Search results

Two major reform movements have shaped child and adolescent mental health services over the past quarter-century: the Systems of Care movement, and more recently, the movement toward evidence-based practice. Results from several studies indicate that youth served in traditional residential or inpatient care may experience difficulty re-entering their natural environments, or were released into physically and emotionally unsafe homes (Bruns & Burchard, 2000; President's Commission on Mental Health, 1978; Stortz, 2000; Stroul & Friedman, 1986; U.S. Department of Health and Human Services, 1999). The cost of hospitalizing youth also became a policy concern (Henggeler et al., 1999b; Kielser, 1993; U.S. Department of Health and Human Services, 1999). For example, it is estimated that from the late 1980s through 1990 inpatient treatment consumed nearly half of all expenditures for child and adolescent mental health care although the services were found not to be very effective (Burns, 1991; Burns & Friedman, 1990). More recent analyses indicate that at least 1/3 of all mental health expenditures for youth are associated with inpatient hospitalization (Ringel & Sturm, 2001).

Despite continuing socioeconomic and racial/ethnic gaps in many health care services, the National Healthcare Disparities Report (2004) documents parity in substance abuse treatment provision among individuals of varying socioeconomic and racial/ethnic backgrounds. This study investigates that achievement by analyzing the relationship between community socioeconomic and racial/ethnic disadvantage and organizational provision of substance abuse treatment, treatment need and utilization across United States counties, 2000, 2002 and 2003. Results confirm equity in service provision in poorer communities and those with higher concentrations of African Americans. Significant disparities remain, however, in communities with higher concentrations of Hispanics, youth and female-headed households. Limitations and implications for future studies of health care provision are discussed.

In this chapter, I develop an analysis of the institutional logics which have shaped the organizational field of public sector mental health and which provide a framework for understanding the complexities facing policy makers, providers, researchers, and community mental health advocates.

I first assess the current state of public sector mental health care. I then describe institutional theory, which focuses our attention on the wider social values and priorities (i.e., institutional logics) which shape mental health care. In the current post-deinstitutionalization era, there are three competing institutional logics: recovery and community integration, cost containment and commodification, and increased social control over those with severe mental disorders. Each of these logics, and the conflict between them, is explicated and analyzed. I then develop a theoretical framework for understanding how conflicting institutional logics are resolved. In the concluding section of this chapter, I offer some guidance to both researchers and advocates seeking meaningful system level reform.

Researchers studying mental health policy need to understand how competing institutional logics work to shape the political climate, economic priorities, and types of services available.

Advocacy is critical for meaningful reform, and a fourth institutional logic – that of social justice – needs to be developed by which to evaluate policy reforms and service offerings.

A system of care is a function-specific, rather than agency-specific approach defined as a “comprehensive spectrum of mental health and other necessary services which are organized into a coordinated network to meet the multiple and changing needs of children and adolescents with severe emotional disturbances and their families” (Stroul & Friedman, 1986). A system of care provides a mental health delivery system for children with SED with a wide array of accessible, community-based services that focus on children's individual needs, include the family in treatment planning, and provide culturally competent services. System of care services are provided by multiple child serving agencies and are collaborative and coordinated (Stroul & Friedman, 1986).

Purpose – This chapter explores claims of social problem workers in criminal justice and mental health with regard to how to manage males who are identified as or self-identify as both victims and perpetrators (V/Ps) of sexual abuse. We also examine the claims of V/Ps with regard to how they manage their dual status.

Methodology – This chapter is based on an action research project on intervention services for V/Ps in Ontario, Canada. Our data include literature reviews, interviews with intervention professionals, V/P narratives, and a transcription of a stake-holder's workshop.

Findings – Intervention workers whose mandate is offender risk management state they give little attention to victimization-related issues of V/Ps, whereas workers in victims’ services often state that adult V/Ps are not covered under their mandate. This suggests that the status of offender is the master status for adult V/Ps. Our V/P narratives recount efforts at self-management and some V/Ps and intervention professionals have expressed interest in the possibility of developing programs specially designed for V/Ps.

Practical Implications – An examination of issues related to the dual status of sexual abuse V/Ps suggests that V/Ps may require special services that cannot be provided by existing programs for perpetrators and victims.

Originality/Value of Paper – Studies of social problem work might benefit from considering not only professionals’ viewpoints but also those of their clients. This chapter explores new intervention models (GLM and RJ) that incorporate ethical concerns based on a rights perspective (“moral repair”) and the experiential concerns of V/Ps.

This chapter summarizes findings and conclusions from recent studies exploring the role of motivation-readiness factors in drug abuse treatment. The research focuses on populations entering drug treatment, particularly therapeutic community programs in community- and prison-based settings. However, findings from studies in other modalities and from samples not entering treatment are also discussed. Issues addressed include (1) the nature of the motivational concept in recovery, (2) motivation as a variable affecting treatment retention and outcomes, (3) motivation in the treatment process, (4) differences in motivation across treatment populations and modalities, (5) client correlates of motivation, and (6) motivational enhancement. Conclusions highlight the critical role of motivation-readiness factors in understanding treatment-seeking, retention, and outcomes. Key implications are discussed for research, theory, treatment practice, and health care policy. These implications underscore issues relating to the interaction of motivation and treatment processes, the interaction of motivation and treatment demands, differences in motivation among special populations, client correlates of motivation, and self-selection and study designs.

This chapter introduces a simulation model to estimate the social costs of problem drug misusers in England and Wales, and how policies to increase the number of drug users in treatment may impact on both social costs and government expenditure. Consequences are divided into five domains – health, crime, social care, work, and driving. Social costs are estimated to be between £12 and £12.3 billion, and the total cost of government expenditure is around £3.5 billion. Increases in the numbers in treatment, are estimated to reduce social costs across a 5-year period by between £3.0 and £4.4 billion.

Purpose – The chapter examines the historical pattern of interconnections between drug policy, research, and treatment in light of recent theoretical developments in the medicalization thesis advanced in the sociology of medicine.

Methodology/approach – The chapter uses interpretive methods to examine how the social construction of addiction as a “chronic, relapsing brain disorder” converges with or diverges from the conceptual framework offered by sociological theorists of medicalization and biomedicalization.

Findings – The approach adopted shows how the meanings of the bio/medicalization of addiction shifted and circulated within and beyond the institutions developed to respond to drug addiction as a hybrid social, medical, and biomedical condition during the 20th century.

Social implications – Bio/medical frameworks for addiction are the outcome of historical attempts to influence public attitudes and develop effective methods to treat and prevent this “disease” in ways that would positively affect the quality of life of people living with addictions.

Originality/value – This original contribution addresses both strengths and limitations of bio/medical models, assessing how their influence has changed over time.

The belief that children have mental health needs different than those of adults is a relatively recent phenomenon. Systematic field studies of mental illness began in the early 19th century (Anthony, Eaton, & Henderson, 1995), although awareness of these illnesses and the recognition of the need for treatment were well established by the 1600s (Grob, 1994). Field studies and census data from mental hospitals in the 1800s reveal few cases of mental illness identified among children under the age of 16. In the late 19th and early 20th centuries, the recognition that children have specific mental health needs arose as the result of the confluence of several factors. The Progressive Movement promoted child labor and mandatory public education laws that created legal separations between the role of children and adults (Abbott, 1908; Sutton, 1983). Hall (1905) helped popularize the idea that childhood and adolescence constituted distinct periods of development. Perhaps most pressing, however, was a perceived rise in juvenile delinquency and sexual promiscuity. To address these problems, separate courts were established for juvenile offenders to keep children out of institutions and to provide treatment and rehabilitation (Alper, 1941). Based on the work of Healy and Bronner (1916), researchers and policy makers began to think of juvenile crime as arising from “mental conflicts” in children. Institutions such as the Chicago Juvenile Psychopathic Institute and the Boston Psychopathic Hospital were established to care for these children (Horn, 1989).

Purpose – To examine the influence of changing diagnostic tools and the pharmaceutical and health insurance industries' practices on perceptions of depression prevalence in the late 20th and early 21st centuries.

Approach – This is a general review of the sociohistorical shifts in depression diagnosis and pharmaceutical and health insurance industry practices during this time period as they impact professional and lay perceptions of changes in depression prevalence.

Findings – Shifts in the definition of depression to an increasingly medically oriented, social context-free definition along with the interaction of the pharmaceutical industry, health care, and health insurance industries in the U.S. system of mental health care have become major organizers of professional and lay perceptions of the nature of depression, its treatment, and prevalence. These sociohistorical and economic influences need to be factored into debates on depression prevalence.

Contribution of paper to the field – This chapter provides an introductory-level synthesis of basic psychiatric epidemiology concepts and social science critiques of professional and lay perceptions of depression prevalence as “epidemic.”