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Revisiting the Relationships among Community Mental Health Services, Stigma, and Well-Being

50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities

ISBN: 978-1-78560-403-4, eISBN: 978-1-78560-402-7

Publication date: 4 July 2016



This chapter examines the effects of mental health services and stigma on changes in self-concept and well-being for individuals with SPMI.


Data for this chapter come from structured interviews and service data for 140 individuals with severe and persistent mental illnesses. We use structural equation modeling to examine the relationship between perceived and internalized stigma, as well as the relationships among stigma, self-concept (self-esteem and mastery), and well-being (quality of life and functioning).


We find that case management is negatively related to quality of life and psychiatric services are positively related to functioning. Crisis services and assessment are associated with mastery in opposite directions. Internalized stigma is positively associated with self-esteem and mastery, and negatively associated with functioning. We do not find a relationship between services and stigma.

Research limitations/implications

A limitation to this chapter is the sample size, which prohibits us from examining a full range of services and outcomes. Nonetheless, our findings provide information about how services and stigma impact well-being, and may be used as a starting point for considering strategies for improving services and reducing stigma. Future work should consider pairing outcomes with services to determine their effectiveness.


This chapter builds on previous research that examines the relative effects of services and stigma among individuals in community health care by extending measures of both services and stigma, and by examining the relationship between them, in order to better determine their implications for self-concept and well-being.




We thank the clients and staff of Community Support Services (CSS) and the Consumer Education Outreach Center for their assistance in research design and data collection. In particular we thank Terrence Dalton and Frank Sepetauc, from CSS, for their help with logistics and their support of this effort. We also thank Tom Grande and Nick Veauthier of the County of Summit Alcohol, Drug Addiction and Mental Health Services Board for technical assistance. This study could not have been done without their help. Collaborators for this project who contributed to the research design include: Richard E. Adams, Kristin Baughman, Natalie Bonfine, Sara E. Dugan, Mary Gallagher, Kristen Marcussen, Kristin Mickelson, R. Scott Olds, Elizabeth Piatt, and James Werner. This work was supported by the Northeast Ohio Medical University Office of Research and Sponsored Programs (Christian Ritter, PI). Funding for the study is provided by Northeast Ohio Medical University, Christian Ritter (PI).


Marcussen, K. and Ritter, C. (2016), "Revisiting the Relationships among Community Mental Health Services, Stigma, and Well-Being", 50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities (Advances in Medical Sociology, Vol. 17), Emerald Group Publishing Limited, Bingley, pp. 177-206.



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