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While deinstitutionalization has changed how and where those with serious mental illness receive mental health treatment, the high rate of homelessness among those with mental illness, the number of mentally ill incarcerated, and the general inadequacy and underfunded nature of public psychiatric resources suggest an inadequate social reaction to their needs. While United States (US) policies have appeared to deemphasize long-term confinement in hospitals, the author contends that various ideologies maintain a process of social control whereby those with serious mental illness continue to be minimized and disempowered within American society.

The author presents three different ideologies for examination: the “otherness” of mental illness, stigma and social exclusion, and perspectives of dangerousness. These ideologies are hypothesized to limit the social capital and power of those with serious mental illness. Considering Antonio Gramsci’s definition of hegemony and “common sense,” this chapter urges a challenge to these hardened ideologies if those with serious mental illness are to have greater inclusion in US society.

The purpose of this paper is to identify regions of Los Angeles County with high burdens of serious mental illness and determine whether these regions align with those experiencing the greatest economic hardship.

This cross-sectional study analyzed the estimated prevalence of serious mental illness and the locations of publicly funded mental health service providers within each census tract of Los Angeles County. The burden of serious mental illness was calculated for each census tract using these variables and an optimized hot spot analysis was conducted to determine which regions were the most underserved in terms of serious mental illness.

There is a significantly higher burden of serious mental illness in Southeastern Los Angeles and Pomona Valley than in the rest of Los Angeles County (p = 0.01). The same can be said regarding the Lancaster-Palmdale area and San Fernando Valley (p = 0.05). These areas do appear to align with the areas of Los Angeles County with an economic hardship index in the fourth quartile.

Mental health initiatives targeting the four hot spot regions should be given priority by the County of Los Angeles. This is especially true when allocating funds from Proposition 63, which aims to address mental health disparities in underserved, unserved or inappropriately served populations.

Mental disorders are common and associated with substantial levels of work disability. Relative to persons with most types of physical impairments, persons with mental disorders have lower employment rates and lower mean wages, and experience greater discrimination in the workplace (Baldwin, 1999, 2000; Baldwin & Johnson, 1995, 2000). Persons with mental disorders have lower socioeconomic status, on average, and greater risk of living in poverty, than persons with physical disorders (Dohrenwend et al., 1992). By 1999, mental disorders had supplanted back cases as the health condition most frequently cited in employment discrimination charges filed under the Americans with Disabilities Act of 1990 (Moss et al., 1999).

This study examines chronic illness, disability and social inequality within an exposure-vulnerabilities theoretical framework.

Using the National Survey of Drug Use and Health (NSDUH), a preeminent source of national behavioral health estimates of chronic medical illness, stress and disability, for selected sample years 2005–2014, we construct and analyze two foundational hypotheses underlying the exposure-vulnerabilities model: (1) greater exposure to stressors (i.e., chronic medical illness) among racial/ethnic minority populations yields higher levels of serious psychological distress, which in turn increases the likelihood of medical disability; (2) greater vulnerability among minority populations to stressors such as chronic medical illness exacerbates the impact of these conditions on mental health as well as the impact of mental health on medical disability.

Results of our analyses provided mixed support for the vulnerability (moderator) hypothesis, but not for the exposure (mediation) hypothesis. In the exposure models, while Blacks were more likely than Whites to have a long-term disability, the pathway to disability through chronic illness and serious psychological distress did not emerge. Rather, Whites were more likely than Blacks and Latinx to have a chronic illness and to have experienced severe psychological distress (both of which themselves were related to disability). In the vulnerability models, both Blacks and Latinx with chronic medical illness were more likely than Whites to experience serious psychological distress, although Whites with serious psychological distress were more likely than these groups to have a long-term disability.

Several possibilities for understanding the failure to uncover an exposure dynamic in the model turn on the potential intersectional effects of age and gender, as well as several other covariates that seem to confound the linkages in the model (e.g., issues of stigma, social support, education).

This study (1) extends the racial/ethnic disparities in exposure-vulnerability framework by including factors measuring chronic medical illness and disability which: (2) explicitly test exposure and vulnerability hypotheses in minority populations; (3) develop and test the causal linkages in the hypothesized processes, based on innovations in general structural equation models, and lastly; (4) use national population estimates of these conditions which are rarely, if ever, investigated in this kind of causal framework.

The purpose of this paper is to discuss five domains impacted by the transformation of correctional mental health care in the USA: public health, public safety, legal obligations, fiscal responsibility and ethical standards, as well as critical issues such as administrative segregation, suicide prevention and reentry planning.

In the last four decades, the USA has seen a sizable growth in its criminal justice system and corrections population. It has also seen reductions in civil and community-based mental health care. Persons with mental disabilities have come to represent a highly disproportional segment of the corrections population. The paper discusses the implications and underlying causes of these developments as well as recent responses to them.

This set of circumstances is starting to change the mission of correctional health services from crisis intervention and suicide prevention to include preparation for the inmate's almost inevitable return to the community.

Such changes have led to further developments in correctional mental health care, in particular, policy designed to treat mental illness, reduce its destructive outcomes such as suicide, and facilitate successful reentry into the community in attempts to reduce recidivism and improve clinical outcomes. Mental health care professionals working within corrections have likewise faced ethical challenges in effectuating treatment.

This paper aims to design and implement an audit of physical health monitoring for patients with schizophrenia or bipolar disorder in primary care.

Evidence‐based criteria for physical health monitoring were developed from current clinical guidelines. Physical health monitoring of 128 patients with a diagnosis of either schizophrenia or bipolar disorder was audited against these criteria in two urban GP practices.

The number of patients whose smoking history, alcohol consumption history, blood pressure and body mass index had been recorded in the preceding 15 months varied significantly by practice, whilst recording of blood cholesterol and diabetes status did not. Patients with a diagnosis of schizophrenia were significantly more likely to have had a diabetes status recorded in the preceding 15 months compared to patients with bipolar disorder.

Standards for compliance with audit criteria need to be debated and agreed with stakeholders. Further research is needed into how physical healthcare services can effectively engage patients with serious mental illness.

Audit of physical health monitoring in primary care is feasible and could be used to identify shortcomings in physical healthcare for people with serious mental illness. Inviting patients on practices' mental health registers for cardiovascular risk screening should be considered.

Regular audit of physical health monitoring in people with schizophrenia or bipolar disorder may help ensure equitable healthcare delivery for patients with serious mental illness.

This paper presents an audit methodology that primary care trusts and general practitioners can use to assess how effectively the physical health of people with serious mental illness is being monitored.

The relationship between employment services and employment outcomes has been the subject of research for a number of years (Bond et al., 2001; Drake et al., 1996). More recently, the competitive employment of service recipients has become an important indicator of community mental health program and service system performance. The National Association of State Mental Health Program Directors’ President’s Task Force on Performance Measures, for instance, recognized the importance of monitoring employment rates for adults with serious mental illness: “For payers, this is the payoff…Monitoring this outcome for populations with mental illness…is critical. This was considered a critical outcome to track.” For similar reasons, the new federal Performance Partnership (Block) Grant program (Federal Register, 2002) requires annual reporting by all states of employment rates for recipients of publicly funded mental health services.

The purpose of the present study was to advance a theoretical understanding of the mechanisms by which WISEs can influence the stigma associated with mental illness. Many people with serious mental illnesses want to work, but despite much attention to work entry strategies, unemployment rates remain exceptionally high among this population. Stigma has been identified as a particularly pernicious barrier to the full community participation of people with mental illnesses. If work integration social enterprises (WISE) are to positively impact the full community participation of people with mental illnesses, then addressing stigma will be integral to their operation.

A comparative case study approach was used to address the following research questions: “How is the stigma of mental illness experienced in the everyday operations of WISE?” and “What influence do WISEs have on the stigma of mental illness within the workplace and beyond?” Five established WISEs that pay workers at minimum wage or better were selected for inclusion. The maximum variation sample included WISEs that varied in terms of geographical location, form of commerce, business size, revenues and degree of connection with mental health systems and local communities. Data analysis was conducted in four stages using qualitative methods.

The study findings suggest processes by which WISEs can positively impact the stigma of mental illness. Three social processes are associated with the potential of WISE to contribute to stigma reduction: perception of legitimacy, perception of value and perception of competence. Each of these social processes is fueled by underlying tensions in practice that arise in the context of negotiating the dual goals of the business.

This study advances theoretical understanding of the ways in which stigma may be perpetuated or reduced in WISE by revealing the social processes and practice tensions that may be associated with operation choices made by WISEs and their partners. Further research would be required to determine if the processes described actually lead to reduced stigma. Although efforts were made to select WISEs that demonstrate a variety of features, it is likely that some important features were absent. Additional research could further explore the findings identified here with WISEs from other sectors, including youth and workers with transient or less severe forms of illness. This work should be replicated internationally to explore how contextual factors may influence individual and public perceptions.

The findings provide guidance for WISE developers in the mental health sector concerning strategies that may help mitigate the development of stigmatizing features within a social enterprise and by extension improve the work experience and workforce integration of employees. The identification of these processes and tensions can be used to advance the development of consensus principles and standards in the WISE field and contribute to ongoing evaluation and research.

WISEs have the potential to reduce stigma, an important goal to support their efforts to improve employment and integration outcomes for people with mental illnesses. Through their business structures and operations they may be able to impact stigma by positively influencing perceptions of legitimacy, value and competence – all issues that have been associated with public assumptions about mental illness that sustain stigma.

To the best of the authors’ knowledge, this study is one of the first to specifically focus on stigma in the WISE sector, particularly as it relates to the work integration of persons with mental illnesses. The findings provide a range of theoretical and practical implications for future development in the field and highlight factors that merit consideration more broadly in the sector.

Mental disorders collectively account for 4 of the 10 leading causes of disability and represent more than 15% of the overall burden of disease in the United States (SAMHSA, 1999). The first Surgeon General’s Report on Mental Health reported that in 1999 nearly 20 million American adults (9.5% of the population) were clinically depressed and that, at any one time, 1 in every 20 employees is experiencing depression (SAMHSA, 1999). The indirect costs of mental disorders to the American economy amounted to an estimated $79 billion in 1990, with loss of productivity because of illness accounting for about 80% of these costs ($63 billion) (Rice & Miller, 1996). Additionally, significant costs may accrue from decreased productivity due to symptoms that sap energy, affect work habits, and cause problems with concentration, memory, and decision-making (SAMHSA, 1999).

The purpose of this chapter is to apply structural functional theory and the concept of “unbundling” to an analysis of the deinstitutionalization and community mental health efforts that have shaped the current mental health services environment.

We examine the original goals of the institutional movement, the arguments supporting it, and the functions of the institutions that were created. We then examine the criticisms of that approach and the success of the subsequent deinstitutionalization process, which attempted to undo this process by recreating the hospitals’ functions in community settings. Finally, we address the question of whether the critical functions of psychiatric institutions have indeed been adequately recreated.

Our overview of outcomes from this process suggests that the unbundling of state hospital functions did not yield an adequate system of care and support, and that the functions of state hospitals, including social control and incapacitation with respect to public displays of deviance were not sufficiently recreated in the community-based settings.

The arguments for the construction of state hospitals, the critiques of those settings, and the current criticism of efforts to replace their functions are eerily similar. Actors involved in the design of mental health services should take into account the functions of existing services and the gaps between them. Consideration of the history of efforts at functional change might also serve this process well.