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SOCIAL RESPONSE TO MENTAL ILLNESS

SOCIAL RESPONSE TO MENTAL ILLNESS. FINDINGS FROM COMMUNITY STUDIES. I. ONLY ABOUT 20% OF PEOPLE DIAGNOSED WITH M.I. SEEK HELP – UNMET NEED II. ABOUT 50% OF PEOPLE WHO ARE IN TREATMENT GET A DIAGNOSIS – “OVERMET NEED” HAVING A M.I. AND GETTING TREATMENT FOR IT 2 DIFFERENT PROCESSES.

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SOCIAL RESPONSE TO MENTAL ILLNESS

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  1. SOCIAL RESPONSE TO MENTAL ILLNESS

  2. FINDINGS FROM COMMUNITY STUDIES • I. ONLY ABOUT 20% OF PEOPLE DIAGNOSED WITH M.I. SEEK HELP – UNMET NEED • II. ABOUT 50% OF PEOPLE WHO ARE IN TREATMENT GET A DIAGNOSIS – “OVERMET NEED” • HAVING A M.I. AND GETTING TREATMENT FOR IT 2 DIFFERENT PROCESSES

  3. STAGES OF HELP-SEEKING • RECOGNITION – FROM VERY LIKELY TO VERY UNLIKELY • SELF OR OTHER RECOGNIZES • INFORMAL CONSULTATION • CHOICE OF PRACTITIONER • ADHERENCE TO TREATMENT • HUGE VARIATION AT EACH STAGE

  4. SOURCES OF VARIATION • STRATIFICATION – MORE POWER AND RESOURCES GET WHAT THEY WANT (INCOME) • CULTURE – VALUES AND ATTITUDES TOWARD TREATMENT (ETHNIC, GENDER, EDUCATION) • INTEGRATION – MORE INTEG. LESS TREATMENT (CONNECTEDNESS)

  5. FOCUS HERE • SOCIAL CLASS – COMBINATION OF INCOME AND EDUCATION (RESOURCES AND CULTURE) • GENDER

  6. SOCIAL CLASS AND TREATMENT

  7. SOCIAL CLASS AND TREATMENT • HOLLINGSHEAD AND REDLICH STUDY OF NEW HAVEN IN 1950s • INCIDENCE = NEW CASES • PREVALENCE = ALL CASES • PREVALENCE = INCIDENCE + REENTRY + CONTINUOUS

  8. TREATMENT OF PSYCHOSES

  9. TREATMENT OF PSYCHOSES • NO S.C. DIFFERENCES IN INCIDENCE EXCEPT LOWER CLASS HAS MORE • STRONG INVERSE RELATIONSHIP OF SOCIAL CLASS AND PREVALENCE OF PSYCHOSES

  10. EXPLANATIONS • WORSE PSYCHIATRIC TREATMENT FOR LOWER CLASS • MORE CONTINUING STRESSORS FOR LOWER CLASS • MORE COMMUNITY SUPPORT FOR HIGHER CLASSES • LONGER DURATION AND WORSE PROGNOSIS FOR LOWER CLASSES

  11. TREATMENT OF NEUROSES

  12. TREATMENT OF NEUROSIS • NO DIFFERENCE IN NEW CASES • HIGHER CLASSES HAVE MUCH GREATER TREATED PREVALENCE • HIGHER CLASSES STAY MUCH LONGER IN TREATMENT • RELATIONSHIP FOR PREVALENCE OPPOSITE FOR NEUROSES AND PSYCHOSES

  13. REASONS • ABILITY TO PAY FOR TREATMENT • MORE FAVORABLE ATTITUDES TOWARD TREATMENT • LESS STIGMA FOR HIGHER CLASSES • RESPONSE OF M.H. PROFESSIONALS

  14. CHANGES OVER TIME • LOWEST INCOME STILL MOST LIKELY TO BE IN PUBLIC MENTAL HOSPITALS • EMERGENCE OF INSURANCE AND MEDICAID FOR OUTPATIENT • WEALTHIEST AND POOREST MOST LIKELY • NEAR-POOR LEAST LIKELY TO USE

  15. USE OF OUTPATIENT • COLLEGE GRADUATES MUCH MORE THAN OTHERS • EDUCATION MORE IMPORTANT THAN INCOME • WHITES 2 – 3 X MORE LIKELY THAN OTHERS • DIVORCED/SEPARATED 2 X MORE THAN SINGLE; 3X THAN MARRIED

  16. GENDER AND TREATMENT

  17. TYPES OF ILLNESS • LITTLE GENDER DIFFERENCE FOR PSYCHOSES • WOMEN = 2/3 OF DEPRESSION, ANXIETY, DISTRESS, SUICIDE ATTEMPTS, ALMOST ALL EATING DISORDERS • MEN = 2/3 OF ALCOHOL AND DRUG PROBLEMS, 4X SUICIDES, ALMOST ALL GAMBLING • OVERALL RATES EQUAL

  18. REASONS • CULTURAL EXPECTATIONS ABOUT GENDER ROLES • WOMEN INTERNALIZE • WOMEN EXPECTED NOT TO EXTERNALIZE • MEN EXTERNALIZE • MEN EXPECTED NOT TO INTERNALIZE

  19. TREATMENT DIFFERENCES • MEN ABOUT 60% OF INPATIENTS • WOMEN ABOUT 2/3 OF OUTPATIENTS

  20. INPATIENT TREATMENT • MEN MORE LIKELY TO BE INPATIENTS • MEN’S SYMPTOMS MORE TROUBLESOME AND VIOLENT • MALE ROLE INCONGRUENT WITH HELP-SEEKING • MEN DELAY TREATMENT UNTIL MORE SEVERE • OTHERS INITIATE TREATMENT

  21. OUTPATIENT TREATMENT • WOMEN MORE LIKELY TO DEFINE SELVES AS HAVING PROBLEMS • WOMEN MORE LIKELY TO SEEK MENTAL HEALTH TREATMENT • WOMEN MORE LIKELY TO REMAIN IN TREATMENT - PATIENT ROLE

  22. MEDICATION

  23. MEDICATION • GREAT VARIATION IN WILLINGNESS TO USE • WOMEN 2x MORE LIKELY THAN MEN

  24. GREATEST UNMET NEED • LOW (BUT NOT LOWEST) INCOME • NO INSURANCE • ELDERLY • RACIAL/ETHNIC MINORITIES • RURAL

  25. SUMMARY • GREAT SOCIAL VARIATION IN RESPONSE TO M.I. • SOCIAL CLASS VERY IMPORTANT • EDUCATION • INSURANCE • GENDER VERY IMPORTANT • ALSO ETHNICITY, MARITAL

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