REALIGNING LOCAL-STATE RELATIONS - GRASS-ROOTS MENTAL-HEALTH RESTRUCTURING IN THE PACIFIC-NORTHWEST

This article provides a historical account of how one county's mental health system transformed itself from an administrative ''pass through'' mechanism for state mental health funding to a five-county mental health authority. Also documented are the efforts to respond to legislative and consumer demands to develop client services in the community rather than at the state hospital. The authors describe the groundwork being laid for establishing a prepaid health plan necessary to manage the mental health Medicaid funds in a managed care environment.