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Book part
Publication date: 4 July 2019

Christopher Donald Gjesfjeld

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…

Abstract

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.

Details

Political Authority, Social Control and Public Policy
Type: Book
ISBN: 978-1-78756-049-9

Keywords

Book part
Publication date: 17 December 2004

Marjorie L. Baldwin

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…

Abstract

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).

Details

Research on Employment for Persons with Severe Mental Illness
Type: Book
ISBN: 978-1-84950-286-3

Abstract

Purpose

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

Methodology/Approach

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.

Findings

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.

Research Limitations

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).

Originality/Value

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.

Details

Social Factors, Health Care Inequities and Vaccination
Type: Book
ISBN: 978-1-83753-795-2

Keywords

Book part
Publication date: 17 December 2004

John A. Pandiani, Steven M. Banks and Monica M. Simon

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…

Abstract

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.

Details

Research on Employment for Persons with Severe Mental Illness
Type: Book
ISBN: 978-1-84950-286-3

Book part
Publication date: 5 October 2004

Pierre Kébreau Alexandre, Joseph Yvard Fede and Marsha Mullings

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

Abstract

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).

Details

The Economics of Gender and Mental Illness
Type: Book
ISBN: 978-0-76231-111-8

Book part
Publication date: 4 July 2016

William H. Fisher, Jeffrey L. Geller and Dana L. McMannus

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…

Abstract

Purpose

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.

Approach

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.

Findings

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.

Social implications

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.

Details

50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities
Type: Book
ISBN: 978-1-78560-403-4

Keywords

Book part
Publication date: 4 July 2016

Teresa L. Scheid

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…

Abstract

Purpose

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.

Approach

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.

Research implications

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.

Social implications

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.

Details

50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities
Type: Book
ISBN: 978-1-78560-403-4

Keywords

Book part
Publication date: 4 July 2016

Russell K. Schutt

Reexamination and reinterpretation of the process of deinstitutionalization of public mental hospital inpatients.

Abstract

Purpose

Reexamination and reinterpretation of the process of deinstitutionalization of public mental hospital inpatients.

Methodology/approach

A comprehensive review of related research is presented and lessons learned for the sociology of mental health are identified.

Findings

The processes of both institutionalization and deinstitutionalization were motivated by belief in the influence of the social environment on the course of mental illness, but while in the early 19th century the social environment of the mental hospital was seen as therapeutic, later in the 20th century the now primarily custodial social environment of large state mental hospitals was seen as iatrogenic. Nonetheless, research in both periods indicated the benefit of socially supportive environments in the hospital, while research on programs for deinstitutionalized patients and for homeless persons indicated the value of comparable features in community programs.

Research limitations/implications

While the process of deinstitutionalization is largely concluded, research should focus on identifying features of the social environment that can maximize rehabilitation.

Practical implications

The debate over the merits of hospital-based and community-based mental health services is misplaced; policies should instead focus on the alternatives for providing socially supportive environments. Deinstitutionalization in the absence of socially supportive programs has been associated with increased rates of homelessness and incarceration among those most chronically ill.

Originality/value

A comprehensive analysis of deinstitutionalization that highlights flaws in prior sociological perspectives and charts a new direction for scholarship.

Details

50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities
Type: Book
ISBN: 978-1-78560-403-4

Keywords

Book part
Publication date: 8 August 2005

Jonathan C. Clayfield, Albert J. Grudzinskas, William H. Fisher and Kristen Roy-Bujnowski

Large numbers of adults with mental illness detained by police, seen in the courts, and confined in prisons and jails has been a longstanding concern of officials in the mental…

Abstract

Large numbers of adults with mental illness detained by police, seen in the courts, and confined in prisons and jails has been a longstanding concern of officials in the mental health and criminal justice systems. Diversion programs represent an important strategy to counteract the criminalization of persons with mental illness. The challenge is to identify and integrate resources in such a way that an organization bridging the police, courts, mental health, substance abuse, homelessness, welfare and entitlements agencies would evolve that would effectively and appropriately serve offenders with mental health issues, keeping them stable in the community and reducing recidivism.

Details

The Organizational Response to Persons with Mental Illness Involved with the Criminal Justice System
Type: Book
ISBN: 978-0-76231-231-3

Book part
Publication date: 17 December 2004

William H. Fisher

That opportunities for gainfully employing persons with severe mental illness should be maximized is a position around which there is virtual unanimity. But identifying obstacles…

Abstract

That opportunities for gainfully employing persons with severe mental illness should be maximized is a position around which there is virtual unanimity. But identifying obstacles to this goal and ways to overcome them is another matter – one that, in different forms, has engaged members of a number of disciplines. In this volume we bring together diverse disciplinary perspectives from psychology, psychiatry, statistics, occupational therapy and psychiatric rehabilitation research, sociology and labor economics to discuss a range of topics related to employment and mental illness. The papers included here span a range of domains, from “person – level” questions of person-environment fit to the broad societal effects of labor markets. Evaluative perspectives on various approaches that the mental health community has taken in seeking to advance the employment of persons with serious mental illness are also examined. While we will not claim to have represented every perspective currently in play in research on employment for persons with mental illness, we feel this volume represents the multi-disciplinary flavor of the small but growing research establishment in this area.

Details

Research on Employment for Persons with Severe Mental Illness
Type: Book
ISBN: 978-1-84950-286-3

1 – 10 of over 1000