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Ronald Reagan and the Commitment of the Mentally Ill:

Capital, Interest Groups, and the Eclipse of Social Policy

Electronic Journal of Sociology (1998)

ISSN: 1198 3655

Ronald Reagan and the Commitment of the Mentally Ill:

Capital, Interest Groups, and the Eclipse of Social Policy

Alexandar R Thomas

Department of Sociology and Anthropology

Northeastern University

[email protected]

Abstract

Conventional wisdom suggests that the reduction of funding for social welfare policies during the 1980s is the result of a conservative backlash against the welfare state. With such a backlash, it should be expected that changes in the policies toward involuntary commitment of the mentally ill reflect a generally conservative approach to social policy more generally. In this case, however, the complex of social forces that lead to less restrictive guidelines for involuntary commitment are not the result of conservative politics per se, but rather a coalition of fiscal conservatives, law and order Republicans, relatives of mentally ill patients, and the practitioners working with those patients. Combined with a sharp rise in homelessness during the 1980s, Ronald Reagan pursued a policy toward the treatment of mental illness that satisfied special interest groups and the demands of the business community, but failed to address the issue: the treatment of mental illness

Introduction

Almost ten years after Ronald Reagan left office as president, the legacy of his administration continues to be studied. What is almost indisputable is that the changes in public policy that were implemented during the 1980s were sweeping and marked a turning point in American domestic policy. Faced with increasing competition from overseas, American business found it necessary to alter the social contract. This would require a realignment of the political economy so as to weaken labor unions and the social safety net. In Reagan, the Right found a spokesman capable of aligning conservatives, centrists, and working class whites. With this coalition, Reagan was able to bring about a number of reactionary changes in public policy (Alford, 1988).

This paper provides an illustration of this co-optation by examining the policies regarding involuntary commitment of the mentally ill. The shifts in such policies were not the result of overt attempts at change, but rather part of an overall effort to realign the political economy to be more profitable for business. The overall result was that political discourse shifted from a focus on social policy to a focus on fiscal policy. As such, social programs that necessitated financial outlays on the part of the federal government were overlooked in favour of policies that seemed less costly.

Still, the administration did not, and perhaps could not, act in isolation and without public support. But they didn't have to. By the middle of the 1970s, there was a consensus among interested groups that reform of the Mental Health Care System was n ecessary. Lobbying on the part of special interest groups and a commitment on the part of President Jimmy Carter led to passage of the Mental Health Systems Act.

With the planned transfer of responsibility for the mentally ill to the states, reformers needed to build coalitions of fiscal conservatives concerned with the cost of social programs; "law and order" Republicans concerned with crime; and those who dea lt with the mentally ill who, in the absence of more comprehensive reform, sought more limited alternatives (Becker, 1993). Within this context, statutes and procedures dealing with involuntary commitment of the mentally ill were attractive. Easing standards cost relatively little, allowed the Administration to claim action simultaneously on mental health care policy, crime, and homelessness, and appeased health care providers and families of the mentally ill.

The Economy

In the aftermath of World War II, the United States experienced a period of dramatic economic growth. The industrial economies of Western Europe and Japan were by and large devastated by the war. As a result, American firms found little competition abr oad in an expanding world market. The implementation of the Marshall Plan under President Truman provided American goods and services on credit to the war ravaged economies. During this period of economic hegemony, American companies were able to make con cessions to labor in regard to wages and fringe benefits. Thus, the postwar political economy of the United States was characterized by relative peace between management and labor. With record corporate profits and rising standards of living, the United States government passed a series of liberal reforms throug hout the period. Among these reforms was the passage of the Civil Rights Act, various social welfare programs, the construction of the interstate highway system, and the deinstitutionalization of the mentally ill.

During the late 1960s and early 1970s, the rebuilt economies of Europe and Japan began to give American companies stiff competition in the world marketplace. The growth experienced by American firms during the previous two decades began to slow, and profit margins were deemed to be too low (Barlett and Steele, 1996; Gruchy, 1985). In order to increase profits, many American firms attempted to become more comp etitive by trimming labor costs through layoffs and the relocation of factories (Bluestone, 1990; Bluestone and Harrison, 1982; Gruchy, 1985; Harrison and Bluestone, 1988; Moriarty, 1991; Perrucci et al, 1988; Sassen, 1991; Wallerstein, 1979). In addition , the reduction of corporate taxes was pursued with a renewed vigor (Barlett and Steele, 1994).

In order to reduce corporate taxes, it was necessary to reduce the size of the welfare state. This objective was carried out by the Reagan administration (Abramovitz, 1992). After taking office in 1981, the administration set out on a course to alter t he (relatively) labor sensitive political economy to be more business friendly. Reagan appointed anti-union officials to the National Labor Relations Board, "implicitly [granting] employers permission to revive long shunned anti-union practices: decertify ing unions, outsourcing production, and hiring permanent replacements for striking workers" (102). Reagan himself pursued such a policy when he fired eleven thousand striking air traffic controllers in 1981. Regulations designed to protect the environment , worker safety, and consumer rights were summarily decried as unnecessary government meddling in the marketplace (Abramovitz, 1992; Barlett and Steele, 1996). Programs designed to help the poor were also characterized as "big government," and the people who utilized such programs were often stigmatized as lazy or even criminal. With the help of both political parties, the administration drastically cut social welfare spending and the budgets of many regulatory agencies.

The new emphasis was on "supply side" economics, which essentially "blamed the nation's ills on 'big government' and called for lower taxes, reduced federal spending (military exempted), fewer government regulations, and more private sector initiatives " (Abramovitz, 1992, 101). Thus, to effect a change in the political economy, Reagan was able to win major concessions regarding social policy that continue today. By taking away the safety net, the working class was effectively neutralized: workers no lo nger had the freedom to strike against their employers or depend upon the social welfare system as a means of living until finding employment. Business was thus free to lower wages, benefits, and the length of contracts. The overall result was that the av erage income for the average American dropped even as the average number of hours at work increased (Barlett and Steele, 1996; Schor, 1992).

It should be understood that a realignment of the political economy did not require the complete dismantling of the welfare state -- although ideally this would be the case. Rather, the welfare state had to be rearranged in a way favorable to business. The concept of the new federalism would perform this function. The new federalism was an outgrowth of the debate over the appropriate role of the federal government relative to that of the states. While liberal Democrats argued that social welfare progra ms and governmental regulation fell within the purview of the federal government, many conservatives argued that such powers should be reserved for the individual states. Since the new environment supported conservative ideologues, the federal government was seen to have improperly assumed powers it had not been granted in the Constitution. The new federalism required that individual states create their own social policies tailored to their own particular needs. Thus, each state would have its own regulat ory and social welfare system. As each state tried to pay for such programs, this would mean fifty different state taxation policies. This effectively pitted states against each other in competition for the most favorable business climate.

Among the policies in need of reform to suit the corporate agenda were those that affected the mentally ill. The funding cuts that altered these policies were part of the overall attempt to alter the political economy in a way that would be more profit able for business rather than a direct assault on the policies themselves. Within the scope of the cutbacks, interest groups operated both in opposition and in support of the changes, both within and outside the government.

Growing Discontent

The fight over involuntary commitment during the 1980s was in some ways separate from the Reagan agenda. But it was fortuitous since it coincided with the administration's desire to dismantle the liberal era reforms. However to understand why groups made committment an issue in the 1980s, we have to take a step back and look at reforms that occurred during the 1960s.

During the early 1960s a series of initiatives designed to reform the mental health system were passed. At issue was the system of state run hospitals for the mentally ill, which were increasingly perceived as inhumane and, with the help of new medicat ions, rather unnecessary for large portions of the patient population. In 1961, the Joint Commission on Mental Illness released Action for Mental Health, calling for the integration of the mentally ill into the general public with the aid of Commun ity Mental Health Centers. In 1963, the Mental Retardation Facilities and Community Mental Health Centers instituted the centers, but due to the financial drain of the Vietnam War during the 1960s and the financial crisis of the 1970s, the program was not fully funded.1 The result was the release of patients into an environment lacking the Community Mental Health Centers to adequately treat them (Becker and Schulberg, 1976; DeLeonardis and Mauri, 1992; Hollingsworth, 1994; Rachlin, 1974; Rachlin et al, 1975; Saathoff et al, 1992; Shwed, 1978, 1980; Talbott, 1992; Worley and Lowery, 1988;).

By the start of the Carter administration in 1977, involuntary commitment had been restricted to those who were deemed as potentially dangerous to themselves or, perhaps more significantly, those around them.2 Typically, the commitment had to be sponsored by a family member and/or ordered by the court. A result of this policy was that the mentally ill patient who refused treatment typically did not receive any at all. If the patient had lost contact with family members, she or he would not be committed unless found to be a threat by the court. Often, those arrested ended up in jail rather than in treatment if they had not been found to be a threat but had committed a crime (Abramson, 1972; Conrad and Schneider, 1980). On e result was a high degree of stress and frustration experienced by the relatives of the patient. Throughout the 1970s, family members organized with the purpose of correcting a policy that they perceived was wrong.

Professional organizations also joined the backlash against the liberal era reforms of commitment regulations. One obvious reason for this is self-interest. When some mentally ill patients do not receive treatment, mental health professionals have lost (or never gained) a potential client. These professionals as a group have much to gain in terms of patients and income if the laws governing involuntary commitment are expanded to include those patients who refuse help but do not pose a serious threat to themselves or the people around them.

Perhaps more important than self-interest is the burden that deinstitutionalization put on mental health practitioners. Time spent in court took away time spent with patients. Moreover, the medical profession saw themselves as being second-guessed by o thers outside the medical community: lawyers, judges, policy makers, etc. The treatments that psychiatrists and psychologists viewed as necessary for the well being of the patient often could not be applied because of the legal rights of the patient. Invo luntary commitment would force those who needed care into the hospitals and force patients to keep appointments and take medication. Without commitment, these things were more difficult for the practitioners (La Fond and Durham, 1992, 112-13).

Critics of Community Mental Health charged that in the rush to shrink the state hospital population, many patients were released prematurely (Robitscher, 1976; Yarvis et al, 1978). Some patients went off their medications after being released into the community. The criteria of "dangerousness" for civil commitment also meant that some patients who needed treatment but were not a danger could not be committed. As a result, patients whose behavior was considered odd by the community in which they lived were increasingly arrested for bothersome and minor infractions such as vagrancy. These individuals were thus detained in the criminal justice system rather than the mental health system (Abramson, 1972; Conrad and Schneider, 1980).

Groups representing mentally ill patients also organized, but generally did not have the success that groups representing their families and practitioners had. Organizations representing patients, such as the Mental Patients Liberation Front and the Na tional Alliance for the Mentally Ill, lacked the political clout of larger organizations and tended not to be as well funded as the other organizations. Phillip Armour (1989) summarized the situation in this way:

In sum, congressmen do not confront well-funded lobbyists for the mentally disordered in the halls of the Capitol, they typically do not receive large contributions from the residents of state and county mental hospitals or the clients of com munity service centers, and they do not have to calculate the electoral risks of offending a multimillion member association of former mental patients. (187-8)

Although many groups were interested in seeing reform, there was a general lack of coordination between them. In addition, the interests of each groups shaded in and out of congruence. No two groups saw the situation the same way. This essentially left the political arena open to corporate interests and other well funded organis ations interested in mental health and capable of lobbying the government (e.g., the American Psychiatric Association, the American Psychological Association, the American Federation of State, County, and Municipal Employees, etc.). Still, the discontent of the practitioners, families, and patients dealing with the mental health system led to new hearings on mental health care policy.

Shortly after taking office in 1977, President Carter appointed the President's Commission on Mental Health. This commission was charged with assessing the particulars of mental health services, and then making specific suggestions on how things should be changed. The commission collected data by holding regional hearings in order to hear testimony from professionals, relatives of the mentally ill, and other politicians. This technique has been utilized as a politically conspicuous means of proving tha t action is being taken, but often has little merit in terms of scientific methodology.3 The final reports from the commission and its task forces were characterized in this way by Levine (1981: 179):