The Dilemma of federal Mental Health Policy: Radical Reform or Incremental Change? Gerald N. Grob, Howard H. Goldman Severe and persistent mental illnesses are among the most pressing health and social problems in contemporary America. Recent estimates suggest that more than three million people in the U.S. have disabling mental disorders. The direct and indirect costs of their care exceed 180 billion dollars nationwide each year. Effective treatments and services exist, but many such individuals do not have access to these services because of limitations in mental health and social policies. For nearly two centuries Americans have grappled with the question of how to serve individuals with severe disorders. During the second half of the twentieth century, mental health policy advocates reacted against institutional care, claiming that community care and treatment would improve the lives of people with mental disorders. Once the exclusive province of state governments, the federal government moved into this policy arena after World War II. Policies ranged from those focused on mental disorders, to those that focused more broadly on health and social welfare. […] Gerald N. Grob is the Henry Sigerist professor of the history of medicine emeritus at Rutgers University. Howard H. Goldman is a professor of psychiatry at the University of Maryland School of Medicine.