Organizational change seldom occurs all at once. More often it
is preceded and facilitated by a series of smaller changes. The
U.S. Centers for Disease Control and Prevention (CDC), founded
in 1946 with a focus on communicable disease, historically
considered mental health to fall outside of its mission. Having
evolved from a World War II-era malaria control program, CDC
expanded in the following decades to address most major types of
disease and injuries, as well as health promotion and disease
prevention. By the late 1980s CDC had evolved into the nation's
leading public health agency. Despite this evolution a widely
held set of underlying assumptions about CDC, namely an
organizational paradigm, persisted that continued to frame
mental health as being outside of CDC's mission. This brief
history describes how that paradigm was challenged and
superseded by a new paradigm recognizing that mental health is
part of CDC's public health mission. One program influencing the
early history of mental health at CDC w