ABSTRACT
Health agencies, mental health agencies, and institutions in general are systems in permanent change. Change may take place so slowly as to seem non-existent, or it may take a rapid, revolutionary pace. It may be generated by the institution's own developmental needs, by the pressures and needs of the context in which the institution operates or by sheer chance. Indeed, most institutional changes occur by a combination of all those undercurrents, a prime example in practice of the principles of Chaos Theory. The 1990s has been an era of reduction of access to public services and a shrinking of what in the United States is known as entitlement funds- that is, public funds for the payment of health services provided at non-public institutions for the poor and the disenfranchised. Most institutional transformations, as most evolutionary processes, take place discontinuously, in bursts, alternating with periods of steady state.
