The relationship between state political culture and adopted state mental health policies: Case management (CM) and assertive community treatment (ACT)

This study examined state patterns of mental health policy decisions pertaining to Case Management (CM) and Assertive Community Treatment (ACT) in 1998, and explored the association between state political sub-culture, as conceptualized by Daniel Elazar, and the CM and ACT policies. Secondary data were taken from the NASMHPD State Mental Health Agency Profiling System (SMHA-PS). Descriptive data of the adopted CM and ACT policies first was reviewed. Data indicated that a majority of states in 1998 supported certain service mandates: mandates to providers for a set of MH services; mandated CM and selected population CM targets for youth, adults and homeless mentally ill persons; and mandated ACT and selected population ACT targets for adults. A majority of states reported providing some version of ACT services, but the scope of those services appeared limited.; Tests of association were conducted on four specific policies pertaining to service mandates and provision of a standardized ACT model. Statistical data indicated little support for Elazar's theory. State sub-cultures only were significantly associated with offering alternative, non-standardized ACT models. As predicted, Traditionalistic and Traditionalistic/Moralistic (T/TM) states were most likely to offer an alternative ACT model. An unexpected finding was that Traditionalistic and T/TM states also were most likely to own and operate community MH services. The results suggested that Elazar's sub-culture typology may have been altered over time by national factors; and that state mental health policy similarly have become homogenized.