Economics and the transformation of the mental health system

Sherry Glied, Richard G. Frank

Research output: Contribution to journalArticlepeer-review


Mental illnesses provide a difficult set of challenges to American health and social institutions. Those challenges have been a continuous concern of David Mechanic's over the course of his career. In this article we trace the development of modern economic and organizational structures that drive the delivery of mental health care in the early part of the twenty-first century. We show how the nature of mental disorders themselves and the treatment for addressing those illnesses pose fundamental difficulties to health care organizational and financing structures. We analyze the factors that have caused the dramatic changes in how American society has addressed mental illnesses over the past fifty years. Specifically, we note the central influence that mainstream health, incomesupport, and disability programs have had in shaping mental health care. We argue that the interaction of the unique features of mental illnesses and changes in mainstream health and social policy led mental health care to evolve so differently from general medical care.

Original languageEnglish (US)
Pages (from-to)541-558
Number of pages18
JournalJournal of health politics, policy and law
Issue number4
StatePublished - Aug 1 2016


  • Managed behavioral health care
  • Medicaid
  • Mental health economics

ASJC Scopus subject areas

  • General Medicine


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