State Public Mental Health Systems Performance: Effects of State Political Culture and State Mental Health Planning and Implementation Characteristics on State Public Mental Health System Comprehensiveness

This study was a retrospective, cross-sectional and comparative investigation of our 52 U.S. state public mental health systems.

A Mental Health Expert Survey was developed and sent to 200 State Mental Authority (SMHA) Commissioners, Planners, Researchers and Members of the State Mental Health Planning Council. Demographic information and retrospective ratings of specific state public health system characteristics were collected. Survey data were used to construct four indexes: state public mental health system comprehensiveness (CSSI; alpha of .95), block grant (annual) and overall (multi-year) planning, and service system integration activities. Well-established secondary sources were used to collect information on state and SMHA characteristics.

A Planning-Implementation-Performance Evaluation Model was developed to test the study's hypotheses. A state sample (44/52 entities) was constructed to maintain the state as the unit of analysis.

The step-wise regression specifications with the highest explanatory power (Composite Policy Libealism, overall planning and per capita expenditures) explained 39% of the variation in respondents' ratings of the CSSI. The model's F-statistic was highly significant (7.064 at p=.001).

Overall findings suggest that state public mental health systems for adult persons with serious mental illness are plausibly more comprehensive if state have: a more liberal political culture; multi-year planning; financial implementation strategies controlled by the SMHA; SMHAs that emphasize planning more than spending, and integrate the two strategies; are either free-standing or structurally linked to other state agencies; and have either decentralized or centralized administrative roles.