Quoted from rpforpres

PURE EVIL went to an elementary school and killed 20 innocent beautiful children and 6 adults who were there not only to teach these young children
but because they loved them. Parents in Conneticut have had or or planning their childs funeral.
People all over the US and around the world are in shock, are mourning the lifes lost.
No matter how we feel about the gun issue we can all agree this is an unspeakable horrible tragedy.
For those who believe in God or a higher power we can only pray and for those who don't can only hope  FOR PEACE

Quoted from rpforpres

PURE EVIL went to an elementary school and killed 20 innocent beautiful children and 6 adults who were there not only to teach these young children
but because they loved them. Parents in Conneticut have had or or planning their childs funeral.
People all over the US and around the world are in shock, are mourning the lifes lost.
No matter how we feel about the gun issue we can all agree this is an unspeakable horrible tragedy.
For those who believe in God or a higher power we can only pray and for those who don't can only hope  FOR PEACE

Quoted from Box A Rox

OK... L4Life... time to get back on your meds!  

Quoted from Box A Rox

Rp
This tragedy is painful for all Americans.  When the victims are so young, merely babies, it's impossible to
not be touched by this terrible event... even if you don't believe in god.  
I can only hope that this tragedy starts a move to prevent this type of act in the future.  

Quoted from Libertarian4life

Diversion and no denial.
You support US government murder, yet denounce non-government murder.
Illogical blind patriotism induced delusional reasoning.
Someday you will be arguing your defense of supporting murder to God.
Tell us more about how people who want to prevent "all" murder need meds.
Tell us more about your approval of selective murder and how those who oppose it need meds.
Tell us where you got your medical degree.
Tell us where you got your selective murder is ok theory.
I got my theory of all murder is wrong from the Bible.
Did Jesus need meds?
He was murdered by the government for condemning murder.
You would have defended the government that killed him for being a law breaker.

Quoted from Libertarian4life

You one sided hypocrite.
You never displayed an ounce of compassion for the Pakistani kids murdered by your lord.
Tell Obama to start the movement by ending his murders.

Quoted from Box A Rox

And this rant, has what to do with School Shooting???
Anything???

Quoted from Libertarian4life

Your mental block refuses to allow you to comprehend the idea that murder is murder.

Obama's murder of school kids is on topic.

Your irrational beliefs and lack of compassion for "all" murders is also on topic.

Quoted from Box A Rox

A great post on the subject of Obama's Drone war... but nothing to do with school shootings.  
You really gotta get a grip!

Quoted from Box A Rox

No L4Life, the topic concerns the kids killed in Connecticut last week, not Obama's drone war.  
Feel free to start a thread on that topic and I'd be glad to join in.

Quoted from Box A Rox

Rp
This tragedy is painful for all Americans.  When the victims are so young, merely babies, it's impossible to
not be touched by this terrible event... even if you don't believe in god.  
I can only hope that this tragedy starts a move to prevent this type of act in the future.  

Quoted from Box A Rox

No L4Life, the topic concerns the kids killed in Connecticut last week, not Obama's drone war.  
Feel free to start a thread on that topic and I'd be glad to join in.

Quoted Text

Electronic Journal of Sociology (199

ISSN: 1198 3655

Ronald Reagan and the Commitment of the Mentally Ill:
Capital, Interest Groups, and the Eclipse of Social Policy

Alexandar R Thomas
Department of Sociology and Anthropology
Northeastern University
alex@telenet.net

Abstract

Conventional wisdom suggests that the reduction of funding for social welfare policies during the 1980s is the result of a conservative backlash against the welfare state. With such a backlash, it should be expected that changes in the policies toward involuntary commitment of the mentally ill reflect a generally conservative approach to social policy more generally. In this case, however, the complex of social forces that lead to less restrictive guidelines for involuntary commitment are not the result of conservative politics per se, but rather a coalition of fiscal conservatives, law and order Republicans, relatives of mentally ill patients, and the practitioners working with those patients. Combined with a sharp rise in homelessness during the 1980s, Ronald Reagan pursued a policy toward the treatment of mental illness that satisfied special interest groups and the demands of the business community, but failed to address the issue: the treatment of mental illness

Introduction

Almost ten years after Ronald Reagan left office as president, the legacy of his administration continues to be studied. What is almost indisputable is that the changes in public policy that were implemented during the 1980s were sweeping and marked a turning point in American domestic policy. Faced with increasing competition from overseas, American business found it necessary to alter the social contract. This would require a realignment of the political economy so as to weaken labor unions and the social safety net. In Reagan, the Right found a spokesman capable of aligning conservatives, centrists, and working class whites. With this coalition, Reagan was able to bring about a number of reactionary changes in public policy (Alford, 198.

This paper provides an illustration of this co-optation by examining the policies regarding involuntary commitment of the mentally ill. The shifts in such policies were not the result of overt attempts at change, but rather part of an overall effort to realign the political economy to be more profitable for business. The overall result was that political discourse shifted from a focus on social policy to a focus on fiscal policy. As such, social programs that necessitated financial outlays on the part of the federal government were overlooked in favour of policies that seemed less costly.

Still, the administration did not, and perhaps could not, act in isolation and without public support. But they didn't have to. By the middle of the 1970s, there was a consensus among interested groups that reform of the Mental Health Care System was n ecessary. Lobbying on the part of special interest groups and a commitment on the part of President Jimmy Carter led to passage of the Mental Health Systems Act.

With the planned transfer of responsibility for the mentally ill to the states, reformers needed to build coalitions of fiscal conservatives concerned with the cost of social programs; "law and order" Republicans concerned with crime; and those who dea lt with the mentally ill who, in the absence of more comprehensive reform, sought more limited alternatives (Becker, 1993). Within this context, statutes and procedures dealing with involuntary commitment of the mentally ill were attractive. Easing standards cost relatively little, allowed the Administration to claim action simultaneously on mental health care policy, crime, and homelessness, and appeased health care providers and families of the mentally ill.

The Economy

In the aftermath of World War II, the United States experienced a period of dramatic economic growth. The industrial economies of Western Europe and Japan were by and large devastated by the war. As a result, American firms found little competition abr oad in an expanding world market. The implementation of the Marshall Plan under President Truman provided American goods and services on credit to the war ravaged economies. During this period of economic hegemony, American companies were able to make con cessions to labor in regard to wages and fringe benefits. Thus, the postwar political economy of the United States was characterized by relative peace between management and labor. With record corporate profits and rising standards of living, the United States government passed a series of liberal reforms throug hout the period. Among these reforms was the passage of the Civil Rights Act, various social welfare programs, the construction of the interstate highway system, and the deinstitutionalization of the mentally ill.

During the late 1960s and early 1970s, the rebuilt economies of Europe and Japan began to give American companies stiff competition in the world marketplace. The growth experienced by American firms during the previous two decades began to slow, and profit margins were deemed to be too low (Barlett and Steele, 1996; Gruchy, 1985). In order to increase profits, many American firms attempted to become more comp etitive by trimming labor costs through layoffs and the relocation of factories (Bluestone, 1990; Bluestone and Harrison, 1982; Gruchy, 1985; Harrison and Bluestone, 1988; Moriarty, 1991; Perrucci et al, 1988; Sassen, 1991; Wallerstein, 1979). In addition , the reduction of corporate taxes was pursued with a renewed vigor (Barlett and Steele, 1994).

In order to reduce corporate taxes, it was necessary to reduce the size of the welfare state. This objective was carried out by the Reagan administration (Abramovitz, 1992). After taking office in 1981, the administration set out on a course to alter t he (relatively) labor sensitive political economy to be more business friendly. Reagan appointed anti-union officials to the National Labor Relations Board, "implicitly [granting] employers permission to revive long shunned anti-union practices: decertify ing unions, outsourcing production, and hiring permanent replacements for striking workers" (102). Reagan himself pursued such a policy when he fired eleven thousand striking air traffic controllers in 1981. Regulations designed to protect the environment , worker safety, and consumer rights were summarily decried as unnecessary government meddling in the marketplace (Abramovitz, 1992; Barlett and Steele, 1996). Programs designed to help the poor were also characterized as "big government," and the people who utilized such programs were often stigmatized as lazy or even criminal. With the help of both political parties, the administration drastically cut social welfare spending and the budgets of many regulatory agencies.

The new emphasis was on "supply side" economics, which essentially "blamed the nation's ills on 'big government' and called for lower taxes, reduced federal spending (military exempted), fewer government regulations, and more private sector initiatives " (Abramovitz, 1992, 101). Thus, to effect a change in the political economy, Reagan was able to win major concessions regarding social policy that continue today. By taking away the safety net, the working class was effectively neutralized: workers no lo nger had the freedom to strike against their employers or depend upon the social welfare system as a means of living until finding employment. Business was thus free to lower wages, benefits, and the length of contracts. The overall result was that the av erage income for the average American dropped even as the average number of hours at work increased (Barlett and Steele, 1996; Schor, 1992).

It should be understood that a realignment of the political economy did not require the complete dismantling of the welfare state -- although ideally this would be the case. Rather, the welfare state had to be rearranged in a way favorable to business. The concept of the new federalism would perform this function. The new federalism was an outgrowth of the debate over the appropriate role of the federal government relative to that of the states. While liberal Democrats argued that social welfare progra ms and governmental regulation fell within the purview of the federal government, many conservatives argued that such powers should be reserved for the individual states. Since the new environment supported conservative ideologues, the federal government was seen to have improperly assumed powers it had not been granted in the Constitution. The new federalism required that individual states create their own social policies tailored to their own particular needs. Thus, each state would have its own regulat ory and social welfare system. As each state tried to pay for such programs, this would mean fifty different state taxation policies. This effectively pitted states against each other in competition for the most favorable business climate.

Among the policies in need of reform to suit the corporate agenda were those that affected the mentally ill. The funding cuts that altered these policies were part of the overall attempt to alter the political economy in a way that would be more profit able for business rather than a direct assault on the policies themselves. Within the scope of the cutbacks, interest groups operated both in opposition and in support of the changes, both within and outside the government.

Growing Discontent

The fight over involuntary commitment during the 1980s was in some ways separate from the Reagan agenda. But it was fortuitous since it coincided with the administration's desire to dismantle the liberal era reforms. However to understand why groups made committment an issue in the 1980s, we have to take a step back and look at reforms that occurred during the 1960s.

During the early 1960s a series of initiatives designed to reform the mental health system were passed. At issue was the system of state run hospitals for the mentally ill, which were increasingly perceived as inhumane and, with the help of new medicat ions, rather unnecessary for large portions of the patient population. In 1961, the Joint Commission on Mental Illness released Action for Mental Health, calling for the integration of the mentally ill into the general public with the aid of Commun ity Mental Health Centers. In 1963, the Mental Retardation Facilities and Community Mental Health Centers instituted the centers, but due to the financial drain of the Vietnam War during the 1960s and the financial crisis of the 1970s, the program was not fully funded.1 The result was the release of patients into an environment lacking the Community Mental Health Centers to adequately treat them (Becker and Schulberg, 1976; DeLeonardis and Mauri, 1992; Hollingsworth, 1994; Rachlin, 1974; Rachlin et al, 1975; Saathoff et al, 1992; Shwed, 1978, 1980; Talbott, 1992; Worley and Lowery, 1988;).

By the start of the Carter administration in 1977, involuntary commitment had been restricted to those who were deemed as potentially dangerous to themselves or, perhaps more significantly, those around them.2 Typically, the commitment had to be sponsored by a family member and/or ordered by the court. A result of this policy was that the mentally ill patient who refused treatment typically did not receive any at all. If the patient had lost contact with family members, she or he would not be committed unless found to be a threat by the court. Often, those arrested ended up in jail rather than in treatment if they had not been found to be a threat but had committed a crime (Abramson, 1972; Conrad and Schneider, 1980). On e result was a high degree of stress and frustration experienced by the relatives of the patient. Throughout the 1970s, family members organized with the purpose of correcting a policy that they perceived was wrong.

Professional organizations also joined the backlash against the liberal era reforms of commitment regulations. One obvious reason for this is self-interest. When some mentally ill patients do not receive treatment, mental health professionals have lost (or never gained) a potential client. These professionals as a group have much to gain in terms of patients and income if the laws governing involuntary commitment are expanded to include those patients who refuse help but do not pose a serious threat to themselves or the people around them.

Perhaps more important than self-interest is the burden that deinstitutionalization put on mental health practitioners. Time spent in court took away time spent with patients. Moreover, the medical profession saw themselves as being second-guessed by o thers outside the medical community: lawyers, judges, policy makers, etc. The treatments that psychiatrists and psychologists viewed as necessary for the well being of the patient often could not be applied because of the legal rights of the patient. Invo luntary commitment would force those who needed care into the hospitals and force patients to keep appointments and take medication. Without commitment, these things were more difficult for the practitioners (La Fond and Durham, 1992, 112-13).

Critics of Community Mental Health charged that in the rush to shrink the state hospital population, many patients were released prematurely (Robitscher, 1976; Yarvis et al, 197. Some patients went off their medications after being released into the community. The criteria of "dangerousness" for civil commitment also meant that some patients who needed treatment but were not a danger could not be committed. As a result, patients whose behavior was considered odd by the community in which they lived were increasingly arrested for bothersome and minor infractions such as vagrancy. These individuals were thus detained in the criminal justice system rather than the mental health system (Abramson, 1972; Conrad and Schneider, 1980).

Groups representing mentally ill patients also organized, but generally did not have the success that groups representing their families and practitioners had. Organizations representing patients, such as the Mental Patients Liberation Front and the Na tional Alliance for the Mentally Ill, lacked the political clout of larger organizations and tended not to be as well funded as the other organizations. Phillip Armour (1989) summarized the situation in this way:

In sum, congressmen do not confront well-funded lobbyists for the mentally disordered in the halls of the Capitol, they typically do not receive large contributions from the residents of state and county mental hospitals or the clients of com munity service centers, and they do not have to calculate the electoral risks of offending a multimillion member association of former mental patients. (187-
Although many groups were interested in seeing reform, there was a general lack of coordination between them. In addition, the interests of each groups shaded in and out of congruence. No two groups saw the situation the same way. This essentially left the political arena open to corporate interests and other well funded organis ations interested in mental health and capable of lobbying the government (e.g., the American Psychiatric Association, the American Psychological Association, the American Federation of State, County, and Municipal Employees, etc.). Still, the discontent of the practitioners, families, and patients dealing with the mental health system led to new hearings on mental health care policy.

Shortly after taking office in 1977, President Carter appointed the President's Commission on Mental Health. This commission was charged with assessing the particulars of mental health services, and then making specific suggestions on how things should be changed. The commission collected data by holding regional hearings in order to hear testimony from professionals, relatives of the mentally ill, and other politicians. This technique has been utilized as a politically conspicuous means of proving tha t action is being taken, but often has little merit in terms of scientific methodology.3 The final reports from the commission and its task forces were characterized in this way by Levine (1981: 179):

The quality of the Task Panel reports vary widely; apparently its members understood their instructions very differently. The reports range from very brief ones, which look as if they had been written by someone on the plane on the way to the meeting, to well-thought out analytic reviews. Some consist of little more than a list of recommendations. No more than a third of the Task Panel reports would pass muster as scholarly documents. The preparation of the reports was sloppy. Many are poorly written. Citations made in the body of the report do not appear in the bibliographies. Citations for key points are often to unpublished sources. To be fair, it should be stated that some of the Task Panels did not expect their reports to be published.
The commission made special references to political interest groups throughout both the task panel reports as well as the final recommendations. After the reports were completed and the Congress attempted to codify these recommendations into law, the l obbying organizations continued to be a presence throughout the process. Some groups were by nature opposed to each other: the National Council of Community Mental Health Centers (NCCMHC) and the National Association of State Mental Health Program Directo rs (NASMHPD), for instance. The former of these groups represents the interests of community mental health centers that would benefit by expanding these services. The latter group represents the directors of state mental hospitals. They would benefit by i ncreases in the funding of such hospitals and reinstitutionalization (Armour, 1989, 185). On this point, the commission searched for a compromise.

The final report of the commission to President Carter contained the recommendations upon which the Mental Health Systems Act of 1980 was based. Despite the methodological flaws of the earlier report, the act was considered a landmark in mental health care policy. The key to the proposals included an increase in funding for Community Mental Health Centers and continued federal government support for such programs. But this ran counter to the financial goals of the Reagan administration, these were of c ourse to reduce federal spending, reduce social programs, and transfer responsibility of many if not most government functions to the individual states. So, the law signed by President Carter was rescinded by Ronald Reagan on August 13, 1981. In accordance with the New Federalism and the demands of capital, mental health policy was now in the hands of individual states.

Settling for Smaller Reforms

In the aftermath of the non-implementation of the Mental Health Systems Act of 1980, the power of the various interest groups had been further weakened. Clearly, the groups that represented the patients themselves were the weakest. Such groups, represe nting the targets of involuntary commitment, tended to be opposed to the easing of commitment requirements. But facing interest groups representing mental health professionals and patients' families, the patient's rights groups found themselves underfunde d and understaffed.

The interests of others fared somewhat better. Pressure from organizations (some of which represented the families of the mentally ill) lead to new legislation in several states that made it easier to commit a mentally ill patient involuntarily. As noted earlier, much of this pressure emerged because the current underfunded system was not providing adequate supports for patients or family. Families of the mentally ill were genuinely concerned about loved ones who they felt were not receiving adequate care. Also, families who were responsible for providing care for their mentally ill members could not support the burden which came from care provision without adequate institutional supports. From the position of the family member, deinstitutionalization appeared more like an attempt by the government to download responsibility. In this context a loosening of commitment standards would, it was thought, force patients to receive care and (hopefully) reduce the burden on the family.

Mental health professionals were also concerned that patients were not receiving adequate care. Estimates of the homeless population ranged from 250 to 500 thousand people (Dear and Wolch, 1987; Jencks, 1994; Rossi, 1989; Wright, 1989). Of these, appro ximately a third were mentally ill (Rossi, 1989). In many cases, such mentally ill patients were arrested for vagrancy and other minor infractions and were processed by the criminal justice system. Concerned that this population was receiving no treatment at all, mental health workers advocated involuntary commitment as a means of getting the mentally ill homeless into treatment.

With such activism, a coalition between the neoconservatives who opposed liberal reforms in general and the interest groups mentioned above was possible. In the absence of the comprehensive reforms planned in the Mental Health Systems Act, the interest groups who opposed specific outcomes of liberal era reforms, although not necessarily all the reforms, turned to the neoconservatives for narrowly focused reforms. The activism of the interest groups supplied the Reagan Campaign with a supportive constituency which could be used as a foil for reactionary reforms. However there was a deep irony here. The 1980 Reagan Campaign received support from a population which might have otherwise supported the liberal objectives of the previous era (had they been adequately funded, for example). The fact that these interest groups had become disillusioned with the implementation of liberal reforms (specifically deinstitutionalization which was largely viewed as a failure), meant that this population would support a change in policy even if it meant policy reforms that would otherwise be unpalatable.

The composition of this coalition was of course antithetical to the interests of the mentally ill themselves. But groups representing the patients themselves were relatively weak. Despite the fact that groups representing the patients stressed the need for better treatment, debate most often revolved around issues defined by other stakeholders in the system like the growing homelessness problem and the burden on the families. And of course, better treatement automatically translated, in an underfunded system, to more more funding - this argument ran counter to the neoconservative need to cut back the welfare state. So often patients concerns were simply ignored.

Cuts in funding for mental health services continued throughout the 1980s, with the emphasis being on the provision of services via the private sector. Overall, the number of beds available to the mentally ill in public and private hospitals dropped ov er forty percent between 1970 and 1984 (Reamer, 1989). Most of this decline was due to cuts in public hospitals. During the 1980s, the number of beds provided by general hospitals in psychiatric wards and in private hospitals for the mentally ill increase d. In 1970, there were 150 private psychiatric centers; in 1980, there were 184; by 1988, there were 450 in the United States. General hospitals offering psychiatric services increased from 1,259 in 1984 to over two thousand in 1988 (Reamer, 1989, 25; LaF ond and Durham, 1992, 115-16). With such growth in the private sector, there were substantial profits to be made in mental illness, assuming that the patient had adequate health insurance. Those without medical insurance frequently did not receive adequat e care.

A Supportive Public Climate

The intersection of interests noted above was an important factor in creating an environment within which reactionary reforms could take place. However other environmental factors also played an important role in creating conditions whereby the desires for progressive reform could be co-opted. For example, the goals of the Reagan Administration were well received in some quarters of the National Institute of Mental Health (NIMH). In the 1980s, the NIMH started to come under the leadership of a different cohort of individuals. While the NIMH had originally been led by individuals who had come of age during the Great Depression, the leaders of the 1980s had come of age later. The result was that while the former cohort had been committed to innovations in government al social policy, the latter generation tended to be less interested in actual social policy and more supportive of measures to reduce the cost to the federal government (Armour, 1989, 187).

The Administrations goals of fiscal restraint also received support from the general public due to the perception of a federal government too prone to waste revenues and not address other basic concerns, such as crime prevention. Certain forms of social welfare spending, such as programs for the mentally ill, were perceiv ed as wasteful and thus easy targets for budget cuts (Gans, 1995; Katz, 1989). In contrast, other social programs, such as Social Security, were perceived as being "earned" by the recipients, and thus equitable. Despite the fact that the average Social Se curity recipient receives more in return than they pay into the system, programs such as this are perceived as being a pension for which the recipient has already paid. As such, they are less susceptible to cuts than categorical spending programs, such as community mental health treatment centers. Indeed, Social Security funding per beneficiary increased under the Reagan Administration (Levitan, 1990, 30). Mental health policy lacks the widespread public support that benefits Social Security (Armour, 1989 , 186). In light of this, it is not surprising that the Reagan Administration was able to cut these programs relatively easily (186-7).

The concerns of the general public were also mobilized in the context of fear over the possibility of a patient committing a violent or otherwise anti-social act. Media attention paid to the problems of the mental health system tended to concentrate in two areas: the growing homelessness problem of the early 1980s and the possibility of criminal acts committed by deinsitutionalized patients. Throughout the 1970s and 1980s, hundreds of thousands of mentally ill people concentrated in the inner cities. With the rise of gentrification during the 1980s, many of them became displaced from their relatively affordable housing and were unable to fin d new accommodations. Many of these patients had lost contact with family members and were unable to work, and many did not have health insurance. Thus, they were unable to receive mental health services in the private sector. Media coverage of the growin g homeless problem helped to pressure legislators in many states to rewrite commitment laws to extend the net and make the streets "safer."

This media attention played into, and supported, the growing perception of violent crime as a problem in the United States. The Reagan Administration answered this general alarm by calling for quick and severe punishment of offenders. For those offenders who were not mentally ill, prison was normally seen as the solution (Gans, 1995). For the mentally ill however, involuntary committment seemed the best answer. Either way, quick removal of individuals threatening the social order fit well with the administration's "law and order" stance (LaFond and Durham, 1992, 114).

The new laws, however, were not intended to make it easier to commit the dangerous mentally ill. Rather, the new laws had more general application and made it easier to commit those only considered a threat (Lafond & Durham, 1992, 11. In addition to this, many of the existing liberal justices began to rule on a "right of treatment" clause rather than a straight civil libertarian viewpoint. The result was that at both the state and federal level, the court became increasingly reluctant to strike down legislation that broadened the definition of who was eligible for involuntary commitment (119). Again, this more stringent approach meshed well with the "law and order" stance taken by the administration.

Discussion

The net result of federal abdication of responsibility, the push to state orientated programs (often underfunded), the dis-organization of groups, and the confluence of public interests (in crime prevention and fiscal restraint) with state goals, were reforms that only marginally addressed the real concerns of stakeholders and that ultimately benefitted capital by reducing the cost of social safety net. To be sure, the shift in policies dealing with involuntary commitment emerged from larger social issues. By the middle of the 1970s, groups representing the mentally ill, their families, and those who cared for them had reached a consensus on the need for reform. This culminated in the passage of the Mental Health Systems Act. This implementation, though not without its problems, was seen as a progressive step forward. However the costs of these reforms were unacceptable in the new neoconservative climate and ran counter to the interests of capital. Reagan, who never presumed to support social policy, promised to cut federal spending and ensure a "favorable business climate." So under Reagan the new law was rescinded. This signaled that for Reagan's administration, social policy was of lower priority than fiscal policy. After this act, the interest groups would need to settle for piecemeal reforms within the limitations of the administration's desire for low cost reform measures.

The "New Federalism" served as justification for relaxed federal "interference" in state issues, including mental health policy. The business community was facing a crisis of accumulation, and a shift in the political economy was perceived as necessary to guarantee adequate profit. With the abdication of the federal government, mental health policy was almost entirely in the province of the individual states.

A survey of initiatives shows that they came primarily from individual state legislatures, and thus varied according to state (Peters et al, 1987; LaFond and Durham, 1992). The procedures for commitment of the mentally ill accordingly vary by state. Ma ny states have adopted outpatient commitment as an alternative to inpatient care, and this policy has met with mixed results. 4 Many state hospitals have been closed, and many others are facing the possibility. Debate around mental health policy is still, to a large degree, concentrated around issues of deinstitutionalization and reinstitutionaliza tion and the relative merits of each.5 Sadly, professional groups with opposing interests have stalled the implementation of a comprehensive mental health policy in most states (Becker, 1993; Wilson, 1993).

Under the Reagan Administration, groups and individuals who had hoped for a change found that the federal government did very little to effect a change. The appointment of conservative justices for the federal court system was a part of the "law and or der" platform advocated by the administration and thus was never intended to have a direct effect on procedures regarding involuntary commitment or any other aspect of mental health policy.

Perhaps what is most interesting about the change in policies of involuntary commitment is the coalition that helped bring it about: a combination of "law and order" conservatives, economic conservatives, and liberal groups that sought reform in the pr ovision of mental health services. But the policy shift had hardly anything at all to do with the mentally ill or the practitioners who treated them. It was designed to lower taxes and shift responsibility away from the federal government. Ironically then , the need for reform perceived by those involved and concerned with the mentally ill (practitioners and families) was co-opted by the interests of capital.

Reagan's social policy is best seen as an abdication. Reagan's economic policy was to adjust government regulation so that it favored business once again, and social policy was merely an outgrowth of this larger issue. While family groups and professi onal groups and patient groups did clamor for respect, the real struggle was between the state and the business community. Reagan worked to lessen the tax load for the rich, and the social policies were meant to match this goal. Business needed a more fav orable corporate climate, and Reagan worked to that end. The coalitions that were necessary for election were either gratified (the elderly) or abandoned (the poor). As for the mentally ill, certain changes that their families and practitioners wanted wer e gained, and the administration pointed this out. Even though these changes came about primarily through state governments and the courts, the Administration would take credit. All in all, business interests were served. Families and doctors were appease d. Patients were forgotten.

Quoted Text

Governor Cuomo Signs Law to Expand Health Care Coverage for Treatment of Autism Spectrum Disorder

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New Law Requires Coverage of Autism Disorder by Health Insurance Providers

Albany, NY (November 1, 2011)

Governor Andrew M. Cuomo today signed a law that will require health insurance providers to offer coverage for the diagnosis and treatment of autism spectrum disorder.

The legislation will help families afford the expensive health care costs related to treating loved ones with autistic disorders. Under the new law, health insurance companies will be required to provide coverage for treatment of autism spectrum disorders, though coverage may be subject to deductibles, co-pays, and coinsurance consistent with those imposed on other benefits.

"This bill will help thousands of families across New York who struggle to obtain proper care for loved ones affected by autism spectrum disorder," Governor Cuomo said. "When it comes to autism, early diagnosis and treatment is essential, and it is inexcusable that financial constraints would stand in the way of a brighter future for those affected by this disorder. This bill opens the door to families seeking earlier treatment and better results. I thank Senator Fuschillo and Assemblyman Morelle for sponsoring this much-needed legislation."

Previously, state law only required that insurance coverage not exclude the diagnosis and treatment of autism disorder. While some health insurers provide limited coverage for ASD treatment, such as vitamins or occupational therapy, most do not offer coverage for treatments that are deemed not medically necessary. Families had little choice but to pay out-of-pocket for the necessary treatment, with costs sometimes more than $50,000 per year. Many families cannot afford to pay for treatment without a severe economic hardship and may have to forgo effective early treatment of ASD for their children.

With today's signing, New York is the twenty-ninth state to require health insurance coverage for conditions relating to autism spectrum disorder. As with other states, this legislation caps the cost of services per year. The law takes effect one year after its enactment on November 1, 2012 and applies to insurance policies issued or renewed after that date.

Autism spectrum disorders are a group of complex, pervasive developmental brain conditions that are often characterized by difficulties in social interaction, impairments in communication, and repetitive patterns of behavior. ASDs occur in approximately one in every 110 children in all racial, ethnic and social groups, and studies suggest that it is four times more likely to occur in boys than girls. Early detection of ASDs, when followed by the right interventions, can lead to better outcomes in functioning. In New York, approximately 30,000 individuals under the age of 19 have been identified with an ASD.

New York State offers a number of services and supports to individuals with ASD and other developmental disabilities, including the Department of Health's Early Intervention Program, preschool special education services and special education services for school children under the auspices of the State Education Department, and an "Autism Platform," provided by the Office for People with Developmental Disabilities that offers certain services and support for individuals with ASD, most of which are Medicaid-funded and provided in conjunction with an individualized service plan.

Senate Majority Leader Dean G. Skelos said, "Thousands of families throughout the state are facing critical choices between providing quality care for children and adults with autism or jeopardizing their finances. This bill will give them access to the tools that have been proven to make a difference in the life of an individual with autism. I thank Senator Fuschillo and Senator McDonald for their leadership, and commend the Governor for partnering with us to get this done."

Assembly Speaker Sheldon Silver said, "A government that steps up to ensure a brighter future for vulnerable children and adults – especially in difficult times such as these – is a government with its priorities in order. I thank the Governor for standing up for those afflicted with Autism Spectrum Disorders and for their families who are striving to give them the best care possible; and to my colleague, Assemblyman Joe Morelle, for his leadership and his tireless efforts to help make today possible."

Senator Charles J. Fuschillo, Jr. said, "Today is a great day for individuals with autism. For years, families have fought for access to treatment coverage for their loved ones. This new law will afford individuals with autism the opportunity to receive treatments and therapies they need without being forced to spend tens of thousands of dollars out of pocket every year. I thank Governor Cuomo for signing this law which will dramatically improve the lives of every New York family affected by autism."

Senator Roy J. McDonald said, "Autism is quickly erupting into epidemic levels with diagnosis rates climbing at an astonishing level, this is a mental health issue that is going to get much worse before it gets better and this legislation helps real people and their families. I want to thank Governor Cuomo for his leadership and support of this bill, along with my colleagues in the Senate and Assembly who sponsored this legislation."

Assemblyman Joseph Morelle said, "With Governor Cuomo's signature today, families will no longer have to decide between affording health care for one child or college education for another. New York has proven with this law that we remain a state that looks out for everyone, especially those who face hardship through no fault of their own. I thank the Governor for his leadership and attention to this issue, and I commend my colleagues in the legislature for passing this important bill."

Dr. Nirav Shah, Commissioner of the Department of Health said, "Early detection of autism spectrum disorders, when followed by the right treatment programs, has been shown to lead to better functioning in patients, and will provide a more stable future for children and their families. I thank and commend Governor Cuomo and our Legislature for working together to enact legislation that will help families all across New York meet the challenges of autism spectrum disorders."

Courtney Burke, Commissioner of the Office for People with Developmental Disabilities said, "I cannot stress enough the importance of early diagnosis and treatment of autism spectrum disorders (ASDs). However, many families have had to forgo early intervention due to economic hardship. With the signing of this bill, caregivers can continue to advocate and support their child who has been diagnosed with autism, and not have to worry about the financial stress related to needed services. Today, the families of the 24,000 New York State citizens diagnosed with an ASD, whom OPWDD serves, join me in applauding Governor Cuomo and his decision to sign this vital bill."

John B. King, Jr., State Education Commissioner said, "The struggle with autism is hard enough for families. Those families shouldn't be forced to choose between a mountain of medical bills or delaying care for their children. And early and accurate diagnosis is vital for long-term, effective treatment. There are some things that are simply the right things to do. This new law is one of them. The Governor and the Legislature have taken a tremendous burden off the backs of thousands of New York parents with children suffering from autism spectrum disorder."

Bob Wright, Co-founder of Autism Speaks said, "Autism Speaks thanks Governor Cuomo for his wisdom and courage in standing by our families who struggle with autism. We commend the Governor's willingness to work with us and our champions, Assemblyman Joe Morelle and Senator Chuck Fuschillo, to craft one of the most powerful autism insurance reform bills in the nation. Today New York becomes the 29th state to enact reform, joining the growing majority of states that put families first."

Mark Roithmayr, President of Autism Speaks said, "Some New York families, already hit hard by the recession, are paying tens of thousands of dollars out-of-pocket each year to provide their children with the therapies they need and deserve. This critical legislation will not only right this wrong, but also save the taxpayers of this state an estimated $13 million in special education, Medicaid and social service costs in the next six years. This is a good day for all New Yorkers."

Paul A. Hamlin, MD, President, Medical Society of the State of New York said, "On behalf of the physician members of the Medical Society of the State of New York, the signing of this bill is a momentous event. The measure will expand health insurance coverage for the screening, diagnosis and treatment of autism spectrum disorders. Patients are often faced with significant gaps in treatments which may be needed over and above those provided pursuant to an individualized family, education, or service plan. We commend Governor Cuomo, Senator Fuschillo and Assemblyman Morelle for their foresight in championing this legislation which will expedite diagnosis and treatment by providing insurance parity for autism sufferers and result in better long-term health outcomes."

Patricia Schissel, LMSW, Executive Director of Asperger Syndrome and High Functioning Autism Association (AHA) said, "Today's signing lifts a great financial burden on families in New York who have to care for individuals with autism. By requiring health insurance companies to provide coverage for the diagnosis and treatment of autism, families can now more easily detect autism in individuals and begin needed treatment as soon as possible. I commend Governor Cuomo and Sponsors Senator Fuschillo and Assemblyman Morelle for their work in passing this legislation."

Elie Ward, Director of Policy & Advocacy, American Academy of Pediatrics, District II, NYS said, "Having a child diagnosed with autism can create enormous financial difficulties for families already struggling with the impacts of our current economy and compounds the emotional/social challenges of caring for a chronically ill child. Without the kind of health care coverage this legislation requires, these families are often left with no choice to but forgo treatments. As a result of this draconian choice, their children are left even further behind their peers and absorb more services going forward. By requiring health insurance companies to pay for the diagnosis and treatment of autism and autism spectrum disorders, Governor Cuomo is ensuring that the tens of thousands of affected children in New York are given access to proper care and a better chance to grow and develop to their full potential. The more than five thousand pediatricians across New York sincerely I thank Assemblyman Morelle and Senator Fuschillo and their many colleagues for getting this law passed in the legislature. And we thank Governor Cuomo for signing it."

Anita Altman, Deputy Managing Director for UJA-Federation of New York said, "For so long, families who are raising children with autism have been weighed down by backbreaking out-of-pocket costs for autism disorder treatments. And for those families who cannot afford treatment, their children are left with even more of a disadvantage academically and socially. Requiring health insurance providers to cover these costs will change the lives of these families, and I thank Governor Cuomo for signing this into law."

Katie Weisman, Secretary of the Autism Action Network said, "My family and I were so relieved when this bill finally passed in the legislature and could not be more excited that the Governor is signing it today. I would like to thank Senator Fuschillo, Assemblyman Morelle and all the advocates who worked on this piece of legislation. This law will acknowledge that autism is a medical condition and not just a psychiatric condition. I have seen first-hand how effective treatment can be. My children have grown leaps and bounds through both medical treatment and intensive educational support. It is important that all the individuals and families affected by autism be able to afford the care they so desperately need. We cannot pinch pennies over something as significant as improving long-term quality of life. This new law should smooth the road for those families whose loved-ones are affected by autism."

Susan Hyman, MD, Associate Professor of Pediatrics and Division Chief of Neurodevelopmental and Behavioral Pediatrics at Golisano Children's Hospital, University of Rochester Medical Center said, "In today's economy, having a child diagnosed with autism can be an enormous financial difficulty on already strained family budgets. Governor Cuomo is ensuring that proper medical and behavioral care will be reimbursed for the 1 in every 110 children and youth in New York with autism by requiring health insurance companies to pay for the diagnosis and treatment of this neurodevelopmental disorder. I would like to personally thank Assemblyman Morelle and Senator Fuschillo for getting this law passed in the legislature."

Stephen Sulkes, MD, Professor of Pediatrics at Golisano Children's Hospital and Director of the Strong Center for Developmental Disabilities, said, "Autism spectrum disorders have profound effects on the lives of thousands of New Yorkers, their friends and their family members. Today, Governor Cuomo's show of support for those impacted by ASDs proves the state government is on their side. I thank the Governor for signing this bill into law and working to minimize the challenges that result from ASDs by requiring health insurance providers to cover its treatment and diagnosis."

Paige Pierce, Executive Director of Families Together in New York State and President of the Board of the Autism Society of the Greater Capital Region said, "I congratulate New York on becoming the latest state to pass the Autism Bill requiring health insurance companies to provide coverage for treating people with Autism Spectrum Disorders. This Bill demonstrates an understanding of the importance of comprehensive and early care and treatment for our children. As a parent of a young man with ASD and the co-chair of the Timothy's Law Campaign, I know firsthand the challenges that families have faced in the past. I thank Governor Cuomo, Senator Fuschillo and Assemblyman Morelle for their progressive leadership and commitment to our children and families."

Jan Campito, Vice President of the Autism Society of the Greater Capital Region said, "Governor Cuomo has made the improvement of healthcare and its financial impact on New York and its constituents a priority since taking office. Today's signing is another example of his commitment to progressive health care for families with special needs. This new law is great news for our children and families who have had to make enormous sacrifices to afford the high costs of ASD treatments, and I commend the Governor, Senator Fuschillo and Assemblyman Morelle for their hard work."

Michael Smith, Chairman of the Foundation for Autism Information and Research, Inc. said, "This bill signing is a monumental achievement for the tens of thousands of New Yorkers directly affected by autism, and their families. Governor Cuomo, together with Senator Fuschillo and Assemblyman Morelle and the entire State Legislature, has ensured that heath care providers will fulfill their obligations and no longer demand that families suffer the burden of these expensive treatments and care. This bill is a positive step forward, but, much work remains to be done in addressing the overall hurdles to insurance coverage for families. The autism epidemic will continue to be a high priority in the State Legislature."

Sarah Milko, President of Upstate New York Families for Effective Autism Treatment said, "In today's economy, having a child diagnosed with autism can be an enormous financial difficulty on already strained family budgets. And if these families are left with no choice to but forgo treatments, their children are left even further behind their peers. By requiring health insurance companies to pay for the diagnosis and treatment of the disorder, Governor Cuomo is ensuring that the tens of thousands of affected children in New York are given proper care. I thank Assemblyman Morelle and Senator Fuschillo for getting this law passed in the Legislature."