This project will explore the state mental health policymaking process in the context of managed care. Research suggests that as many as 20 to 29 percent of Americans will have a mental disorder during any given year (Regier, 1998). Despite recent advances in the diagnosis and treatment of mental illness (Norquist, 1999), significant disparities in health coverage remain for people with mental illness, due largely to limited knowledge about mental diseases, stigma, and inadequacies in insurance coverage (Mechanic, 2002). It is this last category that recent public policy initiatives in mental health have focused on most strongly. In particular, """"""""parity"""""""" of coverage of mental health has been the central thrust of both federal and state health insurance legislation. There is a need, however, to examine the extent to which parity laws can and do accomplish the goal of reducing mental health disparities, and to identify the factors that exist that encourage or hinder their effective implementation. This research uses a case study design the accomplish the following specific aims: 1) Describe the states' mental health policy """"""""packages,"""""""" including the major programs, services, laws, and regulations that constitute the state policy response to the needs of people with mental illness; 2) Examine the political and legislative process in states that causes policymakers to choose one policy vehicle over another in general and with respect to mental health parity laws in particular; 3) Assess whether the content of state mental health packages is different in states that have passed mental health parity laws, and whether passing a mental health parity law significantly changes the mental health policy package in that particular state. A variety of methodological techniques will be used to guide these case studies, including survey questionnaires of legislators and other stakeholders, personal interviews of State Mental Health Program Directors, and comprehensive review of legislative records and policy reports.
