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The evolution of fairness in mental health policy.

Anyone who is involved in health policy, whether as a patient, a health professional, a payer, or an administrator, has at some time experienced feelings about the fairness of a policy. Policies stir intense controversy about who is getting what benefits from a policy, and why. The purpose of this article is to examine fairness in mental health policy as it has evolved over several decades. Because the mental health system has been heavily dependent on public funds and public policy, especially for those persons with the most chronic and severe mental illness, this discussion will be limited to public policy in mental health. States differ in the quality of mental health care and the amount of money earmarked for mental health, but the intent of mental health policy from one state to another is strikingly similar. Thus, the fairness of mental health policy can be discussed as a national issue. Those policies that have been applied in every state throughout the United States are broadly described as institutionalization, deinstitutionalization and community-based care, and the community support program. Many groups of people have a role in the development of policy as well as a personal stake in its outcome. Professionals in the mental health field have traditionally been advocates for patients' interests but also have spoken for the economic and political interests of their various professions. The government must advocate for the interests of sociery as a whole, consider the effect of policies on persons with mental illness as a particular group within society, and be responsive to particular lobbies. In recent years, persons with mental illness and their families have formed organizations and begun to advocate for their interests in mental health policy. Donalda Ellek