| This thesis systematically examines the diffusion of four innovative mental health policies across the 50 American states from 1968 to 2000: (1) freedom of choice laws, which establish the rights of licensed or certified psychologists to bill directly for services covered under insurance, (2) involuntary outpatient commitment statutes, which require mentally ill patients who are at risk of harming themselves or others to follow a specific outpatient treatment plan or risk facing sanctions, (3) Medicaid managed behavioral health care waivers, which are an option in the Medicaid program that allow states to enroll Medicaid beneficiaries in plans that restrict their free choice of providers to those affiliated with the plan in question, and (4) mental health parity statutes, which require insurance companies to offer equivalent benefits for mental and physical disorders with regards to annual and lifetime benefits, coinsurance arrangements, and limits on hospital visits.; I develop three models to describe the policy diffusion process: a policy learning model, a policy emulation model, and a policy symbolism model. Each model has different connotations about the diffusion process. The diffusion of Medicaid managed behavioral care waivers and involuntary outpatient commitment statutes was initially slow to diffuse suggesting these policies involved learning while the diffusion of freedom of choice laws and mental health parity laws was fast suggesting these laws involved either emulation or symbolism.; Event history analysis for discrete time data was utilized to identify the correlates of the four mental health policy innovations. States with greater levels of legislative professionalism were more likely to adopt policy innovations that involved learning while legislative professionalism mattered less for policy innovations that involved emulation or symbolism. The most consistent and strongest predictors of mental health policy innovation were interest groups including psychologists, psychiatrists, the National Alliance of the Mentally ill (NAMI), and managed care organizations. Advocates of mental health services (psychiatrists, psychologists, and NAMI) did not always consistently favor the same policies. Managed care organizations were significant impediments to mental health policy innovations that involved insurance regulation yet supportive of policies that increased their share of the healthcare market. Policy legacies were important predictors of all of the policies examined suggesting that within state learning is an influential determinant of policy innovation. |
