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The Structure and Functions of Government in the United States

Levels of Government

There are four levels of government in the United States—federal, state, county, and municipal.

Different levels of government have different roles, functions and responsibilities, which vary both from one historical period to another and from one state to another.

Except for Social Security, SSI, Medicare, and Medicaid, the federal government has very limited responsibility for health and human services. States have primary responsibility.

The responsibilities of counties for health and human services among state, county and municipal governments vary from state to state and from county to county.

NYC is confusing because it serves both the county and the municipal functions.

Branches of Government

There are three branches of government in the United States--legislative, executive, and judicial.

At the federal level:

The Legislative branch is the Congress, composed of the Senate and the House of Representatives.
The Executive branch consists of the President and the members of a Cabinet, who are appointed by the President with the approval of the Senate. Cabinet members head the federal administrative departments, and most are called "Secretaries."

In New York State:

The legislative branch is the State Legislature, consisting of The Senate and the Assembly.
The executive branch is headed by The Governor, who—with the approval of the Senate—appoints a Cabinet that includes the commissioners who head NYS's administrative agencies.

In New York City:

The legislative branch is the City Council.
The Chief Executive is the Mayor, who appoints the heads of various city departments, who are usually called "Commissioners."

In Westchester County:

The legislative branch is the Board of Legislators.
The Chief Executive is the County Executive, who appoints the heads of various county departments, who are usually called "Commissioners"
In Westchester County there is a very complex array of municipal governments including cities, towns, villages and school districts.

The judicial branch of government exists at all levels of government.

There is a very complicated array of types of courts such as criminal courts, family courts, and surrogate courts, etc.
There is also a hierarchy of local, state, and federal courts culminating in ultimate courts of appeal in each state and in the United States Supreme Court.

Making Laws: Statutory Law, Case Law, and Constitutional Law

Laws made by legislatures are called "statutory law."
Laws made through court rulings are called "case law." Frequently, the only way to know what a statutory law means is to know the history of court rulings related to its interpretation.
Constitutional law is based in the Constitutions of the United States and the individual states.
Ultimately the courts have the authority to determine whether a law is or is not constitutional.

The Formal Process of Enacting Statutory Law is as Follows:

Members of the legislature (called "sponsors") or the chief executive propose a law.
After it is introduced, a proposed statute (generally called a "bill") is given a number.
The bill is referred to a committee, which usually must approve it before the legislature votes.
In addition, bills that require spending must go through a finance committee before reaching the floor.
The legislative leaders usually have the power to prevent a bill for coming up for a vote.
A majority of legislators must vote for the bill, which also must be signed by the chief executive unless his or her veto is over-ridden by a super-majority (usually 2/3).
The informal process of making statutory law depends very heavily on legislators who become experts in a few areas, on their political parties, and on their staff.

Making Budgets

Budgets at all levels of government are made through a 4-step process:

The administrative department makes a request to the chief executive.
The chief executive submits a budget proposal to the legislature.
The legislature passes a budget bill, which must be signed by the chief executive.
The administrative department spends money as provided in the budget.

At all levels of government there are budget departments, sometimes called an Office of Management and Budget, sometimes called a Finance Department, sometimes called The Division of the Budget.

Executing Laws and Implementing Budgets

Making Regulations

Regulations spell out details, which are not included in the laws themselves.
Regulations have the force of law, but they are developed solely by the executive branch.
In general, proposed regulations are issued for information and for public comment prior to being promulgated. Sometimes they are issued on an emergency basis, without public input.
Regulations can be as important as laws in determining mental health policy. Licensing standards, for example, have a great impact on quality of treatment. Approvals for new programs can foster quick development of needed new programs or slow them to a trickle.

Planning

One of the functions of the executive branch of government is to develop plans.
For example, federal law requires all state mental health authorities to submit a plan for mental health services for people with serious mental illnesses.
New York State law requires a five-year plan for mental health services and annual updates.
It also requires local governments to submit local plans to OMH.
Planning processes generally require some sort of public review.
In NYS, the two major planning advisory bodies are The Mental Health Services Council and The Mental Health Planning Advisory Committee.
In NYC, the major advisory groups are the Community Services Board and The Federation.
In Westchester County, the major mental health advisory group is the Community Services Board.

Program Implementation

When laws and budgets create or expand programs, the executive branch must implement them.
Executive agencies may ask for input about how to develop the new programs.
Whether there is a formal process or not, there are usually informal opportunities to influence program development by talking with the staff in charge.

Court Action

The courts can also make mental health policy.
For courts to make rulings that create case law, a legal action must be taken. Legal actions can either be on behalf of specific individuals or on behalf of classes of individuals ("class action lawsuits").
Findings of lawsuits on behalf of individuals apply only to those individuals unless, in the process of appeal to higher and higher courts, rulings are made which set legal precedents.
Findings of class action lawsuits apply to all people who are in the class.
Sometimes lawsuits are settled without a court finding, but such settlements can create new policy when the executive branch of government agrees to do something new.
Some settlements are called "consent decrees." The court is part of the agreement and retains authority to make sure that the government does what it has agreed to do.

Over the years many important mental health policies have been forged in the courts. Issues such as when people can be hospitalized against their will, the grounds for holding people in hospitals, discharge planning requirements, the right to treatment, forced and unpaid labor by psychiatric patients, and many others have been resolved through court action.

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