Policymaking cycles in mental health: critical examination of a conceptual model

Analysts have frequently used the concept of a cycle to describe the historical development of mental health policy in the United States. According to the "cyclical" perspective, the mental health system alternates between crests of high policy and program activity and troughs of stagnation and decline. Analysts also observe that past policy themes are periodically rediscovered, only to eventually lose favor and recede into the background once again. This article critically examines the cyclical model of mental health policymaking, placing it within a context of broader theoretical work on the dynamics of public policy formation. The purpose is to organize in a conceptually coherent way what has emerged as the leading theoretical approach to understanding the evolution of the mental health system; to identify major issues and ambiguities in the application of the cyclical framework to mental health policy analysis; and to derive some general insights about problems and possibilities in modeling policy change.