New Futures for Mental Health Care: The Case of Ohio

Prologue: For much of the twentieth century, mental illness has been a forlorn stepchild of America's health care system. The federal government's interest in addressing the serious problems that arise from mental illness has waxed and waned, depending upon the interests of elected politicians, available resources, and the public's attitude. As a consequence, responsibility for mental health care has resided with state governments. State involvement with mental illness has suffered through its own periods of neglect and difficulties in enacting reforms. Indeed, successful efforts to bring about constructive change are rare because of the political crosscurrents that make reform a difficult course. In this paper Michael Hogan describes how one state—Ohio—has approached reform of its mental health system. Through its reform efforts, Ohio has sought to achieve an appropriate balance between acute care services and community support for mental health care. Hogan was named director of Ohio's mental health agency in March 1991, three years after the state enacted its reform legislation. Before assuming this position, he had spent seven years in Connecticut's state mental health agency, the last four years as its director, and the eight years before that in Massachusetts's state mental health agency. Hogan holds a doctorate in administration of special education from Syracuse University and currently is president of the research institute operated by the National Association of State Mental Health Program Directors in Alexandria, Virginia.