The alchemy of mental health policy: Homelessness and the fourth cycle of reform

This paper examines a fourth cycle of reform emerging in the past decade in response to the failures of community mental health and deinstitutionalization. The new reform advocates creating community support systems, a broad network of mental health and social welfare services for care of the chronically mentally ill in noninstitutional settings. This reform movement is different because it directly addresses the needs of the chronically mentally ill rather than promising to prevent chronicity through the early treatment of acute cases and because it recognizes the problem of the chronically mentally ill as a public health and social welfare problem. The breadth of this mandate, however, is threatened by shrinking health and welfare resources and by a growing expectation that it will solve the problem of homelessness.