Mental health policy in the liberal state: the example of the United States

Mental health policy arises out of the interaction of many different variables. These include (but are not limited to) the composition of the population of persons with severe mental illnesses; the means of dealing with disease and dependency; concepts of the etiology and nature of mental disorders; the organization and ideology of psychiatry; funding mechanisms; and existing popular, political, cultural, and professional values. But an often neglected but crucial factor in shaping policy is the very structure of the American political system, which played a crucial role in shaping mental health policy. Rather than emphasizing the neo-liberal theory and its accompanying hostility toward "unsuccessful" people and disdain of welfare, this article suggests that an understanding of mental health policy in the latter half of the twentieth century is better served by an examination of what actually happened. Theory, however attractive, rarely can encompass the messy data of reality.     

Inching toward incrementalism: federalism, devolution, and health policy in the United States and the United Kingdom

In the United States, the recently enacted Patient Protection and Affordable Care Act of 2010 envisions a significant increase in federal oversight over the nation's health care system. At the same time, however, the legislation requires the states to play key roles in every aspect of the reform agenda (such as expanding Medicaid programs, creating insurance exchanges, and working with providers on delivery system reforms). The complicated intergovernmental partnerships that govern the nation's fragmented and decentralized system are likely to continue, albeit with greater federal oversight and control. But what about intergovernmental relations in the United Kingdom? What impact did the formal devolution of power in 1999 to Scotland, Wales, and Northern Ireland have on health policy in those nations, and in the United Kingdom more generally? Has devolution begun a political process in which health policy in the United Kingdom will, over time, become increasingly decentralized and fragmented, or will this "state of unions" retain its long-standing reputation as perhaps the most centralized of the European nations? In this article, we explore the federalist and intergovernmental implications of recent reforms in the United States and the United Kingdom, and we put forward the argument that political fragmentation (long-standing in the United States and just emerging in the United Kingdom) produces new intergovernmental partnerships that, in turn, produce incremental growth in overall government involvement in the health care arena. This is the impact of what can be called catalytic federalism.     

Domestic food policy in the United States

In this paper we review the major outlines of domestic food programs, assess their adequacy, and recommend ways to improve the relationship between food programs and hunger relief. In the Food Stamp Program we treat problems of outreach, coverage and the adequacy of benefits, and rationing access through imposition of costs on recipients. For WIC and commodity distribution programs we also discuss problems associated with the fragmentation of authority and dependence on nonprofit distributors.     

The United States Supreme Court and the death penalty: The struggle for fairness

In the ten years sinceFurman v. Georgia, the United States has recognized the right of states to adopt and follow different capital sentencing schemes so long as they protect the defendant from arbitrary and capricious imposing of the death sentence. The sentence may not be disproportionate to the crime. Sentencing may be done by a judge or jury. Prospective jurors may not be challenged for cause merely because their deliberations would be affected because a death penalty was possible, but only if they could not fulfill their oath. Habeas corpus petitions in capital cases are not open invitations to avoid finality of judgment and execution of the sentence, but are to find constitutional errors.     

Rethinking retirement-age policy in the United States and Canada

More than legislation, the recent amendments to the Age Discrimination in Employment Act also symbolize a growing interest in the older working population, both in the United States and Canada, particularly the question of their "failing" job skills and the effects of retirement age on the economy. Sociologist Rix examines this issue in terms of demographic, economic and biomedical factors, discussing their implications for management, employee counselors, insurance and pension planners, the tax payers and employees of all ages.     

IP law and policy in the United States: trends and developments

Many scholars in political science and international relationshave discussed the obvious shift in world politics from theCold War period to the post-9/11 era. Nation-states now sharethe turbulent global stage with other important actors (eg non-governmentalorganizations and multinational corporations). The field ofUS intellectual property (IP) law is no different. The presentforces of globalization and technology have shaped the developmentand direction of IP policy. In a collection of six essays, ProfessorHugh Hansen, as editor of US Intellectual Property Law and Policy,invites readers to explore the trends of American IP law. Thesesix essays, as Professor Hansen rightly     

War and peace: Drug policy in the United States and the Netherlands

National drug policy has recently been a source of much debate and discussion in the United States. This paper provides a comparison of the key components of the respective drug policies that have been developed in the United States and in the Netherlands. It is argued that the Dutch approach has generally produced more desirable outcomes than have U.S. efforts, and that policy planners here should consider adopting and/or modifying several of these methods for local application.     

Health policy and the politics of research in the United States

During the past decade research has been more important to the health policy-making process in the United States than at any time in the past. This article describes and assesses three competing normative models for research on health affairs: economizing, social conflict, and collective welfare. The three models provide a context for the history of research bearing on health policy in the past half century, with particular pertinence to the years since 1980. The article concludes with a discussion of some of the consequences of the new legitimacy of research.     

Juvenile parole policy in the United States: Determinate versus indeterminate models

This paper presents an overview of eight approaches in juvenile parole policy for terminating, extending, and discharging youths from juvenile parole or aftercare. These types were derived from the results of a national survey of juvenile parole policy in the United States. This survey was sent to the departments of correction, youth service bureaus, and legislative service agencies for the 50 states. The survey sought comparative data on trends in substantive and procedural approaches for handling parole duration and discharge issues for juvenile offenders. These trends are evaluated in relation to movements toward formalism in corrections, recent reforms in juvenile sentencing, standards promulgated by various standard-setting groups, and recent shifts in juvenile justice philosophy in the United States.     

Public beliefs about the accuracy and importance of forensic evidence in the United States

Recent advances in forensic science, especially the use of DNA technology, have revealed that faulty forensic analyses may have contributed to miscarriages of justice. In this study we build on recent research on the general public’s perceptions of the accuracy of 10 forensic science techniques and of each stage in the investigation process. We find that individuals in the United States hold a pessimistic view of the forensic science investigation process, believing that an error can occur about half of the time at each stage of the process. We find that respondents believe that forensics are far from perfect, with accuracy rates ranging from a low of 55% for voice analysis to a high of 83% for DNA analysis, with most techniques being considered between 65% and 75% accurate. Nevertheless, respondents still believe that forensic evidence is a key part of a criminal case, with nearly 30% of respondents believing that the absence of forensic evidence is sufficient for a prosecutor to drop the case and nearly 40% believing that the presence of forensic evidence – even if other forms of evidence suggest that the defendant is not guilty – is enough to convict the defendant.     

Finding audiences, changing beliefs: the structure of research use in Canadian health policy

The impact of research information depends on its ability to change beliefs or policy assumptions within the relevant audiences. As a hybrid of American and British systems, Canada's chosen decision-making structure for policy-making and its legislative framework for health insurance make these audiences unclear and not readily accessible. This factor and historical characteristics of the research community which made them only partially responsive to the values of decisionmakers provide an explanation for the limited past use of research information in Canadian health policy. More recently, improved responsiveness by researchers and an emerging definition of the audiences by legislative policymakers are bringing about a gradual increase in the potential impact of research at the levels of administrative and clinical policy. Because of continuing decision-making constraints on legislative policy, however, impact at this level is predicted to remain diffuse, with only cautious acceptance of the changes in beliefs implied by research.     

States and the politics of incrementalism: health policy in Wisconsin during the 1990s

Wisconsin officials during the 1990s seemed poised to enact innovative and comprehensive health care reform. During that era, an ambitious, popular, and reform-minded governor led the state. The state had an unusually professional legislature. The state's economy was strong. Even with these advantages, however, the report card on the state's efforts is mixed. The state enacted a fairly modest set of reforms that were financed largely by the federal government and subject to extensive federal oversight. The Wisconsin story thus seems to be about the politics of incrementalism. But while critics of incrementalist politics point out that the number of uninsured continues to grow, the catalytic federalism witnessed in Wisconsin in the 1990s may well be the best model for implementing health care reform.