The evolution of systems of mental health care: the Arizona experience

Reform in a system of mental health services is the result of a variety of forces that operate synergistically to bring about observed events. This evolutionary process is most likely to yield substantial results through multiple interventions over time rather than a single attempt at reform. A process of change in the mental health service system in Arizona has been evolving in response to the interaction of several key variables: a social movement dedicated to reform, a planned design for change, and the use of litigation. The author reviews each of these factors and assesses the overall process of change within the state.