A study of 40 years of news coverage of community mental health policies

Abstract

How does the public learn about mental health policy? This question was investigated by looking at the coverage of one state's public policies concerning deinstitutionalization of the mentally ill in one newspaper for four decades.;A content analysis of 308 articles from the New York Times was completed for the years 1955 to 1994. This qualitative and quantitative research analyzed the manifest content (what was overtly stated) for each of these articles. A total of 408 major themes were identified from these articles (some articles had more than one major theme). The themes from most to least frequency were: primary prevention (108), mental health law and legislation (99), fiscal considerations (65), clinical (48), community reactions (30), Medicaid/SSI (16), political ideology (10), scientific research (10), role of state hospital (9), overcrowded conditions (6), state hospital reactions (3) and public attitudes (1).;The three most frequently covered themes were primary prevention, mental health law, and fiscal considerations. Primary prevention was linked to many themes from clinical to fiscal. No clear definition of primary prevention emerged, it seemed to reflect pervasively cultural and political values rather than empirically tested outcomes.;The law cases cited centered around a patient's right to both freedom and treatment, and right to refuse treatment. Fiscal themes were mostly about balancing the annual state budget.;Scientific explanations concerning deinstitutionalization were rarely linked to policy discussions in the last three decades studied. Scientific findings were consistently mentioned only during the first decade (1955 to 1964).;What is known and reported about clinical practices and all types of applied and basic research concerning chronic mental illnesses and treatments seems to have been segregated from public policy debates. The illusion and reference to primary prevention were often offered as a rationalization for deinstitutionalization. Will research and practice continue to have a minor role as managed care emerges as a powerful new theme in future public debates?