Date of Award


Degree Type


Degree Name

Doctor of Philosophy (PhD)


Political Science

First Advisor

Bert A. Rockman

Committee Chair

Bert A. Rockman

Committee Member 1

Pat Boling

Committee Member 2

Wendy Kline

Committee Member 3

Laurel Weldon


In the United States, the emergence of an outpatient-centered, drug-based model of mental health care was physically feasible from the 1950s onward, with the introduction of thorazine and other first-generation antipsychotics. However, it was not until 1981, with President Reagan’s veto of the Mental Health Systems Act, that American mental health policy tipped over definitively into the outpatient-centered, drug-based model. In this quantitative study of the formation of policy preference, the delay between the feasibility of the outpatient-centered, drug-based model and its adoption was explored through five research questions answered through corpus analysis and time series statistics: How do shifts in (1) the sentiments of the American public; (2) the opinions of psychiatrists, psychologists, and other mental health experts; (3) formal and informal lobbying efforts by pharmacological companies and other commercial stakeholders in mental health; (4) the policy of individual states; and (5) the policy of the federal government explain the delay between the appearance of thorazine and the adoption of the current model of American mental health care? These questions were answered through techniques such as Chow breakpoint analysis, Markov switch models, vector auto-regression (VAR), and autoregressive distributed lag (ARDL) models. It was found that both the outpatient-centered, drug-based model of mental health and community mental health centers viewed for popularity with the public, Congress, and mental health professionals for several years, thus delaying a transmission of a firm preference for the outpatient-centered, drug based model of mental health from the public to Congress. This finding was explored through the theories of multiple streams and disjointed incrementalism. The study demonstrated the existence of a robustly democratic period of policy articulation and explanation followed by a transference of public preference into governmental preference.