ECONOMIC CYCLES AND MENTAL-HEALTH CARE POLICY - EXAMINATION OF THE MACRO-CONTEXT FOR SOCIAL-SERVICE PLANNING

This paper examines the political economy of social service planning. Specifically, it is concerned to demonstrate the links between the general state of the economy and mental health care policy. An examination of the social history of the asylum clarifies the importance of two trends in developing policy attitudes: changing political and professional judgments regarding the appropriate form of confinement for the insane; and variations in care associated with fiscal pressures and chemotherapeutic advances. These trends are explored in detail for the case of the Province of Ontario. The secular (long term) trend in Ontario for the period 1875-1977 is dominated by an increase in levels of admissions, discharges and numbers of patients on the hospital books. These century-long trends are reversed only after 1960, in a climate of increasing costs, mistrust of mental hospitals and advances in drug treatment of mental patients. As a consequence of policy changes, the levels of admissions and discharges increase rapidly, while the resident hospital population diminishes. There is a simultaneous increase in the levels of psychiatric activity in the new treatment centers-the psychiatric units of general hospitals and community-based mental health units. The crucial 1960-1977 period is subject to a more precise time series analysis. Monthly data for five indicators of policy practice at one psychiatric hospital (Hamilton) is related to two indicators of economic activity. Using an iterative least squares regression technique, clear relationships are demonstrated between the rates of unemployment and inflation and the levels of admission, discharge, patients on books, vacancy rate and number of available beds in the hospital. © 1979.