ABSTRACT
This chapter examines new and emerging institutional forces that will shape mental health care. It argues that the institutional environment has a direct bearing on mental health care. The chapter also argues that managed care represents a "controversial" challenge to "traditional definitions of mental illness and treatment goals." It describes the key forces and organizations that exert various forms of institutional pressure on mental health care systems. The chapter looks for evidence of countervailing power, or forces that limit managed care's potential for abuse. The commodification of health care is the movement from a provider- to a buyer-driven system of care, and was a result of the "buyers' revolt" due to escalating health care costs in the 1970s and 1980s. The chapter also examines how CARE has responded both to the state-mandated reform and to the response of a nearby three county system.
