The Revolving Door: Patient Needs and Network Turnover during Mental Health Treatment

Abstract

Purpose

While much research examines the consequences of deinstitutionalization for caregivers, few studies address support mobilization strategies used by patients themselves. We examine the relationship between mental health patients’ needs, their activation of network ties for health discussion, and network dynamics during the course of treatment. We hypothesize that patients strategically activate their network ties for support that matches their needs. Linking activation to network dynamics, we also propose that patients with greater needs exhaust their supportive relationships and experience more network turnover.

Methodology/approach

We draw on a dataset of new mental health patients (N=173) and their associated network members (N=4,144) observed over three years. Random-intercept regression models test the relationship between patients’ needs and (1) network tie activation for health discussion and (2) network turnover.

Findings

Although the overall level of need does not predict network tie activation, mental health patients are more likely to activate network ties who provide support that matches their expressed needs for discussion, emotional, and financial support (although not instrumental or informational support). In addition, patients with elevated needs experience increased network turnover. Strategic activation and its unintended consequence together suggest a revolving door of support for patients in crisis.

Practical implications

In the post-deinstitutionalization era, patients’ informal social safety nets must compensate for needs that are left unmet by deficits in the formal treatment system. We find that patients seek out network members who are well-equipped to help them cope with the onset of illness. At the same time, network activation may lead to instability as high-need patients churn through supportive relationships. Future research should examine the consequences of tie activation and support needs for network dynamics in different treatment contexts.

Citation

McConnell, W.R. and Perry, B.L. (2016), "The Revolving Door: Patient Needs and Network Turnover during Mental Health Treatment", 50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities (Advances in Medical Sociology, Vol. 17), Emerald Group Publishing Limited, Leeds, pp. 119-145. https://doi.org/10.1108/S1057-629020160000017005