From Constitution to contracts: Mental disability law at the turn of the century


John Petrila

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mental disability law, legal strategies, policy framework, mental health services, public services, privatization, managed care, mental illness


Examines the changes in the legal and policy framework that shaped mental health services over the past 30 yrs and discusses emerging legal strategies for addressing the problems that people with serious mental illnesses face today. The chapter begins with a discussion of changes in the public mental health system, including changes in financing and treatment. It then summarizes the emergence of managed care and privatization and discusses the impact of those developments on the public mental health system. The chapter then examines legal advocacy on behalf of people with mental illness in today's environment, focusing on provider and payer liability, as well as government's responsibility as a regulator of services provided through contract. It briefly summarizes legislative responses to issues arising from managed care and privatization and concludes with some predictions regarding legal issues of likely import in the near future. By necessity many of these developments are covered with broad strokes, but a unifying theme is the assumption that law, policy, and services for people with mental disabilities are inextricably connected and that mental disability law must be considered in the context of how and where people with mental disabilities receive services.