduce key concepts from Kingdon's model as a vehicle to describe the context factors relevant to the movement toward major state-level policy changes in Indiana.