Public managed care: developing comprehensive community support systems in Massachusetts

Massachusetts has harnessed taxpayer dissatisfaction with government to support change. Restructuring has permitted the Department of Mental Health to shift resources from state hospitals to comprehensive community support systems, the foundation for the Department's public managed care initiative. A commitment to psychosocial rehabilitation principles and consumer choice have produced radical change in the delivery and composition of mental health care services. While quality and utilization management programs provide the infrastructure to ensure accountability, quality, and cost effectiveness, education and the building of partnerships support planning and promote progress.